Mapping the Neural Circuits of Depression and Anxiety Using Personalized, Accelerated TMS and Deep Phenotyping

This proposal seeks to carry out a double-blinded, randomized, comparative study that investigates neurobehavioral changes induced by personalized, anxiosomatic and dysphoric network guided accelerated intermittent-theta burst (iTBS) using dense functional Magnetic Resonance Imaging (fMRI) sampling in participants with treatment-resistant depression (TRD) and moderate/high levels of anxiety.

Inclusion Criteria: * Male/female aged 21-70 * Diagnosis of MDD as validated by MINI * Non-response to adequate trial (4 weeks) of at least two MDD medication as verified by the study clinician * BDI score of 20 or above; BAI score of 16 or above * Able to give informed consent * Able to understand English Exclusion Criteria: * DSM-5 psychotic disorder * Drug or alcohol abuse or dependence (preceding 3 months) * Rapid clinical response required, e.g., high suicide risk * Significant neurological disorder, which may pose increased risks with TMS, e.g., epilepsy * Metal in the cranium, skull defects, pacemaker, cochlear implant, medication pump or other electronic device * Pregnancy * Unsuitable for MRI * With recent TMS or ECT treatment in past 3 months * Multiple stimulant medications