by Lindsay Israel, MD
Transcranial magnetic stimulation, or TMS, is an FDA-approved, noninvasive treatment for major depression using magnetic pulses targeted at a specific location on the brain.
TMS is a completely outpatient procedure and is gaining momentum in the behavioral health community as an effective alternative treatment for medication-resistant depression.
However, even more statistically significant than depression, anxiety leads as the most commonly diagnosed mental illness in the United States, affecting more than 18% of the adult population every year, according to the Anxiety and Depression Association of America.
It has long been established that depression and anxiety are typically seen together in presentation. In fact, approximately half of the patients diagnosed with depression have some type of anxiety disorder as well.
Why TMS for anxiety should work
If TMS is an effective treatment for depression, and depression and anxiety are so interconnected and likely the result of a dysregulation of the same neurocircuit in the brain, then would TMS be an effective treatment for anxiety? The simple answer is yes. There is evidence.
Symptoms of mood and anxiety disorders are thought to result in part from disruption in the balance of activity in the emotional centers of the brain. The accepted TMS treatment protocol for depression utilizes rapid, stimulatory, high-frequency pulses on the left side of the head, targeted at the prefrontal area of the brain.
If depression and anxiety go hand in hand, then anxiety symptoms should follow suit and improve along with depression symptoms.
With TMS, often they do, and patients feel relief from the stimulatory pulses because the areas of the brain that are underactive in depression and anxiety are brought back to normal reactivity levels, as seen on functional imaging.
However, anxiety can have a life of its own.
Anxiety is thought to be the result of a misfiring of the electrochemical signaling, due to both hyperactive areas and hypoactive areas of the brain, triggering a feeling of excessive worry or fear, leading to physical symptoms including racing heart, shortness of breath, GI upset and muscle tension.
The theory for treating anxiety specifically with TMS was based on the understanding that the right side of the brain is known to send inhibitory signals to the left. Therefore, if the right side of the brain is subjected to repeated slow, inhibitory, low-frequency pulses, would that slow down the areas of the brain that are also overactive, having a calming effect on an anxiety-riddled brain?
Studies on treating anxiety with TMS
After hundreds of small studies conducted all over the world with very positive results, there is now more confidence that TMS can be an effective treatment for various anxiety disorders, including generalized anxiety disorder, panic disorder, and obsessive compulsive disorder.
There is still more to be known, and more consistency between the studies is needed to come to a consensus for an accepted protocol for anxiety, better defining treatment target location, number of pulses and number of treatments needed to achieve remission from anxiety symptoms.
The uplifting message for those who are struggling with debilitating anxiety is that there is a cutting-edge technology available to them.
TMS can offer an approach to treating their symptoms where traditional methods, including psychotropic medications, have failed them.
TMS can bring them hope that they are not out of treatment options, and that they can get relief and resume their lives anxiety-free.
Facts and statistics. Anxiety and Depression Association of America. Available at: https://adaa.org/about-adaa/press-room/facts-statistics.
Lindsay Israel, MD, is a board-certified psychiatrist. She specializes in TMS at Success TMS in Palm Beach Gardens, Florida.