TMS vs Medication: Comparing Depression Treatments

It starts small. A comment, a delay, a tone of voice. Then, before you can stop it, you're yelling, crying, or shaking, and afterward you're left with the cleanup and the shame. If emotional outbursts keep happening and you can't predict or stop them, you're probably wondering why, and what you can do about it.

An emotional outburst is a sudden, intense expression of emotion, usually anger, crying, or panic, that feels out of proportion to the moment and hard to control. Occasional outbursts under heavy stress are part of being human. Frequent or escalating ones are often a sign that something underneath needs attention, such as exhaustion, unresolved stress, or a mental health condition that affects emotional regulation.

What emotional outbursts look like

Outbursts look different from person to person, but common forms include:

• Sudden anger, yelling, or slamming things
• Crying that comes on fast and is hard to stop
• Panic, with a racing heart, shaking, or trouble breathing
• Saying things you don't mean and regret afterward
• Shutting down or storming out
• Feeling flooded, unable to think clearly until the wave passes

Many people describe feeling like a passenger: they can see the outburst happening but can't steer it.

Why emotional outbursts happen

Everyday drivers

Before looking at diagnoses, check the basics. Lack of sleep, hunger, physical pain, ongoing stress at work or home, and alcohol all lower the threshold for losing control. So does carrying unspoken frustration for a long time. These factors don't excuse outbursts, but they're often the easiest to change.

Mental health conditions linked to emotional outbursts

When outbursts are frequent, intense, or out of character, they're often part of a condition that affects how emotions are regulated.

• Borderline personality disorder (BPD). The NIMH describes BPD as involving difficulty regulating emotions, intense and highly variable moods lasting from a few hours to a few days, and inappropriate, intense anger or problems controlling anger.
• Bipolar disorder. During manic or mixed episodes, the NIMH lists feeling extremely irritable or touchy among the symptoms, and mood can shift sharply. Our bipolar disorder treatment page covers how this is treated.
• Depression. Depression isn't only sadness. The NIMH lists irritability, frustration, and restlessness among its common symptoms.
• PTSD. The NIMH lists feeling irritable and having angry or aggressive outbursts among the arousal and reactivity symptoms of PTSD, along with being easily startled and feeling on edge.
• ADHD. Emotional regulation isn't part of the formal ADHD criteria, but a review in the American Journal of Psychiatry found that emotion dysregulation is common in ADHD across the lifespan and is a major contributor to impairment.

Neurological causes of sudden crying or laughing

Sometimes "random emotional outbursts" have a neurological cause. Pseudobulbar affect (PBA) causes sudden, involuntary episodes of crying or laughing that don't match how a person actually feels. According to a 2022 systematic review and meta-analysis, it's associated with conditions including traumatic brain injury, multiple sclerosis, ALS, stroke, Parkinson's disease, and dementia. If outbursts of crying or laughing started after a brain injury or alongside a neurological diagnosis, a neurologist should know about them.

What to do in the moment

When you feel an outburst building, the goal isn't to suppress the emotion. It's to buy enough time for your thinking brain to catch up.

• Name it. Saying, even silently, "I'm getting overwhelmed" creates a small gap between feeling and acting.
• Slow your breathing. Breathe out longer than you breathe in. Repeat for a minute or two.
• Take a planned break. Tell the other person you need ten minutes and will come back. Then actually come back.
• Ground yourself. Notice five things you can see, four you can touch, three you can hear.
• Move. A short walk or a few stretches can burn off some of the physical charge.
• Delay decisions. Don't send the message, quit the job, or end the relationship in the middle of the wave.

None of these is a cure. They're tools to stop an outburst from becoming a crisis.

What helps long term

Treating the underlying condition

If outbursts are part of depression, bipolar disorder, PTSD, BPD, or ADHD, treating that condition is usually what reduces them most. That might involve therapy, medication, or both, chosen by a clinician who understands the full picture.

Therapy for emotional regulation

Dialectical behavior therapy (DBT) was developed specifically for BPD and teaches skills for intense emotions, distress tolerance, and relationships. Those skills are useful well beyond BPD. A 2020 Cochrane review of 75 trials found that psychotherapy reduced BPD symptom severity compared with usual care, with DBT and mentalization-based treatment the most studied. Cognitive behavioral therapy (CBT) can also help people recognize triggers and the thoughts that escalate them.

The basics, done consistently

Regular sleep, limiting alcohol, physical activity, and having at least one person you can talk to don't fix a mental health condition. They do lower the baseline level of stress that outbursts grow from.

When to get help

Talk to a mental health professional if outbursts are frequent, are getting worse, are damaging relationships or work, or come with mood swings, depression, or trauma symptoms. Get help urgently if outbursts involve violence, threats, or self-harm. If anyone is in immediate danger, call 911. If there are thoughts of suicide, call or text 988.

At Amae Health, our clinics specialize in conditions where emotional outbursts are often part of the picture, including Borderline Personality Disorder, bipolar disorder, and Major Depressive Disorder. Our care teams bring psychiatrists, therapists, primary care physicians, peer mentors, and care coordinators under one roof, working from one treatment plan. We've also written about related patterns in quiet BPD and petulant BPD.

Supporting someone who has emotional outbursts

• Stay as calm as you can, and keep your voice low and steady.
• Don't try to reason through the peak. Wait until things settle to talk.
• Set clear limits on behavior you won't accept, such as yelling at you or breaking things.
• Talk about patterns later, when you're both calm.
• Encourage an evaluation if outbursts are frequent or getting worse.
• Take care of yourself too. Supporting someone through this is hard. Our guide on how to help someone with mental health issues has more.

Frequently asked questions

Why do I have random emotional outbursts?

Common reasons include stress, poor sleep, and conditions such as depression, bipolar disorder, BPD, PTSD, and ADHD. In some people, sudden crying or laughing that doesn't match their mood is caused by a neurological condition called pseudobulbar affect.

Are emotional outbursts a sign of a mental illness?

Not always. Occasional outbursts under heavy stress are common. Frequent, intense, or escalating outbursts deserve an evaluation, because they're often linked to a treatable condition.

How do I stop emotional outbursts?

In the moment, name what's happening, slow your breathing, and take a planned break. Long term, treating any underlying condition and learning emotional regulation skills, such as those taught in DBT, are what make lasting change.

What is emotional volatility?

Emotional volatility describes emotions that shift quickly and intensely. It's a feature of several conditions, including BPD and bipolar disorder, and can also come from stress, exhaustion, or substance use.

Key takeaways

• Emotional outbursts are sudden, intense, and hard to control. Frequent ones usually have a cause that can be addressed.
• Conditions linked to outbursts include BPD, bipolar disorder, depression, PTSD, and ADHD. Sudden crying or laughing can also have a neurological cause.
• In-the-moment tools buy time. Treating the underlying condition and learning regulation skills make lasting change.
• Get urgent help if outbursts involve violence, threats, or self-harm.

If emotional outbursts are part of a bigger pattern of mood swings, depression, or unstable relationships, for you or someone you love, request an intake appointment. Our team will explain how an evaluation works and what the first visit involves.

If you or someone you know is in immediate danger or having thoughts of self-harm, call 911 or go to the nearest emergency room. You can also call or text the Suicide & Crisis Lifeline at 988 for free, confidential support 24/7.

You're lying awake at 3 AM with your mind racing through tomorrow's worries, yet feeling too drained to care about things you once loved. Your heart pounds during everyday situations, but you're also pulling away from friends and family.

If this sounds familiar, you're not alone — anxiety and depression often appear together, creating a complex web of symptoms that can feel overwhelming. Understanding what's happening in your mind and body, recognizing the signs, and being aware of effective treatments can help you regain control.

If you’re wondering how to ask for help when depressed, start by choosing one trusted person, describing what you’re experiencing in simple terms, and asking for specific support. Professional help from therapists or mental health clinics can provide guidance when symptoms feel overwhelming.

How Are Anxiety and Depression Connected?

The relationship between anxiety and depression is more common than many people realize. Mental health professionals refer to this as "comorbidity" — when two conditions occur together in the same person. Research shows that about half of people diagnosed with major depression also experience significant anxiety symptoms, and vice versa.

These conditions often feed off each other in a cycle that can be difficult to break. Anxiety frequently comes first, with constant worry and fear gradually wearing down your emotional reserves. This mental exhaustion can lead to hopelessness and low energy characteristic of depression. Conversely, when you're depressed and withdrawing from activities, you might develop anxiety about your changing relationships, work performance, or ability to function normally.

The cycle looks like this: persistent worry leads to emotional and physical exhaustion, which triggers a low mood and avoidance behaviors, creating more situations to worry about. Understanding this connection helps explain why treating both conditions together often produces better outcomes than addressing them separately.

What Is Anxiety?

Anxiety is your body's natural alarm system gone into overdrive. While everyone experiences worry and fear sometimes, anxiety disorders involve excessive, persistent worry that interferes with daily life. The core features include hyperarousal (your nervous system staying "revved up") and worry that feels impossible to control.

Common anxiety symptoms include:

• Restlessness or feeling keyed up
• Racing heart or rapid breathing
• Difficulty sleeping or staying asleep
• Stomach upset or digestive issues
• Muscle tension, especially in the shoulders and jaw
• Difficulty concentrating due to racing thoughts

Anxiety disorders come in several forms. Generalized Anxiety Disorder (GAD) involves worry about many different areas of life. Panic disorder features sudden, intense episodes of fear. Social anxiety centers on fear of judgment in social situations, while specific phobias involve intense fear of particular objects or situations.

What Is Depression?

Depression goes far beyond temporary sadness or "having a bad day." It's a persistent condition that affects how you think, feel, and function. The hallmark features include prolonged low mood, loss of interest or pleasure in activities you once enjoyed, and significant fatigue that is not relieved by rest.

Depression also commonly involves feelings of guilt or worthlessness, difficulty concentrating or making decisions, changes in appetite and sleep patterns, and physical symptoms like headaches or unexplained aches. In severe cases, people may have thoughts of death or suicide.

Signs You May Have Both Disorders

When anxiety and depression occur together, symptoms can overlap and intensify each other. You might notice both the hyperarousal of anxiety and the low energy of depression, creating an exhausting internal conflict between feeling wired and tired simultaneously.

Watch for these combined symptoms:

• Racing thoughts mixed with feelings of hopelessness
• Fatigue coupled with restlessness or inability to sit still
• Difficulty sleeping due to both worry and low mood
• Loss of appetite from anxiety alongside changes in eating changes
• Avoiding social situations due to both fear and lack of interest
• Physical symptoms like headaches, rapid heartbeat, and muscle tension
• Irritability that stems from both anxiety and depression
• Trouble concentrating, whether from racing thoughts or mental fog
• Withdrawing from activities you once enjoyed
• Feeling overwhelmed by everyday tasks and decisions

If these symptoms are affecting your work, relationships, or daily functioning for two weeks or more, it's time to seek professional help.

How Clinicians Diagnose

Mental health professionals use several approaches to diagnose anxiety and depression. The process typically begins with a comprehensive clinical interview where you'll discuss your symptoms, their duration and severity, family history, and how they're impacting your life.

Your clinician will also rule out medical causes, as conditions like thyroid disorders, heart problems, or certain medications can mimic anxiety and depression symptoms. Blood tests or other medical evaluations might be recommended.

Many professionals use brief, standardized screening tools like the GAD-7 for anxiety and the PHQ-9 for depression. These questionnaires help quantify symptom severity and track improvement over time. At Amae Health, our clinicians combine thorough interviews with these validated assessments to ensure accurate diagnosis.

Getting a clear diagnosis is crucial because it guides treatment decisions. When both conditions are present, integrated treatment approaches that address the relationship between anxiety and depression tend to be most effective.

Evidence-Based Treatment for Anxiety and Depression

Psychotherapy

Several types of therapy have strong research support for treating anxiety and depression together. Cognitive Behavioral Therapy (CBT) is often considered the gold standard, helping you identify and change negative thought patterns that fuel both conditions. You'll learn to recognize cognitive distortions — like catastrophic thinking that worsens anxiety or all-or-nothing thinking that deepens depression.

For anxiety specifically, exposure therapy gradually helps you face feared situations in a safe, controlled way. This reduces avoidance behaviors that often contribute to depression as well. For depression, behavioral activation focuses on gradually re-engaging with meaningful activities, which can also reduce anxiety by providing structure and accomplishment.

Medications

Several medications effectively treat both anxiety and depression simultaneously. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are typically first-line treatments because they address the underlying brain chemistry involved in both conditions.

These medications typically take 4-6 weeks to show full benefits, although some people may notice improvements earlier. Common side effects may include initial nausea, headaches, or changes in sleep patterns, but these often improve as your body adjusts. Your prescriber at Amae Health will closely monitor your progress, adjusting dosages as needed and watching for any concerning side effects.

It's essential to work closely with your healthcare provider throughout the medication process, as finding the right medication and dosage can be a time-consuming and patient process.

Lifestyle & Skills

Lifestyle changes play a crucial role in managing both conditions. Maintaining a consistent sleep schedule helps regulate mood and reduce anxiety. Regular exercise — even just 20-30 minutes of walking daily — can be as effective as medication for mild to moderate depression and significantly reduces anxiety symptoms.

Limiting alcohol and caffeine helps stabilize mood and reduce physical anxiety symptoms. Simple coping skills can also make a significant difference:

• Deep breathing exercises to calm your nervous system
• Grounding techniques using your five senses during anxiety spikes
• Setting aside "worry time" to contain anxious thoughts
• Progressive muscle relaxation to reduce physical tension

For individuals who don't respond adequately to standard treatments, options like Transcranial Magnetic Stimulation (TMS) may be considered as additional treatment approaches.

When to Seek Urgent Help

While anxiety and depression are treatable conditions, certain warning signs require immediate attention. Please seek emergency help if you or someone you know experiences suicidal thoughts, plans, or intentions, self-harm behaviors, inability to care for basic needs like eating or hygiene, signs of psychosis such as hallucinations or delusions, or dangerous substance use that puts safety at risk.

How Our Amae Health Clinic Can Help

At Amae Health, we understand the complex relationship between anxiety and depression and offer comprehensive, integrated care. Our approach begins with a same-week evaluation where our experienced clinicians conduct thorough assessments to understand your unique situation.

We then develop personalized treatment plans that may include therapy (or group therapy), medication management, or both, depending on your needs and preferences. Our team coordinates care to ensure all aspects of your treatment work together effectively, addressing both conditions simultaneously rather than in isolation.

We accept most major insurance plans and offer telehealth options for convenient access to care. Our goal is to help you not just manage symptoms, but rediscover joy and confidence in your daily life.

Ready to take the first step toward feeling better? Contact Amae Health today to schedule your comprehensive assessment and begin your journey toward improved mental health.

Medical Disclaimer

This blog post is provided by Amae Health for educational and informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition, treatment options, or before making any changes to your medication regimen.

Reliance on any information provided in this article is solely at your own risk. If you believe you are experiencing a medical emergency, call 911 (or your local emergency services) immediately.

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Finishing a course of TMS and feeling like yourself again brings a new worry: will it hold? How long do TMS results last, and what happens if the depression comes back? The research is more encouraging than many people expect. Among people who respond to a course, roughly half to nearly two-thirds are still responding a year later, and when symptoms do return, restarting TMS brought back the improvement for most people in the research.

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None of that predicts any one person's course. It does show what tends to help results last, and why the months after treatment deserve a plan of their own.

What "Lasting" Means: Response vs. Remission

Two terms do most of the work in durability research. A person has responded when their depression scores fall by at least half on a standard rating scale. They're in remission when scores drop low enough that the depression is largely gone.

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Durability studies then ask a narrower question than the original trials did: of the people who responded or reached remission by the end of a course, how many were still doing well months later? That framing matters when you read the numbers. A result such as 62.5% of people keeping their response for a year describes people who had already responded, not everyone who started TMS. Those follow-up checks happen at set points, typically three, six, and 12 months after a course, so durability is reported as the share of people still responding at each checkpoint.

What the Research Shows About Durability

The most direct data come from a 2014 study in The Journal of Clinical Psychiatry that followed people with medication-resistant major depression for a year after they finished TMS at 42 U.S. clinical practices. Of the 257 people who completed a course and agreed to follow-up, 120 had responded or reached remission by the end of treatment. Of those 120, 75 (62.5%) kept meeting response criteria through the full 12 months.

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Two details shape that result. The study used a practical approach after the course: continued antidepressant medication, plus access to more TMS if symptoms returned. And over the year, 93 participants (36.2%) had TMS reintroduced at some point, averaging about 16 treatment days. So the 62.5% reflects TMS inside ongoing care, not a single course left to stand on its own.

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A 2019 meta-analysis in Brain Stimulation pooled 19 studies of people who had responded to a TMS course. About two-thirds were still responding at three months, about 53% at six months, and about 46% at one year. The authors' summary: roughly half of responders keep their response for up to a year after a successful course.

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Read together, the two studies give a realistic range of around half to nearly two-thirds of responders still doing well a year out. The other side of those numbers matters just as much. A meaningful share of people see symptoms return within the first year, and planning for that possibility is part of good care, not a sign that treatment failed.

Factors That Influence How Long Results Last

The research has identified a few patterns, mostly at the level of groups rather than individuals:

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• Maintenance treatment. In the 2019 meta-analysis, studies that included maintenance treatment showed higher sustained response at some time points.
• The mix of people studied. Studies with a higher proportion of women also showed higher sustained response, a group-level pattern that says nothing reliable about any one person.
• Continued medication. The best-known durability results come from people who stayed on antidepressants after TMS, so those numbers describe that combination.
• A completed course. Durability figures come from people who finished a full acute course. They don't describe what happens after a partial one.

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Clinicians also weigh a person's history when planning follow-up, such as how many depressive episodes they've had and how many treatments failed before TMS. The findings above don't establish how much those factors change the odds, so they inform a clinician's judgment rather than supply a number.

Maintenance TMS: What It Is and Who May Need It

TMS maintenance treatment means periodic sessions after the main course, scheduled to protect a response rather than to answer a relapse. Schedules vary between providers and between people, and no single schedule has become standard.

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The evidence supports the idea without settling the details. The 2019 meta-analysis found maintenance associated with more durable response, and its authors suggested maintenance be considered in practice and tested in future trials. That's a promising signal, not a proven protocol. Maintenance TMS is also separate from staying on medication: in both the year-long and six-month studies, people continued antidepressants whether or not they received more TMS.

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Not everyone needs it. Some people stay well for long stretches without it. Whether maintenance makes sense for a particular person is a judgment a psychiatrist makes from their history and how they're doing in the months after the course.

Can TMS Be Repeated If Symptoms Return?

Yes, and the research on restarting TMS is among the most reassuring parts of this topic. In a six-month study in Brain Stimulation, people whose depression had improved by at least a quarter with TMS stopped treatment gradually over three weeks while starting maintenance antidepressant medication. In that study, worsening had a specific meaning: a clinician-rated decline that held for two consecutive weeks, which triggered restarting TMS. Over the next 24 weeks, 38% had symptoms worsen enough to restart TMS, and 32 of those 38 people (84%) regained their improvement. Only 10% of the 99 people whose results were reported met the study's definition of relapse.

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A repeat course is different from maintenance. Maintenance is planned in advance to hold a response; a repeat course starts because symptoms have come back. In the year-long study described above, about a third of participants had TMS reintroduced at some point. Whether and when to restart is a decision made with a psychiatrist, based on how symptoms are changing.

What Helps Results Last Longer

Beyond maintenance and continued medication, two more things help, though neither promises that results will last for a particular person:

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• Catching changes early. In the six-month study, regular assessments flagged worsening symptoms, and most people who restarted TMS at that point regained their improvement.
• Staying connected to care. Therapy and regular psychiatric visits mean someone is watching for early changes between treatments.

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Knowing what returning depression tends to look like makes early changes easier to catch: shifts in sleep or appetite, lower energy, less interest in usual activities, and a low mood that lingers instead of lifting after a few days. When those signs show up, reaching out sooner gives a care team more options, and our guide on how to ask for help when depressed covers how to start that conversation.

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These describe what research associates with better long-term results in groups of patients. They aren't instructions for any one person's treatment plan; that's a psychiatrist's call, made with the whole history in view.

Talking to a Psychiatrist About a Long-Term Plan

A TMS course is the start of a plan, not the end of one. The months afterward are when follow-up, medication decisions, and a clear plan for what happens if symptoms return matter most.

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At Amae, TMS sits inside our integrated care model, where psychiatric care, therapy, primary care, and peer support stay linked after the course ends. We provide TMS therapy for major depressive disorder at our Los Angeles clinic and at our Bay Area clinics in Los Altos and San Mateo. Commercial insurance plans and cash pay are both accepted, and our intake team handles prior authorization. To map out what comes after a course, talk with an Amae psychiatrist about a long-term plan. Anyone in crisis can reach the 988 Suicide and Crisis Lifeline by call or text.

Frequently Asked Questions

How long do TMS results typically last?

For many people, months to a year or longer, though it varies. In a year-long study of people who responded to TMS, 62.5% kept meeting response criteria for the full 12 months. A 2019 meta-analysis found that about half of responders were still responding at one year.

What percentage of people relapse after TMS?

Some return of symptoms within a year is common. In the 2019 meta-analysis, roughly half of responders were no longer responding at one year. That isn't always a full relapse: in a six-month study, 38% had symptoms worsen enough to restart TMS, while 10% met the study's definition of relapse.

Can TMS be repeated if depression comes back?

Yes. In a six-month study, 84% of people whose symptoms worsened regained their improvement when TMS was restarted. A repeat course is different from ongoing maintenance sessions, and the decision is made with a psychiatrist based on individual history.

Do I need maintenance TMS sessions after my initial course?

Not necessarily. Some people stay well without them, and there is no standard maintenance schedule across providers. Research links maintenance with longer-lasting response, so whether it fits is a decision a psychiatrist makes based on your response and how closely symptoms are being monitored.

What can help TMS results last longer?

The research points to planned follow-up, continued medication when it's part of the plan, and catching symptom changes early. These are general findings from groups of patients, not instructions for any one person's treatment.

Is maintenance TMS covered by insurance?

It depends on the insurer and on whether sessions are billed as maintenance or as a new course for returning symptoms, since coverage can differ between the two. Ask the provider to verify benefits with your insurer before sessions begin.

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Citations

1. Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period. Journal of Clinical Psychiatry. 2014;75(12):1394-1401. https://pubmed.ncbi.nlm.nih.gov/25271871/
2. Senova S, Cotovio G, Pascual-Leone A, Oliveira-Maia AJ. Durability of antidepressant response to repetitive transcranial magnetic stimulation: systematic review and meta-analysis. Brain Stimulation. 2019;12(1):119-128. https://pubmed.ncbi.nlm.nih.gov/30344109/
3. Janicak PG, Nahas Z, Lisanby SH, et al. Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression: assessment of relapse during a 6-month, multisite, open-label study. Brain Stimulation. 2010;3(4):187-199. https://pubmed.ncbi.nlm.nih.gov/20965447/
4. 988 Suicide and Crisis Lifeline. https://988lifeline.org

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