Priming rTMS In Major Depression

The primary outcome measure used is the MADRS (Montgomery-Asberg Depression Rating Scale). This is administered at baseline and on a fortnightly basis. At study end response criteria is defined as a 50% reduction in total MADRS score and remission defined as a MADRS score of less than or equal to 10. Other outcome measures administered fortnightly are: BPRS (Brief Psychiatric Rating Scale), CORE (measure of melancholic symptoms), BDI (Beck Depression Inventory), CGI (Clinical Global Impression Scale), GAF (Global Assessment of Functioning Scale). A cognitive battery is also administered. Inclusion Criteria: * Moderate to severe depressive symptoms as indicated as MADRS \>20 * Failure to respond to a minimum of two antidepressant medications * No increase or initiation of new antidepressant therapy in the four weeks prior to entering the trial Exclusion Criteria * Have an unstable medical condition, neurological disorder or any history of seizure disorder or are currently pregnant or lactating * Previous brain injury or surgery, any metal clips, plates or other metal items in the head, cardiac pacemaker * In the opinion of the investigator, are a sufficient suicide risk to require immediate electro-convulsive therapy * Have a current DSMIV diagnosis of substance abuse or dependence disorder, a diagnosis of a personality disorder or another axis 1 disorder