Anxiety in America has increased exponentially over the last several years. According to the American Psychiatric Association’s 2024 mental health poll, 43% of U.S. adults report feeling more anxious than the previous year. 

For the millions struggling with anxiety disorders, standard treatments don’t always provide relief. Transcranial magnetic stimulation (TMS), which is already approved for depression, is now emerging as a potential option for treatment-resistant anxiety. How does TMS therapy for anxiety work, and what does the current research show? Here’s everything you need to know.

Per the American Psychological Association, “anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” While everyone feels nervous from time to time, anxiety becomes problematic when normal worry becomes excessive and difficult to control.  

There’s a difference between fear and anxiety. Fear happens when we face an immediate threat, like jumping away from a speeding car. Anxiety, however, causes you to worry about things that might happen in the future or threats that aren’t there. Fear passes quickly once danger is gone, but anxiety tends to stick around. 

There are several types of anxiety disorders, including: 

• Generalized Anxiety Disorder (GAD)
• Panic Disorder
• Social Anxiety Disorder
• Separation Anxiety Disorder
• Selective Mutism
• Various Phobias

Anxiety affects both the mind and body. Most people with anxiety experience a combination of mental and physical symptoms that can vary from person to person. Some common symptoms include: 

• Constant worry, racing thoughts, and trouble focusing
• Feeling on edge or unable to relax
• Having an irrational feeling of impending doom
• Rapid heartbeat and breathing
• Sweating or trembling
• Muscle tension and headaches
• Stomach problems like nausea or digestive issues
• Trouble falling or staying asleep

There is no cure for anxiety or its symptoms, but it is treatable through psychotherapy and/or medication.  

Psychotherapy

Psychotherapy is one of the most effective options for treating anxiety disorders. According to a recent study, individuals with moderate to severe anxiety showed significant improvements in their symptoms with structured psychotherapy. 

Cognitive behavioral therapy (CBT) has been shown to be especially effective for anxiety treatment. CBT helps patients understand how their thoughts affect their feelings and behaviors. One piece of CBT is cognitive restructuring, which helps patients recognize and challenge unhelpful thinking patterns like: 

• Catastrophizing (always expecting the worst to happen)
• All-or-nothing thinking (seeing situations as completely good or bad)
• Overgeneralizing (applying one negative experience to everything)
• Jumping to conclusions (making assumptions without evidence)

For specific anxiety disorders, exposure therapy may be more beneficial. This type of therapy gradually exposes patients to feared situations in a controlled, supportive environment. While challenging at first, it actually teaches patients that they’re able to manage uncomfortable feelings and that feared outcomes rarely happen. 

Medications

If therapy alone is not enough for the treatment of anxiety, medication may be prescribed. Several classes of medications have proven effective, with selective serotonin reuptake inhibitors (SSRIs) typically considered first-line treatment due to their effectiveness and tolerability. 

SSRIs work by affecting the concentration and activity of serotonin, which is a brain chemical thought to be linked to anxiety disorders. Common SSRIs prescribed for anxiety include: 

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluvoxamine (Luvox, Luvox CR)
• Paroxetine (Paxil)
• Fluoxetine (Prozac)
• Sertraline (Zoloft)

While SSRIs are often the starting point for medication treatment, other options may be considered depending on symptoms, medical history, and response to initial treatments. These include: 

• Tricyclic antidepressants (TCAs)
• Atypical antipsychotics
• Benzodiazepines (used sparingly due to potential for addiction)
• Anticonvulsants
• Other anxiolytics (e.g., buspirone) 

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation procedure that uses magnetic fields to stimulate specific areas of the brain. For patients who haven’t responded well to standard anxiety treatments, TMS may be an alternative to consider. 

TMS involves a magnetic coil placed against the scalp. This coil generates magnetic pulses that pass painlessly through the skull to reach brain regions that are associated with mood and anxiety regulation. These pulses activate neural circuits that may be underactive in people experiencing anxiety disorders. 

The FDA first approved TMS for treating depression in 2008 after clinical evidence demonstrated its safety and effectiveness. Then, in August 2021, the BrainsWay Deep TMS system received FDA clearance for treating anxiety symptoms.

TMS treatment lasts over a series of sessions over several weeks. Each session lasts about 20 minutes, during which patients remain awake and alert. Most people can resume normal activities immediately afterward as it requires no anesthesia or recovery time.  

Yes, and the research backs it up. Multiple studies have shown improvements in anxiety symptoms following TMS treatment, making it a promising treatment for those who are treatment-resistant. Here’s what three recent studies have found: 

1. TMS improves emotion regulation in GAD and has potential benefits across other anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). 
2. GAD-7 scores were almost halved following TMS compared to baseline, with about 50% of patients classified as anxiety symptom responders and 30% achieving remission. 
3. Patients receiving 36 low-frequency right-sided TMS treatments experienced an average reduction of 14.0 points on their GAD-7 assessments. 

While research continues to evolve on the efficacy of TMS for anxiety, the existing evidence provides a strong foundation for TMS as a treatment option.

TMS works for anxiety by addressing the connectivity issues within the brain related to anxiety. A study showed that anxiety patients show three specific brain abnormalities: 

• Insufficient inhibition from the right dorsolateral prefrontal cortex (DLPFC) to the left frontal and temporal regions
• Abnormal activation patterns in the left temporal lobe
• Overreaction to outside stimuli 

By applying repetitive TMS (rTMS) to the right DLPFC, treatment can help restore normal information flow patterns in the brain. This has two important effects: it strengthens the processing of positive emotions from the left frontal lobe while also reducing excessive worry and threat responses.  

At Pulse TMS, we understand that living with anxiety can be exhausting and frustrating, especially if other treatments have not been effective. Our compassionate team of providers specialize in TMS therapy and offer comprehensive evaluations to determine if this treatment might be right for you. Contact us today to learn more.