fMRI-neuronavigated rTMS for the Treatment of Major Depression Associated With TBI

Inclusion criteria: * Adults age 18 to 65 * History of traumatic brain injury (TBI) at least two weeks prior to study initiation * Presence of an active major depressive episode as defined by DSM-5 criteria, including depression secondary to traumatic brain injury * Baseline score of 10 or greater on Montgomery-Asberg Depression Rating Scale (MADRS) * Failure of at least one prior antidepressant trial after the traumatic brain injury Exclusion criteria History of: * Moderate or severe substance use disorder in the past six months as defined by DSM-5 criteria, with the exception of cannabis and nicotine use disorders. * Dementia, as defined by treating neurologist * Moderate or severe autism spectrum disorder * Bipolar disorder * Schizophrenia spectrum disorders Current evidence of: * Substance-induced mood disorder * Active psychotic symptoms * Depression secondary to a general medical illness, with the exception of TBI * Dysphoria better explained by a baseline personality disorder than a major depressive episode * Dysphoria better explained by a baseline anxiety disorder (including post-traumatic stress disorder) rather than a major depressive episode * Active suicidal ideation Contraindications to rTMS treatment: * Seizure disorder * Significantly elevated seizure risk, as determined by clinician assessment * TBI associated with elevated seizure risk, including penetrating injury and/or cortical intraparenchymal hemorrhage * Presence of metallic objects within the head * Presence of an implanted neurostimulation device within the head Contraindications to MRI * Severe claustrophobia * Severe pain/illness exacerbated by lying prone in the scanner * Presence of non-MRI compatible metal foreign bodies or implants * Weight in excess of 350 lbs * Shoulder width in excess of maximum tolerable width for scanner