The only other source of information about the usefulness of rTMS in BPAD-DP comes from the description of the response of these patients in general trials with mixed samples. Unfortunately, some of the larger studies including the Neuronetics trial described above [18] have excluded BPAD patients and most of the studies other than our own have had too small samples to allow meaningful data to be extracted on subgroups. In studies we have conducted, none of which was designed to directly investigate rTMS responses in BPAD, a total of 50 BPAD-DP have been treated to date. These have been treated across 5 separate trials. In most of these trials the number of subjects is too limited to draw any useful inferences. However, a total of 21 patients with BPAD-DP received LFR-TMS in the clinical effectiveness trial described above over a 4 week period (study 2). In this group, there was a significant reduction in Hamilton Depression Rating Scale (HAMD) scores between baseline and week 2 (baseline = 21.6 ±5.7, week 2 = 12.0±6.3, p<0.001) and between baseline and week 4 (baseline = 21.6 ±5.7, week 4 = 9.7±6.3, p<0.001). Interestingly given that this is the first published sample with a treatment duration of greater than 2 weeks, the group showed a significant reduction in HAMD scores between week 2 and 4 (p<0.05) indicating the benefit of the longer period of treatment. 15 (71%) of these patients met response criteria (>50% reduction in HAMD scores by trial end).