TMS is a cutting-edge, evidence-based treatment for anxiety disorders.
Anxiety disorders are the most commonly diagnosed mental illness in the United States, affecting nearly one in five adults each year.1 While most people experience a healthy amount of anxiety in response to daily stressors, such as preparing for a job interview or making a major life decision, people with anxiety disorders face persistent feelings of fear and worry for months or even years. These feelings often limit a person’s ability to maintain relationships, succeed at work or school, and engage in social activities. Although anxiety disorders are often debilitating, only about one in three people with an anxiety disorder will receive treatment, and those who are treated typically receive a combination of antidepressant medications (such as selective serotonin reuptake inhibitors; SSRIs) and psychotherapy.2
Although antidepressant medications are generally effective at treating anxiety, they may need weeks to months to take full effect, and they are associated with unpleasant side effects such as headache, nausea, insomnia, sexual dysfunction, and dry mouth. An estimated 26 to 45% of people with anxiety disorders who discontinue their antidepressant medications, often due to intolerable side effects, will experience a relapse in anxiety symptoms.3 Consequently, there is a need to identify innovative, evidence-based treatments to relieve anxiety quickly and with few side effects.
Fortunately, a cutting-edge technology known as transcranial magnetic stimulation (TMS) offers a solution for the millions of Americans who suffer with anxiety disorders. First approved by the FDA in 2008 as a treatment for major depressive disorder,4 neuroscientists have expanded the use of this technology to address a wide array of other mental health conditions, including anxiety. Although TMS for anxiety disorders has not yet received FDA approval, mental health care providers are encouraged by the recent 2018 approval of TMS for obsessive-compulsive disorder (OCD),5 which is not an anxiety disorder but is characterized in part by anxious feelings. The FDA also permitted TMS as a treatment for smoking cessation in 2020,6 and experts suspect that anxiety disorders may be among the next in line for formal approval.
TMS works by regulating patterns of activation in neurons that release important chemicals (called neurotransmitters) that are critical for emotional and psychological health. In the brain of someone with an anxiety disorder or other mental health condition, brain cells may miscommunicate or malfunction, releasing too much or too little of certain neurotransmitters. The subsequent imbalance is thought to cause the symptoms associated with a number of debilitating mental health conditions such as anxiety, depression, and OCD. TMS permanently modifies the malfunctioning brain pathways that regulate neurotransmitters, restoring the brain’s ability to maintain an optimal chemical balance.
To do so, the cutting-edge technology uses a small wire coil that painlessly delivers a magnetic field into the brain, where it generates new patterns of electrical activity that stimulate healthy communication between brain cells. During a treatment session, a clinician positions the wire coil above the patient’s prefrontal cortex, the area of the brain where most anxiety-related dysfunction occurs. The process is painless, and the patient remains fully awake and aware for the entire treatment.
Because TMS for anxiety has yet to receive FDA approval, treatment protocols are not standardized and typically vary by clinic or by research study. Most health care providers opt to follow the TMS protocol for depression, which delivers five sessions per week for four to six weeks, but others have successfully administered the treatment at lower volume (two to five sessions per week for two to three weeks).7 A typical session takes less than an hour from start to finish.
Clinical studies have demonstrated that TMS effectively treats anxiety symptoms in patients across the spectrum of anxiety disorders, including generalized anxiety disorder, panic disorder, and social anxiety. One study found that patients who received two sessions of TMS for three weeks showed significantly reduced anxiety symptoms on the Hamilton Rating Scale for Anxiety (HAM-A) and that these improvements were maintained six months after treatment ended.8 Another study found that five TMS sessions per week for six weeks effectively reduced both anxiety and depression symptoms, particularly worry and emotion regulation, for at least three months after treatment.9
Critically, evidence suggests that TMS is an effective treatment for the estimated 46 to 98%10 of people whose anxiety disorder is comorbid with other mental health conditions. For example, one study found that TMS effectively treated anxiety symptoms in patients whose generalized anxiety disorder co-occurred with depression11 or post-traumatic stress disorder (PTSD).12 Given that anxiety disorders are the most common co-occurring condition in individuals with other psychiatric disorders, these findings are promising for patients who seek relief from one or more mental health conditions in addition to anxiety.
Unlike traditional antidepressant medications, TMS is effective within a few weeks of treatment and remains effective after the treatment course ends. Additionally, TMS does not cause the undesirable side effects associated with SSRIs—most people who undergo TMS experience no side effects, and those who do typically report only mild headache or dizziness that resolves soon after treatment.13
TMS is an increasingly popular alternative to treatment with traditional drugs and talk therapy. Although this cutting-edge technology is not yet formally approved specifically as a treatment for anxiety disorders, the robust, fast-growing evidence base for this therapy—not just for anxiety but across the broad spectrum of mental health conditions—likely will motivate consideration from the FDA in the coming years. In the meantime, TMS Program is pleased to offer TMS for people seeking relief from the burden of constant fear, worry, and anxiety.
1 Statistics: Any Anxiety Disorder. National Institute of Mental Health. Retrieved from: https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml
2 Facts & Statistics. Anxiety and Depression Association of America. Retrieved from: https://adaa.org/about-adaa/press-room/facts-statistics
3 Donovan MR, Glue P, Kolluri S, et al. (2010). Comparative efficacy of antidepressants in preventing relapse in anxiety disorders: A meta-analysis. Journal of Affective Disorders, 123(1-3): 9–16.
4 Horvath JC, Mathews J, Demitrack MA, & Pascual-Leone A. (2010). The NeuroStar TMS Device: Conducting the FDA-approved protocol for treatment of depression. Journal of Visualized Experiments, 45.
5 Food and Drug Administration. (2018). FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder
6 BrainsWay. Mental health conditions is deep TMS cleared to treat? (2020). Retrieved from: https://www.brainsway.com/professionals-faqs/what-mental-health-conditions-is-deep-tms-fda-cleared-to-treat
7 Sagliano L, Atripaldi D, De Vita D, et al. (2019). Non-invasive brain stimulation in generalized anxiety disorder: A systematic review. Progress in Neuro-Psychopharmacology and Biological Psychiatry.
8 Bystritsky A, Kaplan JT, Feusner JD, et al. (2008). A preliminary study of fMRI-guided rTMS in the treatment of generalized anxiety disorder. Journal of Clinical Psychiatry, 69(7):1092-8.
9 Diefenbach G, Bragdon L, Zertuche L, et al. (2016). Repetitive transcranial magnetic stimulation for generalised anxiety disorder: A pilot randomised, double-blind, sham-controlled trial. British Journal of Psychiatry, 209(3): 222-228.
10 Noyes R. (2001). Comorbidity in generalized anxiety disorder. Psychiatric Clinics of North America, 24(1):41–55.
11 White D & Tavakoli S. (2015). Repetitive transcranial magnetic stimulation for treatment of major depressive disorder with comorbid generalized anxiety disorder. Annals of Clinical Psychiatry, 27(3):192-6.
12 Transcranial Magnetic Stimulation for the Treatment of Adults with PTSD, GAD, or Depression: A Review of Clinical Effectiveness and Guidelines. (2014). Ottawa (ON): Canadian Agency for Drugs and Technologies in Health.
13 Cui H, Jiang L, Wei Y, et al. (2019). Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis. General Psychiatry, 32(5):e100051.