Deep TMS for PTSD With Suicidal Ideation

The goal of this clinical trial is to evaluate whether deep transcranial magnetic stimulation (DTMS) using the H1-coil can safely and effectively reduce suicidal ideation in adults diagnosed with post-traumatic stress disorder (PTSD). The main questions it aims to answer are: (1) Does DTMS reduce suicidal ideation in adults with PTSD? (2) Does DTMS improve PTSD symptoms?. DTMS is administered together with a brief exposure procedure intended to activate trauma-related neural circuits before stimulation.

Inclusion Criteria: * Adults 22-68 years old * Male or female * Diagnosis of PTSD according to DSM-5 criteria * Active suicidal ideation at screening, confirmed by the Beck Scale for Suicide Ideation (SSI) * Able to provide informed consent * Stable psychiatric medication regimen for at least 4 weeks prior to enrollment (if applicable) * Able to comply with study procedures and attend scheduled sessions Exclusion Criteria: * Current psychotic disorder, bipolar disorder, or severe personality disorder * Substance use disorder within the past 3 months (excluding nicotine or caffeine) * Significant neurological disorder or history of seizures * Contraindications to TMS (e.g., metallic implants in the head, implanted medical devices, history of epilepsy) * Current use of medications that significantly lower seizure threshold * Pregnancy or breastfeeding * Acute medical illness or unstable medical condition * Cognitive impairment that would interfere with participation (based on MoCA) * Imminent risk requiring a higher level of care (e.g., hospitalization) * Prior non-response to adequate TMS treatment * Participation in another interventional study within the past 30 days