Accelerated vs. Conventional Theta Burst Stimulation for Late-life Depression

This study compares two schedules of transcranial magnetic stimulation (TMS) — a non-invasive brain stimulation treatment — for older adults aged 60 and above with depression that has not responded to antidepressant medications. One group receives the usual treatment schedule; the other gets a compressed, faster schedule. **You may be eligible if:** - You are 60 years or older - You have been diagnosed with major depressive disorder with a current depressive episode - You have tried at least one antidepressant at an adequate dose in this episode but it did not work - You are an outpatient (not currently hospitalized) - You have a depression score of 10 or higher on the PHQ-9 questionnaire - Your antidepressant medications have been stable (no changes) for at least 4 weeks **You may NOT be eligible if:** - You have a history of seizures or a brain implant (e.g., a pacemaker, cochlear implant, or metal in the skull) - You have signs of dementia - You have bipolar disorder, a psychotic disorder, or active suicidal intent - You have not responded to electroconvulsive therapy (ECT) in this episode - You are currently taking anticonvulsant medications or high doses of benzodiazepines Talk to your doctor to see if this trial is right for you.