If you’re considering transcranial magnetic stimulation (TMS) for depression, you might be wondering whether this treatment could worsen your anxiety. While TMS is primarily designed to treat depression and generally reduces anxiety as depressive symptoms improve, a small percentage of patients – approximately 5-10% – may experience temporary increases in anxious feelings during the initial treatment sessions. This side effect is typically short-lived and can often be managed by adjusting treatment parameters or providing additional support during therapy sessions.
Can TMS Make Anxiety Worse? Risks and Benefits of TMS
If you’re considering transcranial magnetic stimulation (TMS) for depression, you might be wondering whether this treatment could worsen your anxiety. While TMS is primarily designed to treat depression and generally reduces anxiety as depressive symptoms improve, a small percentage of patients – approximately 5-10% – may experience temporary increases in anxious feelings during the initial treatment sessions. This side effect is typically short-lived and can often be managed by adjusting treatment parameters or providing additional support during therapy sessions.
rTMS is a non-invasive brain stimulation technique that uses magnetic pulses to stimulate specific brain regions associated with mood regulation. The procedure involves placing an electromagnetic coil against your scalp, which delivers focused magnetic pulses to the prefrontal cortex—the brain region that’s often underactive in people with depression.
Unlike electroconvulsive therapy (ECT), TMS doesn’t require anesthesia and allows patients to return to normal activities immediately after each session. A typical course of treatment involves daily sessions lasting 20-40 minutes, five days a week, for four to six weeks.
The relationship between TMS and anxiety is nuanced and varies from person to person. For most patients, anxiety symptoms actually improve alongside depression as treatment progresses. This happens because depression and anxiety often share similar neurological pathways, and stimulating the brain regions involved in mood regulation can benefit both conditions.
Research shows that many patients experience a reduction in anxious thoughts, physical tension, and worry as their depression lifts. The prefrontal cortex plays a crucial role in emotional regulation, and strengthening its activity through magnetic stimulation can enhance your ability to manage stress and anxiety-provoking situations.
However, some individuals may notice heightened nervousness or restlessness, particularly during the first week or two of treatment. This temporary response doesn’t mean TMS isn’t working – rather, it may indicate that your brain is adjusting to the stimulation.
Mental health professionals sometimes refer to a phenomenon called the “TMS dip,” which can occur during the second or third week of treatment. During this period, some patients experience:
The TMS dip is a normal part of the treatment process for some individuals and doesn’t indicate treatment failure. Think of it as similar to the adjustment period many people experience when starting antidepressant medications. Your brain is undergoing neuroplastic changes, and these temporary fluctuations are part of that recalibration process.
Most patients who experience a TMS dip find that their symptoms improve significantly once they move past this phase. Staying in close communication with your treatment team during this time is essential so they can provide reassurance and make any necessary adjustments to your protocol.
While mild, temporary increases in anxiety are relatively common and manageable, you should inform your TMS provider if you experience persistent or severe increased anxiety. Warning signs that require attention include:
Panic attacks that weren’t present before treatment
Anxiety that worsens progressively rather than stabilizing
Physical symptoms like a racing heart, chest tightness, or difficulty breathing
Intrusive thoughts or compulsive behaviors
Anxiety that interferes with daily functioning
Your provider can address these concerns by adjusting treatment intensity, changing stimulation frequency, or targeting different brain regions. In some cases, adding short-term anti-anxiety medication or therapy support can help you remain comfortable while continuing TMS treatment.
Individuals with bipolar disorder require particularly careful monitoring during TMS treatment. While TMS can effectively treat depressive episodes in bipolar disorder, there’s a small risk of triggering manic or hypomanic episodes, which can include increased anxiety, agitation, and racing thoughts.
If you have bipolar disorder, your psychiatrist will likely recommend mood-stabilizing medications alongside TMS to minimize this risk. They’ll also watch closely for early signs of mood elevation, such as decreased need for sleep, rapid speech, or impulsive behavior. The good news is that with proper precautions and monitoring, many people with bipolar disorder successfully benefit from TMS without experiencing mood destabilization.
When evaluating whether TMS is right for you, it’s helpful to understand how it compares to other depression treatments in terms of anxiety-related side effects.
Traditional antidepressant medications, particularly SSRIs and SNRIs, commonly cause initial increases in anxiety during the first few weeks of treatment. Some people also experience ongoing restlessness or jitteriness as a persistent side effect. TMS typically has fewer side effects overall compared to medications, and any anxiety-related effects tend to be shorter in duration.
Therapy approaches like cognitive behavioral therapy (CBT) are excellent for addressing both depression symptoms and anxiety symptoms simultaneously, without the risk of medication side effects or the time commitment of TMS. However, therapy alone may not be sufficient for moderate to severe depression.
The advantage of TMS is that it can be combined with therapy and doesn’t interfere with most medications, allowing for a comprehensive treatment approach tailored to your specific mental health needs.
If you’re undergoing TMS treatment, several strategies can help you manage any temporary anxiety that arises:
Maintain open communication: Keep your TMS technician and psychiatrist informed about all symptoms you experience, even minor ones. They can’t help if they don’t know what you’re experiencing.
Practice relaxation techniques: Deep breathing exercises, progressive muscle relaxation, or meditation before and after sessions can help calm your nervous system.
Stick to your schedule: Consistency in treatment timing helps your brain adapt more smoothly to the stimulation.
Avoid caffeine before sessions: Caffeine can amplify feelings of nervousness and may make you more sensitive to treatment-related anxiety.
Get adequate sleep: Sleep deprivation worsens both depression and anxiety, potentially interfering with your body’s ability to respond well to treatment.
TMS represents just one option within the broader category of brain stimulation therapies for mental health conditions. Other approaches include vagus nerve stimulation (VNS), deep brain stimulation (DBS), and electroconvulsive therapy (ECT). Each has its own profile of benefits and potential side effects.
What makes TMS appealing to many patients is its relatively mild side-effect profile. The most common side effects are scalp discomfort and headaches during or after treatment, not anxiety worsening. When anxiety does increase, it’s usually manageable and temporary.
Deciding to pursue TMS for your depression symptoms is a significant choice that should be made in consultation with your mental health provider. Be sure to discuss your anxiety history specifically, as this will help your doctor anticipate and plan for any potential challenges.
The majority of patients who complete a full course of TMS treatment experience meaningful improvements in both depression and anxiety without significant complications. For those who do experience temporary anxiety increases, the benefits of successful depression treatment typically far outweigh the short-term discomfort.
Remember that mental health treatment is not one-size-fits-all. What works beautifully for one person may not be the best choice for another. Your unique symptom profile, treatment history, and personal preferences should all factor into finding the right approach for you. With proper monitoring, open communication, and realistic expectations, TMS can be a valuable tool in your journey toward better mental health.
If you’re ready to explore whether TMS therapy is right for your medication-resistant depression or other mental health disorders, TMS Therapy Near Me offers a comprehensive online directory of qualified TMS providers across the country.
Our directory makes it easy to locate experienced practitioners who specialize in treating not only depression but also generalized anxiety disorder, post-traumatic stress disorder, panic disorder, and other conditions that may benefit from brain stimulation therapy. Each provider listing includes information about their credentials, treatment approaches, and the specific conditions they treat, helping you find a practitioner who understands your unique needs and can help relieve symptoms that have been resistant to traditional treatments.
Simply enter your location to connect with TMS specialists in your area and take the first step toward exploring this innovative treatment option.
So, can TMS make anxiety worse? The evidence suggests that while a minority of patients may experience temporary anxiety increases during the early stages of treatment, TMS remains an effective treatment for both major depressive disorder and depression and comorbid anxiety. The procedure works by targeting the dorsolateral prefrontal cortex to stimulate brain activity in regions responsible for mood regulation, which is why many patients find relief from anxious depression as their treatment progresses.
For those specifically seeking TMS therapy for anxiety, research continues to demonstrate promising results, particularly for individuals whose symptoms haven’t responded to traditional approaches. Whether you’re looking to treat major depression, treat anxiety, or address both conditions simultaneously, TMS offers a non-invasive option that can be tailored to your specific needs. The key to success lies in working closely with an experienced provider who can monitor your response, adjust treatment parameters as needed, and ensure you receive the comprehensive support necessary for optimal outcomes.
