rTMS for Fatigue and Brain Fog in Long-COVID

Study start date: January 1, 2025

Inclusion Criteria: 1. 18+ years of age 2. Prior hx of PCR confirmed COVID-19 infection. Determined by the PI or participant's physician. 3. Subsequent development of post-acute neuropsychiatric symptoms with fatigue and brain fog as primary outcomes 4. USE of Psychotropic medications 5. Stable on psychotropic medications for 4+ months 6. Confirmed diagnosis of Long COVID 7. Subjects are willing and able to adhere to the treatment schedule and required study visits Exclusion Criteria: 1. Mentally or legally incapacitated or unable to give informed consent 2. MOCA \< or = 24 3. Infection of poor skin condition over the scalp where the rTMS device will be positioned 4. Pregnancy: Female participants will be tested for pregnancy at baseline and agree to use a medically acceptable form of birth control throughout the study, for women younger than 60. 5. Lifetime history of diagnosed bipolar disorder; psychosis, such as schizophrenia, schizophreniform, or schizoaffective disorder; intellectual disability (intellectual developmental disorder); organic brain damage; or suicide attempts in the past 24 months. 6. Severe MDD with suicidality of Psychosis- excluded 7. As-needed use of benzodiazepines and beta-blockers will be permitted but discouraged during assessment days. 8. Current abuse or dependence on alcohol or any illicit drug of abuse (disorder in last 6 months). Any recent use of cocaine or opiates will also be exclusionary. 9. Participants with asthma or with a history of serious, uncontrolled medical illness or instability (including significant cardio-pulmonary disease, organic brain including significant cardio-pulmonary syndrome, pre-existing dementia, seizure disorder, cerebrovascular disease, and diabetes) 10. Taking medications known to lower seizure thresholds (Clozaril/ Wellbutrin) 11. Neurological conditions that include epilepsy, cerebrovascular disease, dementia, increased intracranial pressure, having a history of repetitive or severe head trauma, or primary or secondary tumors in the central nervous system. 12. Presence of an implanted metallic and magnetic-sensitive medical device present in the body scan, including but not limited to a cochlear implant, infusion pump, implanted cardioverter defibrillator, pacemaker, vagus nerve stimulator, aneurysm clip, metal prosthesis, or metal aneurysm clips or coils, staples, or stents.