TMS for Anxiety
TMS for generalized anxiety disorder (GAD) is not yet FDA-approved. It is used off-label, based on a growing body of clinical research that supports its effectiveness for some patients.
We are transparent about what is known and what is still emerging. The evidence base for TMS in anxiety is smaller than for depression or OCD, but multiple studies and clinical experience support its use, and newer accelerated protocols are showing promising early results. We discuss the current state of the evidence during your consultation so you can make an informed decision.
How TMS Works for Anxiety
Generalized anxiety is associated with dysregulation in brain circuits involved in threat appraisal and emotional regulation, including the prefrontal cortex. TMS targets these areas to modulate circuit activity and reduce the intensity of chronic worry and anxiety symptoms.
Accelerated Protocols
Use theta burst stimulation or compressed treatment schedules to deliver a full course of treatment in a shorter timeframe than traditional multi-week approaches.
Single-Day Protocol
Delivers the full treatment course in one day. Early research on single-day TMS for anxiety shows promising response and remission rates, though the evidence base is still developing.
Because TMS for anxiety is off-label, standard multi-week insurance-covered protocols are generally not available for this indication. The protocol decision is made during your consultation with Dr. Nazarani based on your symptoms, treatment history, and clinical picture.
Who Is a Candidate?
You have tried medication or therapy without adequate results.
If treatment for anxiety has not provided sufficient improvement, TMS offers a different mechanism of action that may be effective where other approaches have not been.
You prefer a non-medication approach.
Some patients want to pursue TMS as an alternative to medication, and that is a valid clinical choice.
You understand this is an off-label use.
TMS for anxiety is not yet FDA-approved. It is based on emerging research and clinical experience, and we discuss the current evidence with you during your consultation. All TMS for anxiety is self-pay.
TMS is not appropriate for patients with metal implants in or near the head, a history of seizures, or certain neurological conditions. Candidacy is evaluated during your consultation.
What the Research Shows
The evidence base for TMS in generalized anxiety is smaller than for depression or OCD, but it is growing. We present this data honestly because informed patients make better decisions.
Standard Multi-Session Protocols
In small trials, response rates for TMS in GAD have typically ranged from approximately 40–60%. A meta-analysis of six studies found that TMS produced a large reduction in anxiety severity compared to sham treatment.
Single-Day Accelerated Protocol
An open-label study of a single-day TMS protocol for GAD (N=21) reported response rates of approximately 66–72% and remission rates of approximately 50–56% at 12 weeks. These are early findings from a small study, and larger trials are needed.
What is still emerging
One-year durability data for TMS in anxiety are not yet established. Available reports indicate that improvements can persist for at least several months after treatment, but long-term maintenance patterns are still being studied.
Not everyone responds to TMS. The evidence base for anxiety is less extensive than for depression, and individual results vary. Dr. Nazarani will discuss realistic expectations and the current state of the research during your consultation.
What else you should know
This page covers TMS for anxiety specifically. For details on how TMS treatment works, what sessions feel like, and cost and insurance information, see our TMS Overview.
Frequently Asked Questions
TMS for anxiety is not FDA-approved, but it is not experimental in the sense of a clinical trial. TMS is an established, FDA-approved technology that is applied off-label to anxiety based on growing clinical research. Off-label use of FDA-approved treatments is common in medicine when supported by evidence and clinical judgment.
Insurance typically covers TMS for FDA-approved indications (depression and OCD). Because TMS for anxiety is off-label, it is currently self-pay. We offer financing through CareCredit and can work with patients on pricing on a case-by-case basis.
Many patients with anxiety also experience depression. TMS protocols can address both conditions, and the treatment approach is tailored to your specific clinical picture during the consultation.
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Read articleFind Out If TMS for Anxiety Is Right for You
The first step is a consultation with Dr. Nazarani to evaluate whether TMS is appropriate for your anxiety and to discuss the current evidence, available protocols, and realistic expectations. You are not committing to treatment. You are finding out if it makes sense for you.