Treatment of Depression Post-SCI

Inclusion criteria: 1. Age 18 - 70; 2. At least 6 months post incomplete cervical or incomplete or complete thoracic level SCI; 3. Have at least partial active movement of the right thumb (abductor pollicis brevis) to allow for FDA approved rTMS dosing; 4. Major depressive disorder, as identified through screening tools; 5. No antidepressant medications or no change in doses of psychotropic medication(s) for at least 4 weeks prior to the study (6 weeks if newly initiated medication). Exclusion criteria: 1. Concomitant neurologic diseases/disorders or dementia; 2. Cognitive impairment, as identified through a screening tool (Montreal Cognitive Assessment); 3. History of major head trauma as identified through a screening tool (Ohio State University Traumatic Brain Injury Identification Method); 4. History of psychosis or other Axis I disorder that is primary; 5. Positive screen for bipolar disorder, as identified through a screening tool (The Mood Disorder Questionnaire); 6. Life expectancy \<1 year; 7. Attempt of suicide in the last 2 years; 8. Electronic or metallic implants (i.e. metal in the head, cochlear implant, or pacemaker); 9. History of seizures or currently prescribed anti-seizure medications; 10. Taking medication that increases the risk of seizures; 11. Pregnancy as identified through a positive pregnancy test; 12. Inability or unwillingness of subject or legal guardian/representative to give informed consent.