SAINT in Postpartum Depression (PPD)

Inclusion criteria

• Reproductive Women ages 18-45 at the time of consent.
• Diagnosis of non-psychotic Major Depressive Episode (MDE) with peripartum onset as assessed through the Quick Structured Clinical Interview for DSM-5.
• 0-12 months postpartum. Participants must be 0-12 months postpartum at screening and remain within 12 months postpartum at the 5-day post-treatment visit.
• If currently taking an antidepressant medication and/or receiving psychotherapy must be on a stable regimen for 30 days at the time of enrollment.
• Severe depression as measured by MADRS ≥20 at screening.
• A good candidate for repetitive transcranial magnetic stimulation (rTMS) as determined by a physician.
• Participants must be capable of giving informed consent. Participants must be proficient in English in order to comprehend study requirements.
• Agree to use effective contraception in the postpartum period for the study duration.
• Willing and able to comply with all study procedures, complete required assessments and visits, and be available for the duration of the study.

Exclusion criteria

• Participant has attempted suicide in the last 6 months and/or expressed suicidal ideation with intent as determined by physician assessment at the time of enrollment.
• Score of 6 on MADRS item 10 (high rating of suicidal ideation) at screening.
• Participant has active psychosis per investigator assessment.
• Participant with a primary lifetime diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder and/or obsessive-compulsive disorder.
• Participant has an active eating disorder or substance use disorder in the past 6 months and/or has a positive urine toxicity screen that the Principal Investigator (PI) deems exclusionary.
• Participant is using any exclusionary medications: high dose of benzodiazepines (\>2mg lorazepam daily equivalent and/or \>3 times per week) or medications that would interfere with treatment with TMS as per PI or designee discretion.
• Participant has a history of untreated or insufficiently treated sleep apnea.
• Participant has a history of significant neurologic disease, including developmental disability, dementia, Parkinson's or Huntington's disease, brain tumor, unexpected seizure/epilepsy disorder, subdural hematoma, multiple sclerosis, or history of significant head trauma.
• Any untreated major somatic illness such as hypertension/cardiovascular disease/diabetes/endocrine disorders etc.
• Contraindications to receiving rTMS (e.g., metal in head, history of seizure, known brain lesion).
• Contraindications to MRI (e.g., ferromagnetic metal in their body).
• Currently pregnant.
• History of receiving rTMS for any reason, as this may compromise blinding.