Treatment, Emotion, and Neuromodulation of Depression (TREND) Study

The study has a longitudinal design in which participants complete a baseline assessment, 20 or 30 theta burst stimulation (TBS) sessions, a post-TBS assessment, and a follow-up assessment 4 months later. Ideally, TBS sessions will be delivered two or three times a day, 5 days/week, for 2 weeks. This procedural design of a shorter treatment duration is based on findings of pattern of improvement and newly developed SAINT protocol. A subset of participants will receive training in enhancing positive affect, with 10 training sessions occurring between pairs of TBS sessions. In this study, "response" to intervention will be defined as a greater than 50% decrease in severity of depression symptoms reported by participants.

Inclusion criteria

• Current Diagnostic and Statistical Manual (DSM-5) Depressive Disorder

Exclusion criteria

• Bipolar disorder (lifetime)
• Obsessive-compulsive disorder (lifetime)
• History of psychosis
• Daily use of nicotine
• Past-month use of cocaine, amphetamines, Methyl enedioxy methamphetamine (MDMA), Phencyclidine (PCP), Ketamine, or gamma-hydroxybutyrate (GHB)
• Past 6 month substance use disorder
• Binge drinking (using NIAAA criteria) within the past week, alcohol use in the past 12 hours
• Neurological disorders: Epilepsy, Parkinson's Disease, brain tumor, brain injury, stroke
• History of head trauma with a loss of consciousness (e.g., concussion)
• History of seizures
• MRI contraindications: body shape/size too large to fit in scanner, claustrophobia, and ferromagnetic metal in the body
• Pregnancy
• Current use of Clozapine, Bupropion, or prescription stimulants
• Current use of benzodiazepines or mood stabilizers
• Body shape/size too large to fit in MRI scanner
• Claustrophobia
• Metal in the head or ferromagnetic metal in the rest of the body
• Implanted medical devices
• High-risk suicidality