OTHER GAPS IN THE LITERATURE Clearly BPAD is a relapsing illness and there is no substantive data on the impact of rTMS on longer term outcomes. Long term follow-up data with rTMS treatment is very limited in general. One study has reported similar 6 month relapse rates following rTMS and ECT treatment [31] but only considered the outcome in a limited group of patients (n=21 in the rTMS group). Unpublished data from the Neuronetics trial (CIA 52) suggests that relapse rates post rTMS are similar or lower than those seen in previously published large ECT studies (M Demitrack, personal communication). We have reported relapse and re-treatment at an average time of 9 months post acute treatment but this sample was not comprehensively followed between the end of acute treatment and relapse (CIA 36). We will aim to significantly contribute to understanding the outcome of treatment by including structured assessments over a 12 month follow up period in this study.