Patient-oriented Randomized Pragmatic Feasibility Trial with RTMS in Depression and Anxiety

This trial tests transcranial magnetic stimulation (TMS) — a non-invasive brain stimulation technique — for treating depression and anxiety in outpatients. TMS uses magnetic pulses to stimulate specific areas of the brain. This study is designed as a pragmatic trial, meaning it reflects real-world treatment conditions. **You may be eligible if...** - You are 18 or older - You are an outpatient seeking treatment for depression or anxiety - You score 26 or higher on the IDS-30-SR depression scale - You have not changed or started any psychiatric medications in the past 4 weeks - You pass the TMS safety screening **You may NOT be eligible if...** - You have active thoughts of suicide - You are pregnant - You have schizophrenia, bipolar type I, or active psychotic symptoms - You have dementia, epilepsy, or brain implants (clips, stimulators, cochlear implants) - You have a serious unstable medical illness - You have metal objects in or near your head Talk to your doctor to see if this trial is right for you.