To determine efficacy High Frequency Repetitive Transcranial magnetic Stimulation In The Management Of Treatment Resistant Depression A Single Blind Randomised Sham Controlled Study From North Karnataka

To assess the efficacy of High Frequency Repetitive Transcranial Magnetic Stimulation in treatment resistant depression is single blind randomised sham Controlled trial with eligible,consented , adults of 18-65years with treatment resistant depression ( Operational definition According to Ruhe and colleague) satisfying all inclusion and exclusion criteria ( excluding pregnancy, substance use disorder except nicotine use disorder, epilepsy, vascular,brain lesions , psychosis, implanted ferromagnetic device or ones who had ECT excluded ) are recruited,with sample size of 56  participants randomised in a 1:1 ratio to active rTMS(modified accelerated intermittent theta bursts stimulation at 600 pulses/ session over 3-10 minutes 3 pulses at frequency of 50 hertz every 200 msec with motor threshold of 90% ,2sessions / day with minimum gap of 45 minutes for 10 days ,total 20 session ,at left DLPFC. Using standard localising technique)  or sham rTMS ( clicking sounds / tapping without delivery of magnetic stimulation) using fixed block randomisation,with allocation concealment sequentially numbered ,sealed opaque envelopes , participants and outcome assessors are blinded and treatment provider is not blinded , to intervention, ,primary outcome to assess treatment response using Montgomery Asberg Depression Rating scale baseline end of 10 days ,4th week and 8 th week of treatment and study period is over duration of  12 months.