Clinical, Cognitive and Neural Effects of Potentiation of ECT by rTMS in Treatment-Resistant Depression

Inclusion Criteria: * Patients with Major Depressive Disorder according to Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria * HAMD score ≥15 * In case of unipolar disorder: no remission after at least two different antidepressants prescribed at a dose and duration sufficient for the current episode * In the case of bipolar disorder: no remission despite lithium at an adequate plasma level combined with lamotrigine or quetiapine monotherapy at full dose * No change of antidepressant or mood stabilizer treatment for at least 15 days * To be rTMS-naive * Without benzodiazepine or antiepileptic treatment for at least 15 days * To understand spoken and written French * Having given their informed, written consent Exclusion Criteria: * Contraindication to Electroconvulsive therapy (ECT), repeated Transcranial Magnetic Stimulation (rTMS), Magnetic Resonance Imaging (MRI), anesthesia * Patients who have received ECT in the last 6 months * Patients suffering from poorly stabilized epilepsy, serious neurological or systemic disorders * Patients with a serious substance use disorder (other than nicotine or caffeine) according to DSM-5 criteria * Patients suffering from severe hearing problems * Subjects already treated with an electrical or magnetic stimulation technique * Women who do not have adequate contraception, pregnant or breastfeeding women * Being deprived of liberty by an administrative or judicial decision * Patients participating or having participated in an interventional clinical trial within 30 days before the inclusion visit