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Does TMS Work for Anxiety? (What the Research Says)

Image of Dr. Mark Allen, Ph.D.
Updated on 10 February, 2025
Medically Reviewed by

Dr. Diane Spangler, Ph.D.

Does TMS Work for Anxiety? (What the Research Says)

Clinics across the U.S. now offer TMS therapy specifically for anxiety. While early research suggests TMS may be an effective treatment, only a handful of studies have focused exclusively on anxiety.

In contrast, for patients with anxiety coupled with depression — a condition known as anxious depression — significantly more research supports TMS as an effective treatment for reducing symptoms.

This article explores the effectiveness of TMS for anxiety and anxious depression based on current research.

We cover:

Understanding Anxiety vs. Anxious Depression


What are the key differences?


According to the American Psychiatric Association, anxiety arises when patients worry about potential future problems, leading to muscle tension and avoidance behavior. Patients with anxiety often feel like they’re always on guard, as they remain tense and alert to the possibility of upcoming challenges or threats, even when no such threat exists.

Symptoms vary from patient to patient but commonly include restlessness, irritability, nervousness, increased heart rate, rapid breathing, sweating, insomnia, trembling, fatigue, a sense of doom, rumination, and difficulty concentrating.

From a diagnostic perspective, anxiety disorders include various subtypes, such as generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, panic disorder, and agoraphobia. Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) were once part of this classification but have since been reclassified.

As a group, anxiety disorders are the most common type of mental health disorder, affecting one in 13 individuals. Around 40 million U.S. adults reportedly experience an anxiety disorder.

Anxiety can occur independently or alongside depression. Patients with major depressive disorder (MDD) who develop significant anxiety symptoms are diagnosed with the subtype anxious depression. Depression comorbid with an anxiety disorder refers to the simultaneous presence of both conditions.

How are anxiety and anxious depression typically treated?


In general terms, the standard anxiety treatment options typically involve prescription medications and psychotherapy.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line pharmacological treatments, but about half of patients don’t experience significant improvements with these medications. This approach is also frequently associated with side effects, including weight gain, sexual dysfunction, and gastrointestinal disturbances, which can contribute to treatment non-adherence.

The challenge is greater for patients with both anxiety and depression. Studies have reported poorer outcomes in patients with anxious depression compared to nonanxious depression. For example, in the largest antidepressant medication study (the STAR*D trial), more than half of patients treated with antidepressant medication had anxious depression. Remission in this group was less likely and took longer than in patients with depression without anxiety symptoms. In addition, patients with anxious depression were also more likely to experience serious side effects.

Among talk therapy approaches, cognitive behavioral therapy (CBT) is the most supported by evidence for anxiety disorders. Unlike medication, CBT addresses more than just symptoms. It helps patients uncover the underlying causes of their worries, modify cognitive processes, and develop better ways to face challenges. Since anxiety disorders vary, therapy must be tailored to specific symptoms.

For example, CBT for panic disorder differs in focus from CBT for generalized anxiety disorder. The length of therapy depends on the type and severity of the symptoms, with many patients seeing significant improvement after 8–16 weeks of weekly sessions.

TMS for Anxiety: Limited Research but Promising Potential


Transcranial magnetic stimulation (TMS) has emerged as a potential treatment for anxiety, though research in this area remains limited. TMS is a non-invasive, outpatient procedure that delivers repeated magnetic pulses to stimulate nerve cells in a part of the brain called the dorsolateral prefrontal cortex (DLPFC), which is consistently affected by depression and other mental health conditions.

In patients with depression, hypoactivity in the DLPFC is believed to impair the ability to experience positive emotions, including reward and motivation. Similarly, for anxiety, imaging studies suggest that disrupted communication between the DLPFC and the amygdala — an area of the brain involved in fear and anxiety responses — may play a key role. By stimulating and enhancing the connection between these regions, TMS might alleviate anxiety symptoms.

Preliminary studies have shown encouraging results. One study, for example, reported a reduction of over 70% in anxiety symptoms among patients with occupational stress and generalized anxiety disorder. Nearly 80% of participants responded to treatment, with 33% achieving remission. Importantly, these improvements persisted for at least three months after treatment. However, the small sample size of these studies makes it difficult to draw definitive conclusions about the treatment's overall effectiveness.

Despite promising findings, researchers are still refining the optimal parameters and target locations for TMS in treating anxiety. At present, the FDA has not approved TMS specifically for anxiety due to insufficient evidence. While ongoing research may eventually establish its role in treating anxiety, more robust studies are needed to confirm its efficacy.

TMS for Anxious Depression: Research Confirms High Efficacy and Garners FDA Approval


In contrast to TMS for anxiety, TMS for depression has been extensively studied. Meta-analyses have provided strong evidence of its effectiveness, and repetitive transcranial magnetic stimulation (the original method of TMS) has been FDA-approved for treating major depressive disorder (MDD) since 2008.

While there is less research on TMS specifically for anxious depression — where patients experience both depression and anxiety symptoms simultaneously — strong evidence still supports its effectiveness.

For example, one study found that after at least 20 TMS sessions, about 50% of patients experienced reductions in anxiety symptoms, and 30% achieved remission. Patients reported improvements in anxiety symptoms shortly after starting treatment, with benefits sustained for months.

In light of sufficient evidence, the FDA has approved TMS for treating patients with anxious depression. The first device to receive approval was a deep TMS system in 2021. Since then, several devices and protocols have been approved, including one in November 2024 that combines rTMS or intermittent theta burst stimulation (iTBS) with neuronavigation to precisely target the DLPFC.

Considerations for Patients Seeking TMS for Anxious Depression


If you have a diagnosis of anxious depression and are thinking about TMS, here are a few points to consider:

The Type of TMS You Receive Can Significantly Impact Success Rates


It’s important to understand that different TMS methods yield different success rates.

For example, about 50% of patients with depression respond well to the original and most widely available method — repetitive TMS or rTMS — with 30% achieving remission.

In contrast, newer approaches, such as the protocol offered at Cognitive FX (SAINT TMS), produce significantly higher success rates.

In a double-blind randomized controlled clinical trial, about 85.7% of patients responded to the treatment (meeting prespecified criteria for reduced depressive symptoms), and around 78.6% achieved remission. All participants had treatment-resistant depression and had failed at least two prior depression treatments. At the one-month mark, 60% remained in remission.

There are other methods as well, such as deep transcranial magnetic stimulation (dTMS) and standard intermittent theta-burst stimulation (iTBS), each with its own success rates.

To help you choose the right clinic, and the most suitable form of TMS, consider exploring these resources:


Response and Remission Rates for Anxious Depression Are Slightly Lower Than TMS for Depression Alone


The success rates mentioned above apply specifically to the treatment of depression. Treating anxious depression is more challenging, so success rates tend to be slightly lower.

For instance, one TMS study reported higher response rates among patients with depression alone (54%) compared to those with comorbid panic disorder or anxiety disorder (35% and 47%, respectively).

That said, for anxious depression, TMS remains more effective than standard antidepressant medications and has significantly fewer unpleasant side effects.

TMS May Temporarily Increase Anxiety Symptoms


There is a small risk that TMS may increase symptoms of anxiety. For example, patients may experience heightened anxiety if their TMS treatment is not producing the desired results. Increases in anxiety are more likely to occur when patients undergo TMS treatment following the original protocol (rTMS) as opposed to more advanced methods using neuronavigation, such as SAINT TMS.

Though no studies have confirmed this, we believe the SAINT protocol has a lower risk of triggering anxiety symptoms and delivers better results for patients with anxiety symptoms compared to earlier TMS methods.

By Reducing Depressive Symptoms, Patients Can Have More Energy to Address Their Anxiety


For patients with anxious depression, the use of TMS to decrease depressive symptoms — even if anxiety symptoms remain or worsen — can free them up and provide more energy to address their anxiety.

Here are some ways in which TMS can help patients with anxious depression:

  • Reduce feelings of worry and apprehension
  • Improve sleep quality
  • Increase energy levels
  • Enhance concentration and focus
  • Improve overall mood and quality of life

Receiving SAINT TMS for Anxious Depression at Cognitive FX


A comparison of remission rates for rTMS/iTBS, electroconvulsive therapy (ECT), and SAINT-iTBS.

A comparison of remission rates for rTMS/iTBS, electroconvulsive therapy (ECT), and SAINT-iTBS.


At Cognitive FX, we offer the most targeted, safe, and effective form of TMS — fMRI-guided intermittent theta-burst stimulation (SAINT TMS). As mentioned earlier, 85.7% of patients responded positively to this treatment in a double-blind randomized controlled trial, with 60% still in remission one month later. This FDA-approved treatment, known for its minimal side effects, is available at fewer than ten clinics in the U.S.

In contrast to rTMS, which can take four to six weeks to complete, SAINT TMS is completed in just one week. Patients undergo ten treatment sessions over five days, with each session consisting of 10 minutes of magnetic pulses followed by a 50-minute break between sessions.

To improve outcomes for our patients, we incorporate cognitive behavioral therapy (CBT) into our treatment. Combined with traditional TMS (rTMS), CBT improves response and remission rates by approximately 8% and 19%, respectively, in the short term. We anticipate that adding CBT to SAINT TMS will further improve both initial and long-term outcomes.

Our TMS treatment is ideal for most patients with treatment-resistant anxious depression. However, we do not treat individuals under 16 or over 65 years of age. Additionally, as a safety measure, we do not treat patients who have a history of seizures or those who are actively suicidal and in need of crisis care.

Click here to learn more about TMS therapy for anxious depression at Cognitive FX.

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