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May 15, 2023

Transcranial magnetic stimulation (TMS) has been increasingly used as an alternative treatment option for individuals with anxiety. However, concerns have arisen regarding the potential risks and whether TMS can make anxiety worse.

Does TMS Work for Anxiety?

Transcranial magnetic stimulation (TMS) is an alternative treatment for people with depression and other mental health disorders. It works by enhancing activity in areas of the brain with a magnetic coil that sends alternating pulses to neurons to stimulate the brain. TMS is noninvasive and largely painless, with the most common side effect after treatment being a minor headache. 

When used to treat anxiety, TMS has largely effective results. According to a 2022 meta-analysis, out of seven papers analyzing the effect of TMS treatment on patients with anxiety disorders, five published results demonstrated patients had a sustained decrease in anxiety symptoms.

Further, 21 of 25 studies examining the effect of TMS on patients with anxiety symptoms found a long-term improvement in anxiety symptoms for patients after treatment.

Though these results have positive implications for the use of TMS in anxiety treatment, patients with anxiety may still have questions and concerns about TMS treatment, including whether TMS can make anxiety worse.

girl sitting in the labyrinth

Can TMS Make Anxiety Worse? 

Many studies have provided evidence to support the use of TMS therapy for anxiety, however, others suggest TMS therapy may actually worsen anxiety symptoms. In 1997, an initial investigation into the use of repetitive TMS in three patients with primary anxiety noted that panic and anxiety in patients increased after fast repetitive treatment over the left or right prefrontal cortex.

Additionally, a 2019 article found that TMS might also increase anxiety in healthy subjects. Again, this finding was thought to be linked to increased activity in the prefrontal cortex, though, this finding was specific to healthy individuals.

While there have been some studies that suggest TMS therapy may have a negative effect on participants, there is much greater evidence demonstrating the benefits of TMS therapy in treating patients with anxiety.

In addition to the  2022 meta-analysis described above, which found TMS therapy produced a lasting alleviation of anxiety symptoms in patients with both anxiety disorders and generalized anxiety symptoms, a separate systemic review from 2019 also described the benefits of TMS treatment for patients with anxiety and PTSD. 

This 2019 study found robust evidence from four separate studies supporting the benefit of TMS on patients with generalized anxiety disorder.

Each of these studies showed that TMS therapy had a strong negative effect on the presentation of anxiety symptoms after the intervention, and, as a group, these studies show that repetitive TMS treatment is promising to alleviate symptoms of generalized anxiety disorder.

Potential Risks of TMS for Anxiety

Though TMS therapy is considered effective in treating anxiety, there are some possible side effects potential patients should be aware of before beginning a TMS session.

While repetitive TMS is a non-invasive form of brain stimulation and the therapy is performed while the patient is awake, participants may still experience some mild to moderate side effects, including:

  • Scalp discomfort and pain.
  • Headache.
  • Tingling, spasms, or twitching of facial muscles. 
  • Lightheadedness. 

These side effects will generally improve shortly after the TMS session and are likely to decrease over time as the patient gets used to the TMS sessions. 

There are other rare side effects that a patient may experience, including: 

  • Seizures
  • Emotional highs, or mania, in people with bipolar disorder
  • Hearing loss if ears are not well-protected during treatment. 

There is no current evidence to suggest that TMS has long-term side effects, though future studies assessing this possibility are needed to be certain.

young depressed man

If you are considering TMS treatment for anxiety, talk with your medical provider to determine whether TMS therapy is right for you. You may be asked to complete a physical exam with lab tests and a mental health evaluation to make sure that TMS therapy is a safe option for you. You should also inform your healthcare provider if: 

  • You are pregnant or plan to become pregnant.
  • You have a metal or implanted medical device in your body, including aneurysm clips or coils, stents, implanted stimulators, implanted vagus nerve or deep brain stimulators, a pacemaker, electrodes monitoring brain activity, cochlear implants, magnetic impacts, bullet fragments, or other metal devices. 
  • You are taking medicines including prescriptions, over-the-counter medications, supplements, or vitamins. 
  • You have a history of seizures or a family history of epilepsy.
  • You have other mental health conditions or substance abuse disorders.
  • You have brain damage from an illness or injury. 
  • You have frequent or severe headaches. 
  • You have any other medical conditions. 
  • You have had treatment with TMS in the past. 

Factors that Influence TMS Outcomes 

Patients should also consider factors that may influence the success of their TMS treatment. Factors that may reduce the potential efficacy of TMS treatment for anxiety include: 

  • Elderly age
  • Psychotic Depression
  • Long duration of the disorder 
  • High degree of treatment resistance 
  • Drug naïve patients
  • Short treatment sessionsgirl with anxiety disorder during therapy

Is TMS Effective for Anxiety? 

While the evidence analyzing TMS treatment for anxiety is relatively limited compared to other treatment methods, doctors and scientists have seen abundant support for using TMS to treat anxiety.

Multiple meta-analyses have shown significant benefits for individuals who have been diagnosed with anxiety disorders and individuals with general anxiety symptoms. TMS is a safe treatment for Anxiety because it is non-invasive, painless, and is associated with mostly minor side effects.

Though TMS is a safe and effective treatment for anxiety, potential patients should ask their doctor whether TMS therapy may be right for them. By undergoing physical and mental examinations, you and a trusted medical professional will be able to determine whether TMS therapy will be the best option for you.

While TMS therapy is safe and effective, certain additional factors, including age, pregnancy, and intensity of your anxiety disorder may prevent you from receiving treatment or experiencing noticeable benefits. Continue to do your research and reach out to your doctor to determine if TMS therapy might help treat your anxiety.