Feasibility Trial of Exercise as a Priming Strategy for rTMS Treatment in Difficult-to-Treat Depression

This study is testing whether doing exercise before brain stimulation therapy (called rTMS — repetitive transcranial magnetic stimulation) improves outcomes for people with depression that has not responded to antidepressant medications. rTMS uses magnetic pulses to stimulate areas of the brain linked to mood. **You may be eligible if...** - You are between 18 and 75 years old - You have been diagnosed with major depression or persistent depressive disorder (without psychosis) - At least one antidepressant medication in the current episode has not helped you - Your depression symptoms are moderate to severe (score of 15 or higher on a standard rating scale) - You have not changed your medications or therapy for at least 4 weeks - You are currently physically inactive - You are able to do structured exercise **You may NOT be eligible if...** - You have a different primary psychiatric diagnosis - You have changed medications recently - You are already physically active - You have a medical condition that prevents you from exercising safely Talk to your doctor to see if this trial is right for you.