iTBS in Refractory Pediatric Depression

Inclusion Criteria:

   - 10 participants ages 12-21 years of age

   - with at least moderate to severe depressive symptoms confirmed by the Children's
   Depression Rating Scale-Revised (CDRS-R>40) or Hamilton Rating Scale for Depression
   (HRSD-17 ≥ 18)

   - able to commit to protocol schedule and provide Informed consent by a legal guardian
   and assent by a youth participant

   - have had at least one prior antidepressant treatment failure with adequate dose and
   duration

Exclusion Criteria:

   - prior neurological diagnosis (neurodevelopmental disorders, strokes/traumatic brain
   injuries, brain tumor, epilepsy)

   - contraindications for TMS or MRI e.g. have any implanted metal

   - unstable medical conditions

   - acute suicide risk, defined as an attempt in past 6 months that required medical
   treatment, or history of ≥2 suicide attempts in the past 12 months, or has a clear cut
   plan for suicide

   - pregnancy, suspected pregnancy or not on birth control if sexually active; 6)
   Inability to locate and quantify a motor threshold

   - any factor that the PI determines to be reason for exclusion.