SAINT® Therapy for Memory Problems in Older Adults With Treatment-Resistant Depression

Inclusion Criteria: * Age 65 years or older * Diagnosis of treatment-resistant depression * Current depressive symptoms, with a Montgomery-Asberg Depression Rating Scale (MADRS) score of 20 or higher * A memory concern reported by the participant or caregiver * A Mini-Mental State Examination (MMSE) score between 10 and 28 * Able to understand the study, provide written informed consent, and complete study assessments * Determined by an independent treating clinician to be an appropriate candidate for accelerated SAINT treatment, consisting of 10 treatment sessions per day for 5 consecutive days * Completed an amyloid PET scan and/or Lumipulse G pTau217/Amyloid 1-42 blood test as part of usual medical care within 6 months before the baseline visit * Health insurance coverage confirmed for rTMS/SAINT treatment for treatment-resistant depression * Willing to follow study requirements, including medication restrictions and study visits Exclusion Criteria: * Pregnancy * Unable or unwilling to use an acceptable method of birth control during the 5-day treatment period and for 30 days afterward, if of childbearing potential or sexually active with a partner of childbearing potential * Non-removable metal or an implanted medical device in or near the head that is not safe for transcranial magnetic stimulation or magnetic resonance imaging, such as a cochlear implant, aneurysm clip, stent, or metal fragment * An implanted neurostimulator in or near the head, such as a deep brain stimulator or vagus nerve stimulator * History of epilepsy or a seizure disorder, except for isolated febrile seizures during childhood * A brain condition that may increase seizure risk, such as prior brain surgery, skull defect, stroke-related brain disease, or brain tumor * Any other contraindication to transcranial magnetic stimulation listed in the device instructions for use that the study doctor believes would increase risk * A clinically significant abnormal magnetic resonance imaging (MRI) result * A current psychiatric diagnosis other than major depressive disorder that could affect safe participation, including schizophrenia, schizoaffective disorder, bipolar disorder, or post-traumatic stress disorder * A diagnosis of borderline, paranoid, histrionic, schizotypal, schizoid, or antisocial personality disorder * Substance abuse or dependence within the past year, including alcohol or benzodiazepines, except caffeine or nicotine * High current risk of suicide or a suicide attempt within the past 6 months * A serious or unstable medical condition that could make participation unsafe or affect interpretation of the study results * Resting heart rate below 40 beats per minute or above 110 beats per minute at the clinic visit * Use of a medication or procedure that the study doctor determines may significantly interfere with transcranial magnetic stimulation treatment * Any other condition that, in the study doctor's judgment, would make participation unsafe or prevent completion of the study requirements