The proposed study seeks to improve the prevention of suicide by advancing our understanding of the neurobiology of suicide by using a randomized control trial of repetitive transcranial magnetic stimulation (rTMS) as a hypothesis driven intervention for acute suicidality. In 2010 suicide was responsible for more than 38,364 deaths in the United States and 447 in the state of Arkansas (CDC, 2012). Suicide represents the 10th leading cause of death in this country, and claims more deaths than chronic liver disease, hypertension, Parkinson's disease or homicide. Furthermore, suicide consequences extend beyond the termination of an individual's life to impact those that are left behind. These statistics are far more alarming because they are believed to be underestimates, with substantial numbers of suicides and suicide attempts undetected or misclassified. The high and rising prevalence of suicide is complicated by the clinical challenge of identifying those patients at highest risk for suicide. A variety of biological, psychological and social risk factors for suicide have been identified. However, we currently lack reliable predictors of suicide risk and must rely heavily upon self-report and clinical judgment. Thus, it remains singularly difficult to predict who is going to commit suicide. Therefore, there is an urgent unmet need to develop effective early detection methods and treatments for high-risk populations.