Abstract Depression is characterized by disturbed emotional processing, with increased amygdala reactivity during perception of negative emotional stimuli. Here, we assessed whether intermittent theta-burst stimulation (iTBS) modulates amygdala activity during an emotional picture anticipation paradigm using functional magnetic resonance imaging (fMRI) in a patient sample with depression. Patients were randomized to either active (n=21) or sham (n=21) iTBS over the dorsomedial prefrontal cortex (DMPFC), delivered twice daily for ten days at target intensity. Depression symptom assessment and fMRI scanning took place just before treatment start and once again four weeks later. During fMRI scanning, picture stimuli of negative and positive valence were presented, indicated by a prior red or green screen, respectively. Behavioral valence ratings of the picture stimuli were conducted outside of the scanner. Amygdala activation during perception of negative picture stimuli was reduced after active, but not sham, iTBS (left amygdala: F(1,25)= 7.22, p=.013, right amygdala: F(1,25)=8.65, p=.007). Baseline amygdala reactivity was not correlated with depressive symptom levels. Behavioral valence ratings remained unchanged after active iTBS. The findings suggest a treatment effect of active iTBS in an emotional processing network in depression, spanning the DMPFC and amygdala. Keywords: dorsomedial prefrontal cortex, emotion, iTBS, transcranial magnetic stimulation