While the U.S. FDA hasn’t yet approved TMS specifically for the treatment of anxiety, psychiatrists have been prescribing it off-label owing to its beneficial effects. It has long been established that depression and anxiety are typically seen together in many people. In fact, around 50% of patients diagnosed with depression have some form of anxiety disorder as well, often referred to as anxious depression.

TMS therapy is FDA-approved for the treatment of depression. And given that anxiety and depression go hand in hand, anxiety symptoms may improve and “lift” along with the depressive symptoms after a successful course of TMS.

In depression, TMS functions by stimulating the underactive areas of the brain. However, anxiety is believed to be a process of a misfiring of electrical signals with a constant chatter between different brain regions. Hence, anxious minds have both overactive and hypoactive areas.

Especially noted, are abnormally low levels of activity in the left area of your brain known as the prefrontal cortex. The prefrontal cortex is not only your brain’s “executive control” center but also plays a role in regulating your emotions. More importantly, a segment of the prefrontal cortex dubbed as the dorsolateral prefrontal cortex (DLPFC) helps your cognitive reasoning processes overpower your emotional processes.

Hence, an underactive prefrontal cortex will lack the potential to regulate your emotions through cognitive appraisal, putting you at risk of anxiety and depression.

The DLPFC is connected to another almond-shaped brain region referred to as the amygdala (the hub of fear and emotions in your brains).

In people with anxiety, the amygdala classically shows overactivity in response to anxiety cues. That said, it is the hyperactivity of the “right” amygdala that is shown to drive undue and disruptive worrying defining an anxiety disorder.

Because the right side of your brain fuels anxiety, blunting the activity levels in the right hemisphere may help ease anxiety. Thus, applying slow, inhibitory, low-frequency magnetic pulses via TMS to the right side of the brain, could inhibit and calm down the hyperactive circuits of the brain on that side.

At the same time, TMS can also help buffer the activity levels of the DLFPC. Altogether, TMS may help quieten an anxiety-ridden brain.

Nonetheless, there is currently no single “standard” intervention protocol for the use of TMS in people with anxiety, which is why individualized treatment planning is essential.

A 2019 scientific survey compiled about 32 studies to evaluate the effects of rTMS on anxiety. Though this survey suggested the need for more studies to determine the effects of TMS on anxiety, it did reveal the beneficial impact of TMS on anxiety symptoms.

According to this survey, one of the clinical trials conducted on participants with a generalized anxiety disorder (GAD) showed a clinically substantial reduction in anxiety symptoms after receiving 25 rTMS sessions.

Another 2016 study conducted by Dr. Diefenbach and fellows showed improved outcomes in patients with GAD after a 3-month rTMS treatment. Six of nine patients in the active group achieved remission during the 3-month follow-up period.

Patients with anxious depression particularly appear to benefit from rTMS sessions. A 2019 study evaluated and compared the outcomes of 172 patients with comorbid anxiety disorders with patients who did not have comorbid anxiety. At the end of the TMS session, 39.5% of patients showed 50% improvement in their symptoms of depression. In addition, 23.3% of patients with depression and comorbid anxiety achieved remission.

Another condition that often follows anxiety symptoms is Restless Legs Syndrome (RLS). In fact, stress and anxiety are major triggers of RLS. A study done on patients with RLS who received TMS therapy revealed significant improvements in the symptoms of restless legs, anxiety symptoms, and sleep quality.