The goal of this single-arm, observational pilot study is to learn about the safety, feasibility, preliminary efficacy of TMS for the treatment of depression in people with MS. Participants will receive outpatient TMS treatment over the course of 5-6 weeks. Participants will complete validated questionnaires and exams before, during, and after treatment.

Multiple sclerosis (MS) is a chronic, immune-mediated disease of the central nervous system. Depression, or major depressive disorder, is highly prevalent in people with MS and often has a serious impact on quality of life. MDD can be difficult to treat with medications in MS. Transcranial magnetic stimulation (TMS) is a safe and approved treatment for treatment-resistant depression in the general population. However, little is known about the use of TMS for MDD in people with MS. This pilot study will evaluate the safety, feasibility, and preliminary efficacy of TMS for MDD in MS. Participants will receive outpatient neuronavigated-TMS for MDD. Various measures of MS and MDD symptoms will be monitored over the course of treatment. Clinical brain imaging will also be compared before and after TMS.

Inclusion Criteria:

• Established diagnosis of multiple sclerosis (any subtype) by 2017 McDonald criteria
• Established diagnosis of major depressive disorder (MDD) by DSM-5 criteria
• Eligible for transcranial magnetic stimulation (rTMS) for depression

Exclusion Criteria:

• MS relapse and/or steroid use within 3 months
• Active suicidal ideation
• History of seizure/epilepsy, brain tumor, or stroke
• History of bipolar disorder or psychosis
• Currently or planning to become pregnant

Adults diagnosed with MDD and MS who are eligible for TMS