Search for Novel Transcranial Magnetic Stimulation (TMS) Targets for Mental Illness

Inclusion criteria

• Age 18-65
• English proficiency sufficient for informed consent, questionnaires/tasks, and treatment
• Primary diagnosis of one of the following: major depressive disorder (MDD), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), or schizophrenia (determined by focal assessment using the Structured Clinical Interview for DSM-5)
• ≥20 on the Beck Depression Inventory for patients with MDD
• ≥16 on the Beck Anxiety Inventory for patients with GAD
• ≥16 on the Yale-Brown Obsessive-Compulsive Scale for patients with OCD
• ≥58 on the Positive and Negative Symptom Scale for patients with schizophrenia
• Stable psychotropic medication regimen, or remain medication free, for 4 weeks prior to treatment (Medication changes during study enrollment period will be tracked for post hoc analysis).
• Primary clinician (e.g. psychiatrist, therapist, psychologist, APRN, PA, etc.) responsible for psychiatric care before, during, and after the trial

Exclusion criteria

• Active pregnancy as determined by a urine pregnancy test
• Cluster B personality disorders (antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder)
• PTSD with active, clinically significant symptoms, as determined by clinician
• Diagnosis of Schizoaffective Disorder, Bipolar Type
• Recent (within 4 weeks) or concurrent use of rapid-acting antidepressant agent (ketamine/esketamine/ECT)
• Ferromagnetic metallic implant that would contraindicate receiving TMS or obtaining MRI
• Any other TMS or MRI safety concerns identified by the clinician
• Receiving or planning to receive other TMS treatments during course of participation
• History of:
• Neurosurgical intervention for mental illness
• Moderate to severe autism spectrum disorder
• Intellectual disability
• Severe cognitive impairment
• Significant neurological illness (e.g., dementia, Parkinson's, Huntington's, brain tumor, seizure disorder, subdural hematoma, multiple sclerosis)
• Untreated or insufficiently treated endocrine disorder
• Eating disorders
• Treatment with investigational drug or intervention during the study period
• Current evidence of:
• Mania or hypomania
• Active suicidal ideation or a suicide attempt within the past year
• Contraindications to either TMS or MRI (e.g., metallic implants, etc.).
• Current moderate or severe substance use disorder or demonstrating signs of acute substance withdrawal
• Significantly increased seizure risk as determined by a clinician
• For participants with schizophrenia:
• Evidence of impaired capacity to consent, e.g. impaired insight into illness, as deemed by a licensed psychiatrist or psychologist on the study team
• Hospitalization with psychosis in the past 6 months
• Positive urine drug screen for illicit substances
• Existing tinnitus (ringing in the ears)
• Any other condition deemed by the PI to interfere with the study or increase risk to the participant