This is a non-blinded, randomized sham-controlled trial for effectiveness and feasibility of virtual reward reality training and rTMS for MDD with two arms. Patients with MDD who meet inclusion and exclusion criteria will be identified and recruited from the practices of Sunnybrook psychiatrists. Subjects will undergo either: i) VR RT + rTMS (n = 17) or ii) VR sham + rTMS (n = 17). Each treatment session involves: 12-15 min VR viewing, 15 min descriptive and imaginal recounting followed immediately by 3 min rTMS delivery with iTBS to the left DLPFC. The study will proceed according to the schedule laid out below. Both patients and treating team will be aware of all treatment parameters at all times.
