Safety and Efficacy Study of Deep Transcranial Magnetic Stimulation in Bipolar Depression

This is a multi center, randomized, double blind study to evaluate the efficacy and safety of
H1-Coil deep brain rTMS in subjects with bipolar depression, taking mood stabilizers and
previously unsuccessfully treated with antidepressant medications. The study is designed for
a period of 8 weeks of which up to 3 weeks subjects will be tapered down from their
medications and treated for 5 weeks. Two follow up visits will be performed at week 6 and 8
after the last TMS treatment. Mood and mental status will be closely monitored with standard
psychological scales and assessments

Inclusion Criteria:

- Outpatients

- patients suffering from an episode of bipolar depression (BP1 or BP2) according to DSM
IV, with the additional requirement of duration for the current episode ≥ 4 weeks and
CGI ≥ 4.

- Men and Women Ages 22-68 years.

- Negative answers on safety screening questionnaire for transcranial magnetic
stimulation.

- Taking mood stabilizing medication (e.g., Lithium, Lamictal, Tegretol, Topamax, etc.)
at a therapeutic dose or atypical antipsychotic medication which was prescribed as
mood stabilizers by their treating physician, except for Leponex (Clozapine).
According to the treating physician the patient is compliant with taking the
mood-stabilizing medication.

Exclusion Criteria:

- patients suffering from other diagnoses on axis 1 such as schizophrenia , or suffering
from psychotic depression in current episode.

- Diagnosed as suffering from Severe Borderline Personality Disorder or hospitalized due
to exacerbation related to of borderline personality disorder. Subjects suffering from
any other Severe Personality Disorder will also be excluded.

- Present suicidal risk as assessed by the investigator

- Patients with a bipolar cycle of less than 30 days.

- History of epilepsy or seizure (EXCEPT those therapeutically induced by ECT ) or
history of such in first degree relatives.

- Increased risk of seizure for any reason, including prior diagnosis of increased
intracranial pressure (such as after large infarctions or trauma), or history of
significant head trauma with loss of consciousness for greater than or equal to 5
minutes.

- History of head injury.

- History of any metal in the head (outside the mouth).

- Metallic particles in the eye, implanted cardiac pacemaker or any intracardiac lines,
implanted neurostimulators, intracranial implant (e.g., aneurysm clips, shunts,
stimulators, cochlear implants, or electrodes) or implanted medical pumps.

- Hearing loss.

- Individuals with a significant neurological disorder or insult including, but not
limited to:

- Any condition likely to be associated with increased intracranial pressure

- Space occupying brain lesion

- History of cerebrovascular accident

- Transient ischemic attack within two years

- Cerebral aneurysm

- Dementia

- Parkinson's disease

- Huntington's chorea

- Multiple sclerosis

- Current History of substance abuse including alcoholism or history of substance abuse
including alcoholism within the past 6 months (except nicotine and caffeine).

- Inadequate communication with the patient.

- Under custodial care.

- Participation currently in another clinical study or enrolled in another clinical
study within 30 days prior to this study.

- Participants who suffer from an unstable physical disease such as high blood pressure
or acute, unstable cardiac disease

- Use of fluoxetine within 6 weeks of the baseline visit

- Use of a Monoamine Oxidase Inhibitor (MAOI) within 2 weeks of the baseline visit

- Current use of antidepressant medications during the course of the trial.

- Current use of Leponex (Clozapine).

- Previous treatment with TMS

- Women who are breast-feeding

- Known or suspected pregnancy

- Women of childbearing potential and not using a medically accepted form of
contraception when engaging in sexual intercourse.