High-frequency vs. Low-frequency vs. Sham DMPFC-rTMS for Major Depression

Inclusion Criteria (Patient): * Voluntary and competent to consent to treatment * MINI confirmed diagnosis of MDD * Outpatient * Between the ages of 18-65 * Failed to achieve a clinical response to at least one pharmacotherapy or behavioral treatment in the current episode. * Have had no increase or initiation of any psychotropic medication in the last 4 weeks prior to screening * Must adhere to study assessment and intervention schedule. * Pass the TMS Safety Screening Questionnaire. Exclusion Criteria (Patient): * Have a concomitant major unstable medical illness, cardiac pacemaker or implanted medical pump * Have active suicidal intent * Are pregnant * Have a lifetime MINI diagnosis of bipolar I or II disorder, schizophrenia, schizoaffective disorder, schizophreniform, delusional disorder, or current psychotic symptoms have a MINI diagnosis of obsessive-compulsive disorder, post-traumatic stress disorder (current or within the last year), anxiety disorder (generalized anxiety disorder, social anxiety disorder, panic disorder), or dysthymia assessed by a study investigator to be primary and causing greater impairment than MDD * Have received rTMS for any previous indication due to the potential compromise of subject blinding.