Age

18–65

Sex

ALL

Healthy volunteers

Not accepted

Aged 18-65 years
Clinical diagnosis of Major Depressive Disorder (MDD), confirmed by structured clinical interview
Current moderate-to-severe depressive episode (MADRS score ≥ 20)
Moderate-to-severe treatment resistance, assessed using the Maudsley Staging Method
Able to comprehend English sufficiently to complete study procedures and assessments
Able to maintain stable antidepressant regimen or remain medication-free for at least 4 weeks prior to and during the study

Primary psychiatric diagnosis other than MDD
Contraindications to MRI (e.g., implanted metal)
Conditions or medications that may increase risk associated with TMS
Prior exposure to repetitive TMS (rTMS)
Non-response to electroconvulsive therapy (ECT)
History of psychosurgery for depression
High suicidal risk as assessed by the Columbia Suicide Severity Rating Scale (C-SSRS)

Early Brainwave Biomarkers for Personalized Neuromodulation in Treatment-resistant Depression