Biomarker-guided rTMS for Treatment Resistant Depression

This trial uses brain imaging to identify the best target in the brain for treating depression with transcranial magnetic stimulation (TMS), a non-invasive treatment that uses magnetic pulses to stimulate brain areas. The goal is to personalize TMS treatment using brain scan data — called a biomarker-guided approach — to improve response rates in people who haven't responded to antidepressants. **You may be eligible if...** - You have been diagnosed with major depressive disorder - You have not responded to at least one antidepressant medication - You are 22-75 years old - You are willing to have brain MRI scans and TMS sessions **You may NOT be eligible if...** - You have metal implants in your head or a pacemaker - You have epilepsy or a history of seizures - You have a diagnosis of bipolar disorder, schizophrenia, or active psychosis - You are currently abusing substances - You are pregnant Talk to your doctor to see if this trial is right for you.