rTMS for Orthopaedic Trauma Patients

Inclusion Criteria:

   - Male or female, 18 to 65 years of age.

   - Able to provide informed consent.

   - Present to Stanford Emergency Department as a trauma with a major operative lower
   extremity injury

   - Glasgow coma scale of 15 within 24 hours after admission or extubation

   - Negative urinary toxicology screen for illicit substances;

   - Negative pregnancy test if female and less then 60 y/o;

   - No suspicion for a head injury and/or negative head CT scan for intracranial
   hemorrhage or injury based on standard of care

   - No history of seizure disorder or other neurological disorders.

   - All patients included must screen positive for PHQ-9 score >4 (positive symptoms of
   depression) and CES-T score <36 (poor coping self-efficacy).

Exclusion Criteria:

   - Incarceration,

   - Pregnant females,

   - Prior psychotic disorder,

   - Current use of anti-depressant or anti-psychotic medications,

   - Prior-admission opioid use within 30 days (patients will be screened for recent
   prescription opioid use using the CURES report),

   - Heavy alcohol use,

   - Lesional neurological disorder or brain implant or intracranial ferromagnetic
   material,

   - Seizure disorder