Electroconvulsive therapy (ECT) is the most effective acute biological treatment for TRD but the use of ECT is limited by potential negative effects on mood and thinking. Focal Electrically Administered Seizure Therapy (FEAST) is a new form of ECT and pilot studies show that FEAST appears to have good outcomes on measures of depression with fewer effects on the patients? cognitive ability. This study is being done to compare FEAST to standard ECT to determine if it will serve as a comparable treatment for TRD while preserving the patients mental processes. Patients who are at least 18 years old, have a diagnosis of major depression, have not responded or been intolerant to other depression therapies, and are interested iin electro-convulsive therapy as a form of treatment for their depressive symptoms may qualify for this study.