Impact of Intermittent Theta Burst Repetitive Transcranial Magnetic Stimulation on Irritability: A Retrospective Analysis of Patients with Major Depressive Disorder

Irritability is common in major depressive disorder (MDD) and associated with poor outcomes The impact of repetitive transcranial magnetic stimulation (rTMS) for MDD on irritability is poorly explored. A retrospective analysis was conducted on 63 patients with MDD who received 20 sessions of intermittent theta burst rTMS targeting the left dorsolateral prefrontal cortex. The primary outcome was the Concise Associated Symptoms Tracking: Irritability scale (CAST-IRR). Depression symptoms were tracked using the 17-item Hamilton Depression Rating Score (HAMD-17). Mean irritability scores improved from baseline to week 4 of treatment after controlling for age, gender, depression scores, and baseline anxiety. There was greater improvement of irritability from baseline to week 4 among those who responded. Greater improvement in irritability was associated with higher odds of response at week 4. This study provides preliminary evidence that intermittent theta burst rTMS for MDD is associated with improvement in irritability that correlates with response.