The Effects of Stanford Accelerated Intelligent Neuromodulation Therapy on Explicit and Implicit Suicidal Cognition

Inclusion Criteria:

   - Male or female, between the ages of 18 and 75 years at the time of screening.

   - Able to read, understand, and provide written, dated informed consent prior to
   screening.

Proficiency in English sufficient to complete questionnaires / follow instructions during
fMRI assessments and aiTBS treatments. Stated willingness to comply with all study
procedures, including availability for the duration of the study, and to communicate with
study personnel about adverse events and other clinically important information.

   - Currently diagnosed with either Major Depressive Disorder (MDD) or Bipolar Affective
   Disorder II (BAD-II) and meets criteria for a current Major Depressive Episode (MDE)
   according to the criteria defined in the Diagnosis and Statistical Manual of Mental
   Disorders, Fifth Edition, Text Revision (DSM-5).

   - Medical records confirming a history of moderate to severe treatment-resistance as
   defined by a score of 7-14 on the Maudsley Staging Method155 (MSM).

   - Endorses clinically significant explicit suicidal cognitions (score ≥ 9 on the M-SSI
   and score ≥ 6 on the BSS self-report).

   - MADRS and HDRS-17 score of >/=20 at screening (visit 1).

   - rTMS/iTBS naive.

   - Access to ongoing psychiatric care before and after completion of the study.

   - Access to clinical rTMS after hospital discharge.

   - In good general health, as evidenced by medical history.

   - For females of reproductive potential: use of highly effective contraception for at
   least 1 month prior to screening and agreement to use such a method during study
   participation.

   - Lifestyle considerations:

   - Abstain from becoming pregnant from the screening visit (Visit 1) until after the
   final study visit (Visit 9).

   - Abstain from caffeine- or xanthine-containing products (e.g., coffee, tea, cola
   drinks, and chocolate) for 3 hours before the start of each dosing session until after
   the final TMS session.

   - Abstain from alcohol for 24 hours before the start of each dosing session until after
   collection of the final MRI.

   - Participants who use tobacco products will be instructed that use of cigarettes will
   not be allowed during the trial.

Exclusion Criteria:

   - Pregnancy

   - The presence or diagnosis of prominent anxiety disorder, personality disorder, or
   dysthymia

   - Current severe insomnia (must sleep a minimum of 5 hours each night before
   stimulation)

   - Current mania or psychosis

   - Bipolar Affective Disorder I and primary psychotic disorders.

   - Autism Spectrum disorder or Intellectual Disability

   - A diagnosis of obsessive-compulsive disorder (OCD)

   - Current moderate or severe substance use disorder or demonstrating signs of acute
   substance withdrawal.

   - Urine screening test positive for illicit substances.

   - Any history of ECT (greater than 8 sessions) without meeting responder criteria

   - No recent (during the current depressive episode) or concurrent use of a rapid acting
   antidepressant agent (i.e., ketamine or a course of ECT).

   - History of significant neurologic disease, including dementia, Parkinson's or
   Huntington's disease, brain tumor, unexpected seizure/epilepsy disorder, subdural
   hematoma, multiple sclerosis, or history of significant head trauma.

   - Untreated or insufficiently treated endocrine disorder.

   - Contraindications to receiving rTMS (e.g., metal in head, history of seizure, known
   brain lesion)

   - Contraindications to MRI (ferromagnetic metal in their body).

   - Any current or past history of any physical condition which in the investigator's
   opinion might put the subject at risk or interfere with study results interpretation.

   - Treatment with another investigational drug or other intervention within the study
   period.

   - Depth-adjusted aiTBS treatment dose > 65% maximum stimulator output (MSO)

   - Any other condition deemed by the PI to interfere with the study or increase risk to
   the participant.