Pain and Major Depressive Disorder

Inclusion criteria

• All Subjects must be between 18-75 years of age
• Language: Participants must speak English fluently, as demonstrated by verbal skills sufficient to answer questions at a level that assures adequate understanding of the study
• Must have confirmed diagnosis of moderate Major Depressive Disorder (single or recurrent episode), minimum score of 17 on the 17-item Hamilton Rating Scale for Depression (HAM-D17). No minimal MDD duration necessary for study participation
• Failure to respond to a minimum of 2 trials of antidepressant medication
• Failure to respond from at least two different agent classes
• Accompanied by at least two evidence-based augmentation therapies (Benzodiazepines do not count)
• Must have a trial of psychotherapy known to be effective in the treatment of MDD of an adequate frequency and duration\*
• Must have a confirmed FM or ME/CFS diagnoses and moderate pain complaints, minimum score of 15 on the McGill Pain Questionnaire.
• Pain chronicity for at least 3 months prior to study enrollment.
• Subjects are willing and able to adhere to the treatment schedule and required study visits.

Exclusion criteria

• Are mentally or legally incapacitated, unable to give informed consent.
• Are pregnant.
• Have an active suicidal intent or plan.
• Have had prior Transcranial Magnetic Stimulation treatment.
• Have an infection or poor skin condition over the scalp where the device will be positioned.
• Have increased risk of seizure because of family history, stroke, or currently use medications that lead to increased risk for seizure.
• Psychotic depression or other acute or chronic psychotic symptoms or disorders (such as schizophrenia, schizophreniform or schizoaffective disorder) in the current depressive episode.
• Neurological conditions that include epilepsy, cerebrovascular disease, dementia, increased intracranial pressure, having a history of repetitive or severe head trauma, or with primary or secondary tumors in the central nervous system.
• Presence of an implanted metallic and magnetic-sensitive medical device present in the body scan, including but not limited to a cochlear implant, infusion pump, implanted cardioverter defibrillator, pacemaker, vagus nerve stimulator, aneurysm clip, metal prosthesis, or metal aneurysm clips or coils, staples, or stents. (Note: Dental amalgam fillings are not affected by the magnetic field and are acceptable for use with transcranial magnetic stimulation and MRI)