TMS for Panic Disorder

Panic disorder affects about 6 million adults in the U.S. each year. While therapy and medication can help, not every finds relief from those options. This has led researchers and clinicians to explore innovative treatments, like transcranial magnetic stimulation (TMS). This therapy focuses directly on the brain circuits responsible for fear and anxiety. Here’s what you need to know about TMS for panic disorder.

A panic disorder involves panic attacks that are usually frequent, sudden, and without warning, often disrupting everyday life. It can overwhelm someone with intense fear and physical reactions, something many describe as feeling like a heart attack. They can become so disruptive that someone may go to great lengths to avoid an attack, even if it means social isolation. 

Symptoms of a Panic Disorder

Doctors diagnose panic disorder by following the criteria listed in the DSM-5. Individuals must experience panic attacks that are accompanied with more than a month of constant worry about future attacks and maladaptive behaviors to avoid them. The symptoms must not be related to another mental health condition, or by substance abuse. 

Common symptoms during an attack include: 

• Chest pain or pressure that can mimic heart trouble
• Shortness of breath or the feeling of choking 
• Dizziness, faintness, or sudden weakness
• A pounding or racing heartbeat
• Nausea or upset stomach
• Sweating, trembling, or body shakes
• Numbness, tingling, or sudden chills
• Feeling disconnected from yourself or your surroundings
• An intense fear of losing control or dying  

Doctors typically treat panic disorders with therapy, medication, or both. Cognitive behavioral therapy (CBT) is the most common psychotherapy in which a licensed therapist helps you work through recreated panic attack symptoms in a safe environment. With practice, those symptoms start to go away and no longer trigger the same fear response. 

One study found CBT improved panic symptoms, with participants reporting better functioning at work and in social settings. This demonstrates how effective CBT is in helping patients restore the parts of their lives affected by their condition. 

Medication is also frequently prescribed. Common ones include SSRIs or SNRIs for long-term management and benzodiazepines for short-term use (due to risk of dependence). 

Results don’t happen overnight, and even after attacks happen less often, you may still need regular check-ins to keep them from intensifying or coming back. Even still, about 20-40% of patients don’t fully respond to standard treatments.

TMS sends short bursts of magnetic pulses through a coil that’s placed on the head. These pulses stimulate neurons in certain areas of the brain and change how they fire and communicate. The effect depends on the frequency: 

• High-frequency stimulation activates underactive brain areas
• Low-frequency stimulation calms down overactive circuits

Researchers are especially interested in how the dorsolateral prefrontal cortex (DLPFC) interacts with brain structures like the amygdala. The amygdala plays a part in fear and anxiety responses, and when its communication with the prefrontal cortex is disrupted, the brain can get stuck in cycles of panic. TMS for panic disorders restores this broken communication, decreasing the intensity of anxiety and panic symptoms. 

There’s also a published case report that shows TMS may affect cortical functions during an emotional crisis, like a panic attack. In other words, treatment may calm down brain activity and lessen symptoms when a person is under distress. 

TMS has many benefits, starting with the procedure itself: 

• Non-invasive and non-surgical
• Done without anesthesia or pain medication
• Well tolerated by most people
• Only mild, temporary side effects like scalp discomfort or headaches
• Targets the brain directly instead of affecting the whole body like medication does

Aside from being a generally pleasant procedure, TMS has also shown positive effects on mental health symptoms: 

• Reduced feelings of worry
• Better sleep quality
• More stable energy levels
• Improved concentration and focus
• Brighter mood and better quality of life overall

Research Supporting TMS for Panic Disorder

Research is still limited, but early findings are promising: 

• In one study of anxiety-related disorders, 100% of participants completed a full course of 36 TMS treatments and experienced significant reductions in anxiety symptoms. Patients receiving low-frequency right-sided TMS dropped an average of 14 points on the GAD-7 scale, moving from severe anxiety to minimal levels. 
• A randomized, double-blind trial of 21 patients with panic disorder and depression found that 50% of patients improved with active TMS compared to only 8% in the sham group. 
• Another study using 1 Hz stimulation over the right prefrontal cortex showed that panic symptoms improved after four weeks of TMS. When patients continued treatment, panic disorder and depression improved even more, and benefits lasted for at least six months. 

Unfortunately, TMS is not approved by the FDA for the treatment of panic disorder. That said, many insurance companies will approve TMS only when it’s used for conditions they explicitly cover, such as treatment-resistant depression, which is approved by the FDA. 

Even if coverage is possible, your insurance company will likely have a few requirements: 

• Proof that you’ve tried and failed multiple medications and therapies
• Documentation of symptoms and diagnosis
• Authorization from a psychiatrist
• Periodic re-authorization to continue treatment 

If your insurer still denies coverage, you may be able to appeal the decision or request an exception. Your provider can help you with letters or supporting documentation you might need.

Feeling fearful and on edge all of the time doesn’t need to be your normal. At Pulse TMS, we use the latest in TMS to target the brain circuits involved in fear and anxiety, giving patients a non-invasive option when therapy or medication haven’t been enough.

If panic attacks are controlling your life, there’s hope. Contact us today to learn how TMS can help you get your peace of mind back.