Clinical Research Directory

Inclusion Criteria: * 18-55 * verbal agreement to maintain dose of prescribed psychotropic medication (if any) and/or psychotherapy (if any) constant throughout the study, provided they are stable on it for the past 4 weeks (except exclusion medication and except if there is a medical emergency requiring changes in medication). * DMQ Impairment score \>= 14 Exclusion Criteria: * current or past history of mania or psychosis; current hypomania * verbal IQ\< 90 as per the NART * not medically cleared for TMS or fMRI (such as taking medications known to reduce the seizure threshold such as Lithium, Clozaril, stimulants including the ADHD medications (e.g. Ritalin, Adderall), Wellbutrin/Buproprion, Provigil (Modafinil), Aminophylline, and Theophylline) * DMQ Impairment score \< 14 * younger than 18 and older than 55 * pregnant * high risk for suicide (defined as having attempted suicide in past 6 months; suicide attempt within the past 10 years with current ideation with plan or preferred method available) * moderate/severe current alcohol or substance use disorder, or past severe alcohol use disorder * unable to read, blind, or deaf, or unwilling to give consent * cannot come to Duke for the in-person study visits * current uncontrolled anorexia or other condition requiring hospitalization * conditions associated with increased intracranial pressure, space occupying brain lesion, transient ischemic attack, cerebral aneurysm, dementia, Parkinson's or Huntington's disease, multiple sclerosis * use of investigational drug or devices within 4 weeks of screening * started/changed psychotropic medications or started psychotherapy in the prior 4 weeks, or plans to change medication or stop psychotherapy during the study