Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment primarily used for major depressive disorder. Many individuals considering TMS wonder about its broader impact, particularly concerning anxiety levels. Concerns about whether TMS might worsen anxiety are understandable given it involves brain stimulation.
What is TMS and How Does it Relate to Anxiety?
TMS uses magnetic fields to stimulate nerve cells in specific brain regions. This non-invasive technique modulates brain activity, particularly in areas associated with mood regulation. The dorsolateral prefrontal cortex (DLPFC), which plays a role in emotional control and stress responses, is a primary target for conditions like depression and anxiety.
TMS received initial FDA approval for major depressive disorder in 2008. Its application has expanded to include obsessive-compulsive disorder (OCD) and anxious depression, which refers to anxiety symptoms co-occurring with major depressive disorder. Research continues to explore TMS as a potential “off-label” treatment for various anxiety disorders, including generalized anxiety disorder (GAD).
Addressing the Core Concern: Can TMS Worsen Anxiety?
TMS does not commonly worsen anxiety. However, some individuals may experience a temporary increase, particularly during the initial stages of treatment. This transient period, sometimes called a “TMS dip,” typically lasts a few days to two weeks.
Several factors can contribute to this temporary increase in anxiety. The novelty of undergoing a new medical procedure can induce fear or uncertainty. Initial stimulation of brain regions may also lead to a period of neural adjustment, manifesting as heightened anxiety or emotional instability. Some individuals might become more hypervigilant to their emotional fluctuations, leading to increased worry about symptoms.
These occurrences are generally brief and do not indicate treatment failure. The brain adapts to the new stimulation, and these initial responses are often part of the therapeutic process. In rare cases, if a patient has an undiagnosed condition not approved for TMS, such as certain types of bipolar disorder, anxiety symptoms could be exacerbated.
Navigating Potential Side Effects During TMS
If increased anxiety or other discomfort arises during TMS treatment, open communication with your healthcare provider is important. Providers can adjust treatment parameters to help mitigate these feelings. Adjustments might include modifying the stimulation intensity, frequency, or the precise placement of the magnetic coil.
Beyond anxiety, other common side effects of TMS are typically mild and temporary. These can include headache, scalp discomfort or pain at the treatment site, tingling sensations, or facial muscle twitching. Headaches are a common initial side effect and tend to diminish over the course of treatment. Scalp irritation usually subsides after the first week or two.
Most of these side effects are manageable and decrease as treatment progresses. Over-the-counter pain relievers can often alleviate headaches. If discomfort persists, the provider may reduce the stimulation strength. Serious side effects like seizures are extremely rare, occurring in less than 1% of sessions.
The Broader Picture: TMS and Anxiety Improvement
Despite the potential for a temporary increase in anxiety for some individuals early in treatment, TMS has demonstrated promise in reducing anxiety symptoms for many. It is particularly effective for individuals experiencing anxious depression, where anxiety co-occurs with major depressive disorder. Studies show significant reductions in anxiety symptoms, with some reporting over 70% reduction in specific anxiety disorders like generalized anxiety disorder.
TMS works by improving emotional regulation, which can lead to a reduction in feelings of worry and apprehension. Many patients report feeling calmer, with improved sleep quality, increased energy levels, and an enhanced ability to cope with stressors. While research is ongoing for anxiety disorders alone, the therapeutic potential of TMS for anxiety, especially when linked with depression, provides a positive outlook for those seeking relief.