TMS Therapy for Anxiety and Depression
Like spaghetti and meatballs, anxiety and depression often coexist. Either one of these common mental health disorders alone can cause serious impairment in one’s daily life, but when they are both present it can be absolutely debilitating. Anxiety can cripple one with irrational fears, and coupled with depression can leave a person depleted and despairing.
Individuals diagnosed with major depressive disorder often present with a co-occurring anxiety disorder. These are traditionally treated with a combination of antidepressants, or other mood stabilizers, along with psychotherapy. Patients will trial the drug for about six weeks with the hope that it will help stabilize the symptoms of the mental health disorder. In a large number of patients, however, the medications—even after trialing several different drugs—are simply not successful in relieving symptoms.
Transcranial magnetic stimulation (TMS) is a relatively new approach to treating medication-resistant depression, and was cleared by the FDA in 2008 for this purpose. In Europe, the European Medicines Agency (EMA) has already cleared TMS therapy for anxiety. Ongoing research on the efficacy of TMS therapy for anxiety continues to demonstrate promise, and it is already being used “off label” here in the US. When using TMS to treat a patient with major depression who happens to also have a co-occurring anxiety disorder, it has been found that both disorders benefited from the TMS therapy.
About Anxiety Disorder
According to the National Institute of Mental Health, approximately 40 million Americans struggle with an anxiety disorder. While most adults will experience everyday anxiety due to stressful events, someone with an anxiety disorder will have debilitating symptoms, such as extreme fear, that may lead to impairment in functioning. Anxiety disorders tend to run in families and have a biological basis.
There are different manifestations of anxiety, creating the following types:
- Generalized anxiety disorder
- Panic disorder
- Specific phobias
- Social anxiety disorder
- Separation anxiety
Each type of anxiety disorder will have its own profile of specific symptoms, but in general anxiety disorders involve the following symptoms:
- Excessive worry
- Irrational fear
- Isolating behaviors
- Physical symptoms such as sweating, racing heart, palpitations, trembling
- Sleep disturbances
Traditional treatment protocols for anxiety disorders include psychotherapy, such as cognitive behavioral therapy, exposure therapy, and eye movement desensitization reprocessing (EMDR), and medication. Medications can include antidepressants, anti-anxiety medications such as benzodiazepines, and mood stabilizers.
Just as with depressive disorders, some patients do not achieve relief from the anxiety symptoms through these conventional therapies. In other cases, individuals prefer to treat their anxiety without the use of drugs. TMS therapy is a safe and effective alternative treatment for individuals with medication-resistant anxiety.
TMS Therapy for Anxiety Disorders
TMS is a noninvasive treatment that involves making incremental changes in brain chemistry using magnetic fields. A coil is placed over the scalp strategically, depending on which disorder is being treated, and repetitive magnetic pulses penetrate the brain tissue. Over time, the treatment can reset brain chemistry that was out of balance, contributing to the mood disorder.
Because of the common relationship between depression and anxiety disorders, treating the depression can also positively impact the anxiety symptoms as well. Patients who had sought out TMS therapy for their medication-resistant major depressive disorder (MDD) have been surprised to notice that the therapy also helped their coexisting anxiety disorder.
Neuromodulation using TMS technology can improve depression symptoms and anxiety symptoms by stimulating the dorsolateral left pre-frontal cortex of the brain, affecting the limbic system as well as producing cascading effects to connecting regions. TMS therapy has been successfully used as an off-label option for treating the following anxiety disorders:
Generalized anxiety disorder (GAD). GAD features excessive worry that persists for six months or longer. The symptoms include trouble concentrating, palpitations, dizziness, shortness of breath, restlessness, fatigue, sweating, and insomnia.
Post-traumatic stress disorder (PTSD). PTSD can occur following a traumatic event, such as combat, a natural disaster, a terrorist attack, or sexual or physical assault. The condition may last for months or years after the trauma occurred, with symptoms including nightmares, flashbacks, severe anxiety, hostility, irritability, anger, avoidance of triggers, isolating behaviors, and substance abuse.
Obsessive-compulsive disorder (OCD). OCD involves a cycle of obsessive thoughts that trigger compulsive behaviors. The compulsions serve to help mitigate the stress experienced by the obsessions. Symptoms include ritualistic behaviors, such as washing hands dozens of times a due to an obsessive fear of germs.
Research Supports TMS Therapy for Anxiety
Where TMS therapy is being studied or prescribed for the treatment of generalized anxiety disorder (GAD) and post-traumatic stress disorder (PTSD), promising results have been seen.
Ongoing studies continue to demonstrate the safety and efficacy of TMS therapy for the treatment of anxiety. Some of these include:
- A new study published in Journal of Affective Disorders conducted a nonrandomized trial with 248 participants who received TMS therapy for MDD. Of these, 172 participants had a co-occurring anxiety disorder. When comparing the two groups the researchers determined that TMS therapy demonstrated clinical efficacy for both groups equally.
- Another recent clinical trial has provided scientific evidence of efficacy in applying TMS on the right prefrontal cortex for the anxiety and the left prefrontal cortex for the depression. The results showed that 84.5% of participants saw anxiety symptoms in remission, and 76.9% saw improvements in depression scores.
- A randomized sham-controlled trial with 25 participants that received targeted treatment to the right dorsolateral prefrontal cortex. The results demonstrated higher response and remission rates (43%) for GAD symptoms in the TMS group versus the sham group.
- Studies have shown that applying low frequency (1 Hz) TMS therapy for anxiety to the right dorsolateral prefrontal cortex (DLPRC) shows promising results. Participants in sham-controlled trials reported a significant decrease in anxiety symptoms, which can be attributed to an increase in theta activity. This placement of the coil and the frequency used differs from TMS treatment for depression, which is typically placed over the left DLPFC and utilizes a high frequency (10 Hz).
Is TMS Therapy Safe?
Where other brain stimulation techniques may require a general anesthetic, such as ECT, TMS does not. This eliminates the risks commonly associated with general sedation, making TMS a safe treatment option. Since the FDA cleared TMS for treating medication-resistant major depression in 2008 it has been well tolerated by patients. Some minimal adverse side effects from TMS have been reported, but they are short-lived, resolving spontaneously during the course of the treatment period. These include headache and localized scalp irritation.
Because TMS therapy doesn’t use sedation, the patient is fully alert during the 40-minute treatments. Patients often pass the time by reading, listening to music, or watching television. After the treatment, patients can drive themselves back to work or home to resume normal daily activities.
TMS therapy is not appropriate for individuals with metal implants or devices in or near the head. This would include individuals with pacemakers, vagus nerve stimulators, aneurysm clips, stents, cardioverter defibrillators, bullet fragments or shrapnel, electrodes to monitor brain activity, or facial tattoos with metallic ink.
Anew Era TMS Leading Provider of TMS Therapy for Anxiety
Anew Era TMS is a Southern California provider of TMS therapy for the treatment of medication-resistant depression. Because anxiety disorders often accompany major depression, including PTSD and generalized anxiety disorder, TMS therapy has been shown to be useful in also relieving symptoms of anxiety.
If you have not found relief from antidepressants, or cannot tolerate the side effects commonly experienced with these drugs, TMS therapy may be the answer to improving your quality of life. For more information about this exciting treatment for depression and co-occurring anxiety, contact Anew Era TMS today at (888) 503-1549.