Major depressive disorder (MDD) is one of the most prevalent mental health conditions in New York City and across the U.S., affecting millions of adults and significantly impacting quality of life. While the hallmark symptoms of Depression are persistent sadness and low energy, irritability in Depression is another common and often overlooked symptom.
For individuals living in New York City, where the fast pace of life can exacerbate stress and irritability, effective treatment is essential. While antidepressants are commonly prescribed, they often come with side effects that are intolerable for many patients, including weight gain, sexual dysfunction, and gastrointestinal disturbances. This is where transcranial magnetic stimulation (TMS), specifically intermittent theta burst stimulation (iTBS), is emerging as a promising treatment option for Depression and the irritability it brings.
The Significance of Irritability in Depression Patients
Irritability is not merely a nuisance symptom—it is associated with poorer clinical outcomes in Depression. In fact, research shows that irritability is present in roughly half of patients experiencing a major depressive episode. Patients with irritability often face longer episodes of Depression, higher anxiety rates, greater psychosocial dysfunction, and even an increased risk of suicidal thoughts.
Patients who are irritable tend to experience more severe Depression, longer episodes, and reduced overall well-being. Irritability can also complicate treatment, as it is sometimes less responsive to standard antidepressant therapy, leaving patients frustrated and disheartened.
Traditional antidepressants, while effective for many, may not be adequately effective or fully address irritability. Moreover, side effects can lead some patients to discontinue medication altogether, preventing them from achieving full remission of depressive symptoms. For these individuals, with alternative therapies such as iTBS TMS irritability can be properly addressed as part of a larger treatment plan.
What is Intermittent Theta Burst TMS for Irritability in Depression?
TMS is a non-invasive brain stimulation therapy that uses magnetic fields to modulate neural activity in specific regions of the brain. For Depression, TMS typically targets the left dorsolateral prefrontal cortex (DLPFC), an area involved in mood regulation.
Intermittent theta burst stimulation (iTBS) is a specialized form of TMS that delivers rapid bursts of stimulation in short sessions—typically only a few minutes compared to traditional TMS, which may last 30–40 minutes. iTBS has been shown to be as effective as standard TMS while significantly reducing treatment time, making it especially convenient for busy New Yorkers balancing work, family, and social commitments.
How iTBS Compares to Antidepressants
While some antidepressants, such as sertraline, have been shown to reduce irritability over time, the process can take several weeks, and side effects may limit adherence. In contrast, iTBS offers a fast-acting, non-pharmacologic alternative. Patients in the study experienced measurable improvements in just four weeks, without the systemic side effects commonly associated with medications.
For New Yorkers, who often juggle high-stress jobs and urban living challenges, iTBS offers a therapy that is both efficient and well-tolerated, enabling patients to maintain daily routines while receiving effective treatment.
Recent Research on iTBS for Irritability in Depression
When it comes to TMS irritability can be mitigated through treatment protocols. A recent study published in Translational Psychiatry investigated the impact of intermittent theta burst TMS on irritability in Depression patients with MDD. The study conducted a retrospective analysis of 63 patients with major depressive disorder who received 20 sessions of iTBS targeting the left DLPFC over four weeks.
Key Findings
- Improvement in Irritability in Depression: Patients showed significant reductions in irritability scores from baseline to week 4 of treatment, measured using the validated Concise Associated Symptoms Tracking: Irritability scale (CAST-IRR).
- Correlation with Depression Response: Greater improvement in irritability was associated with higher odds of overall Depression response, meaning that patients who became less irritable were more likely to see significant improvements in depressive symptoms.
- Early Intervention Benefits: While early changes in irritability (week 1 or 2) did not predict week 4 response, the overall reduction by week 4 was clinically meaningful.
- Controlled Analysis: The improvements in irritability were observed even when controlling for age, gender, baseline anxiety, and Depression severity, suggesting that iTBS may have a direct effect on irritability, not just mood symptoms.
These findings highlight that iTBS is not only effective in reducing depressive symptoms but can also directly alleviate irritability, a symptom often resistant to pharmacotherapy.
How iTBS TMS Works for Irritability in Depression
With TMS irritability can be effectively mitigated. iTBS uses a figure-8 magnetic coil to deliver bursts of magnetic pulses to the left DLPFC. These pulses stimulate neural circuits involved in mood regulation, enhancing synaptic plasticity and promoting improved communication between brain regions. Over repeated sessions, these neuroplastic changes can lead to sustained improvements in mood, irritability, and overall emotional regulation.
At Mid City TMS in New York City, patients typically undergo daily 3–5 minute iTBS sessions, five days per week for 7-8 weeks, more sessions than the 4 week protocol used in the study by Ng et al. and thereby producing even more effective and long lasting results. Treatments are painless, non-invasive, and require no anesthesia or sedation, allowing patients to return to work or daily activities immediately after each session.
Who Can Benefit from iTBS?
iTBS is particularly suitable for individuals with treatment-resistant Depression who have not responded to antidepressants, those experiencing intolerable side effects from medication, patients with significant agitation or irritability in Depression, and busy individuals who require brief, outpatient treatments.
Safety and Tolerability
iTBS is generally well-tolerated where TMS irritability treatment is concerned. The most common side effects are mild scalp discomfort or mild headache after the first few treatment sessions, which typically resolve shortly after the session. Importantly, iTBS does not carry the systemic side effects of antidepressants, such as gastrointestinal upset, weight changes, or sexual dysfunction.
Clinical Implications for New York City Patients
For many New Yorkers struggling with Depression and irritability, iTBS TMS offers a compelling alternative to traditional medications. Whether you are a busy professional, a parent managing multiple responsibilities, or someone who has tried multiple antidepressants without success, iTBS provides:
- Rapid symptom relief in as little as four weeks
- Reduction of irritability, which is linked to better overall Depression outcomes
- Minimal disruption to daily life thanks to short, outpatient sessions
- No systemic side effects, making it a safe alternative for those sensitive to medications
Research shows that targeting irritability specifically is important, as persistent irritability can lead to poorer clinical outcomes and increased psychosocial difficulties (Jha et al., 2019). iTBS addresses this symptom directly, providing a more holistic approach to Depression treatment.
Mid City TMS Can Assist with Irritability in Depression With iTBS
At Mid City TMS in Manhattan, patients benefit from the most experienced providers specializing in TMS and neuromodulation in NYC, personalized treatment plans designed around your symptoms and schedule, state-of-the-art equipment and iTBS protocols, and a supportive environment that makes therapy convenient and comfortable for busy New Yorkers.
Intermittent theta burst stimulation (iTBS) represents a powerful, evidence-based treatment option for individuals with major depressive disorder, particularly those struggling with irritability and side effects from antidepressants. By targeting the left dorsolateral prefrontal cortex (DLPFC) with TMS irritability can become a thing of the past as treatment works to improve mood and enhance overall functioning—all without the systemic side effects of traditional medications.
For patients in New York City seeking effective, fast-acting, and well-tolerated Depression treatment, iTBS at Mid City TMS offers a clinically validated solution backed by emerging research. If you or a loved one are experiencing Depression with irritability, contact us today to explore whether iTBS could help you reclaim balance, calm, and emotional stability.
Sources
- Fava, M., Hwang, I., Rush, A. J., Sampson, N., Walters, E. E., & Kessler, R. C. The importance of irritability as a symptom of major depressive disorder: results from the National Comorbidity Survey Replication. Molecular Psychiatry. 2010;15(8):856–867. https://pubmed.ncbi.nlm.nih.gov/19274052/
- Judd, L. L., Schettler, P. J., Coryell, W., Fiedorowicz, J. G., Solomon, D. A., Rice, J., Endicott, J., Keller, M. Overt irritability/anger in unipolar major depressive episodes: prevalence and clinical significance. Journal of Affective Disorders. 2013. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1737169
- Perlis, R. H., Minhajuddin, A., Chin Fatt, C., Kircanski, K., Stringaris, A., Leibenluft, E., Trivedi, M. H. Association between irritability and suicidal ideation in three clinical trials of adults with major depressive disorder. Neuropsychopharmacology. 2020;45(13):2147–2154. https://pubmed.ncbi.nlm.nih.gov/32663842/
- Ng, E., Abramian, M., Nestor, S., Rabin, J., Hamani, C., Lipsman, N., & Giacobbe, P. Impact of intermittent theta burst repetitive transcranial magnetic stimulation on irritability: A retrospective analysis of patients with major depressive disorder. Translational Psychiatry. 2025;15:100091. https://doi.org/10.1016/j.transm.2025.100091
- Jha, M. K., Minhajuddin, A., Chin Fatt, C., Kircanski, K., Stringaris, A., Leibenluft, E., & Trivedi, M. H. Irritability as a predictor of depression outcomes including reduction of irritability. Journal of Affective Disorders. 2019. https://pubmed.ncbi.nlm.nih.gov/30922100/
- Jha, M. K., Minhajuddin, A., Chin Fatt, C., Kircanski, K., Stringaris, A., Leibenluft, E., & Trivedi, M. H. Improvements in irritability with sertraline versus placebo: Findings from the EMBARC study. Journal of Affective Disorders. 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC9764261/