Does TMS Therapy Work for Anxiety? What the Research Actually Shows
Reviewed by Daniel Montville, MD, Psychiatrist
SiggyMD Clinical Team · Last updated June 18, 2026
Key Takeaways
- TMS (transcranial magnetic stimulation) is FDA-cleared for major depressive disorder (2008), OCD (2018), and in 2024 received expanded clearance specifically to decrease comorbid anxiety symptoms in adults with depression who have not responded to antidepressants.
- TMS is not FDA-approved as a standalone treatment for generalized anxiety disorder or other primary anxiety disorders. Research on this application is ongoing and promising, but the evidence base is not yet sufficient for formal clearance.
- A 2019 meta-analysis of four randomized sham-controlled trials found a large effect size for TMS in GAD (effect size -2.06). A 2025 systematic review covering studies through July 2025 found limited high-quality RCT evidence for GAD specifically.
- For patients with depression and comorbid anxiety, TMS treatment for the depression consistently produces meaningful reductions in anxiety symptoms. BrainsWay's Deep TMS received FDA clearance for this anxious depression indication in 2024.
- About 50% of patients with GAD do not respond adequately to first-line SSRIs or SNRIs, making the development of alternative treatments like TMS a genuine clinical priority.
If you have been treating anxiety for months without adequate relief, you have probably wondered whether there are options beyond the standard medication and therapy combinations. Transcranial magnetic stimulation is one treatment that comes up in that conversation, and the answer to whether it works for anxiety is more nuanced than most people expect.
TMS is not simply “approved for anxiety” or “not approved for anxiety.” The clinical reality is more specific: TMS is FDA-cleared for depression and OCD, has received expanded clearance for anxiety symptoms in people with depression, and has growing but not yet definitive research for anxiety as a standalone diagnosis. Understanding those distinctions helps you have an informed conversation with a prescriber about whether it might be relevant to your situation.
What This Page Covers
- What TMS is and how it works in the brain
- The current FDA clearance status for TMS and anxiety
- What the clinical research shows for GAD and anxious depression
- Why anxiety comorbid with depression responds well to TMS
- What the research gaps are
- Who might be a candidate and how to access TMS for anxiety
- What SiggyMD’s clinical approach looks like for treatment-resistant anxiety
How TMS Works on Anxiety Circuitry
TMS uses an electromagnetic coil placed against the scalp to deliver focused magnetic pulses to specific brain regions. For depression, the target is typically the left dorsolateral prefrontal cortex (DLPFC), a region that is underactive in depression and involved in regulating emotional response.
For anxiety, the picture is slightly different. Imaging studies suggest that disrupted communication between the DLPFC and the amygdala, an area of the brain involved in fear and anxiety responses, may play a key role in anxiety disorders. The right DLPFC has received particular research attention for anxiety because it is thought to be overactive in some anxiety presentations, and low-frequency (inhibitory) TMS can reduce that activity.
Research suggests that stimulating the right dorsolateral prefrontal cortex can reduce anxiety symptoms, given its role in emotional regulation. This is distinct from the left-sided stimulation used for depression, and it is one reason why anxiety-specific protocols are being studied separately from depression protocols.
The FDA Clearance Picture
TMS has the following cleared indications relevant to anxiety:
Major depressive disorder (2008, all manufacturers). The primary FDA-cleared indication. TMS for MDD also reduces anxiety symptoms that co-occur with depression.
OCD (2018, BrainsWay Deep TMS). In 2018, the FDA approved deep TMS for OCD treatment. The protocol targets the medial prefrontal cortex and its connections to limbic anxiety circuits.
Anxious depression (2024, BrainsWay). BrainsWay received FDA clearance specifically for the indication of decreasing comorbid anxiety symptoms in adults with major depressive disorder who have failed to achieve satisfactory improvement from prior antidepressant treatment. This was a significant step: it formalized what clinicians had observed in practice, that TMS reduces anxiety when it reduces depression in patients who have both.
Standalone GAD and primary anxiety disorders: Not FDA-cleared. TMS for generalized anxiety disorder, social anxiety disorder, panic disorder, or other primary anxiety diagnoses remains off-label and is not FDA-cleared. It is being studied in clinical trials, but the evidence base is not yet at the threshold for formal clearance.
What the Research Shows for GAD
The research on TMS for primary GAD is genuinely promising but is not yet at the level that supports routine clinical use outside of research or highly treatment-resistant cases.
A 2019 meta-analysis of four randomized sham-controlled trials in GAD found a large overall treatment effect for TMS compared to sham stimulation (effect size -2.06, 95% CI -2.64 to -1.48). This effect size is larger than typically seen in medication trials for GAD, which is encouraging. The key limitation: these four trials had a combined total of relatively few participants, and methodological quality varied.
A 2025 systematic review searching through July 2025 evaluated the efficacy and safety of TMS for GAD, OCD, and PTSD. For GAD specifically, the review found limited high-quality RCT evidence, while finding stronger evidence for OCD and PTSD. The authors identified this as an important evidence gap: GAD is one of the most common and disabling anxiety disorders, and TMS research in this population has lagged behind its use in depression.
Most of the published TMS anxiety trials have used right DLPFC stimulation at low frequency. The most effective protocol for TMS treatment for anxiety disorders appears to involve low-frequency stimulation (1 Hz), with 110% of the motor threshold.
TMS for Anxious Depression: The Clearest Signal
The most clinically relevant finding for many patients is that TMS consistently reduces anxiety in people who have both depression and significant anxiety.
Patients report clinically meaningful reductions in anxiety symptoms via the GAD-7 scale following TMS for depression, consistent across multiple studies of adults. This is why BrainsWay’s 2024 FDA clearance expansion was significant: it formalized the anxious depression indication based on accumulated evidence that TMS reliably addresses the anxiety component alongside the depression.
For patients who have treatment-resistant depression with comorbid anxiety, TMS through the depression pathway may address both. This is also clinically relevant because anxious depression is harder to treat than depression alone: more than half of patients in the STAR*D antidepressant trial had anxious depression, and remission in that group was less likely and took longer than in patients with depression without anxiety symptoms.
Who Might Be a Candidate
If you are considering TMS for anxiety, the most realistic pathway depends on your clinical picture.
If you have depression with comorbid anxiety: You may qualify for TMS through the MDD indication, which also benefits the anxiety component. Most insurance covers TMS for MDD following documented antidepressant failure. The 2024 clearance for anxious depression strengthens this pathway.
If you have primary GAD without depression: TMS for primary GAD is off-label. Insurance generally does not cover off-label TMS. Clinical trials are one option if other treatments have been inadequate. Discuss this with a psychiatrist who specializes in neuromodulation.
If you have OCD: FDA-cleared Deep TMS is available and increasingly covered by insurance.
For all pathways: TMS is contraindicated in patients with metal implants near the skull, certain cochlear implants, and history of seizure disorders. A TMS-trained prescriber conducts a full safety screening before treatment.
What First-Line Anxiety Treatment Looks Like Before TMS
About 50% of patients may not respond to first-line SSRI or SNRI treatment for GAD. This is a real clinical problem, and it is why interest in neuromodulation alternatives is justified. But most people who reach TMS for anxiety have gone through a careful escalation of other options first.
For GAD and most anxiety disorders, that escalation typically includes: an adequate trial of an SSRI or SNRI at therapeutic dose and duration (at least 8 to 12 weeks); cognitive behavioral therapy, which has the strongest evidence base for anxiety disorders; and, in treatment-resistant cases, switching medication classes, adding augmentation agents, or exploring off-label options like hydroxyzine, buspirone, or pregabalin.
SiggyMD’s clinical model supports this kind of structured monitoring through the SSRI and SNRI escalation. Daily check-ins give a licensed prescriber visibility into whether a medication is producing adequate response, allowing course corrections earlier rather than waiting through months of inadequate treatment before considering next steps.
“The question about TMS for anxiety comes up regularly, and my first question is always whether we have been thorough about medication and therapy options first,” says Daniel Montville, MD, Psychiatrist of the SiggyMD clinical team. “The research on TMS for primary anxiety is promising, but we are not at the point where I would recommend it ahead of SSRIs, structured CBT, and an adequate trial of the best available medications. For anxious depression where medication has failed, TMS is a very different conversation.”
Starting with What Has the Strongest Evidence
If you are experiencing anxiety that is not responding well to current treatment, the most productive next step is a clinical evaluation that reviews your full treatment history, considers whether comorbid conditions are being addressed, and discusses whether the current medication and dose are adequate.
Start your anonymous intake with SiggyMD to connect with a licensed prescriber who can review your full clinical picture, evaluate whether your current treatment is optimized, and discuss what options make sense if it is not. For context on what treatment-resistant anxiety and depression management looks like, read our guide to treating treatment-resistant depression.
What Members Are Saying
KL
K.L., 44
Anxious Depression
“I had depression and anxiety for years and antidepressants only partially helped. My psychiatrist referred me for TMS through the depression pathway, and I noticed the anxiety improving around week four. By week six, both the depression and the anxiety were significantly better. I was not expecting the anxiety response. My prescriber told me it was consistent with what the research shows for anxious depression.”
MR
M.R., 39
GAD, Treatment-Resistant
“I have not done TMS yet. I am in the process of going through the SSRI options more thoroughly with my prescriber before looking at neuromodulation. My prescriber at Siggy was clear that the research on TMS for pure anxiety is promising but still developing. That honest answer made me trust the process.”
Member stories reflect real experiences. Names and identifying details have been changed to protect privacy. Results vary. SiggyMD is currently invite-only.
The Bottom Line
TMS works for anxiety in specific clinical contexts: it is FDA-cleared for anxious depression and OCD, and research on primary GAD shows large effect sizes but remains limited in scale and quality. It is not a first-line anxiety treatment and is not FDA-cleared for standalone anxiety disorders.
For patients with depression plus anxiety, TMS is a real option when antidepressants have been inadequate. For patients with primary GAD that has not responded to standard treatments, TMS is a plausible next step to discuss with a specialist, but the evidence base is still developing, and clinical trials remain the most structured pathway.
Sources
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Cirillo P, Gold AK, Nardi AE, et al. Transcranial magnetic stimulation in anxiety and trauma-related disorders: A systematic review and meta-analysis. Brain and Behavior. 2019;9(6):e01284.
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Rodrigues PA, et al. Transcranial magnetic stimulation for the treatment of anxiety disorder. Neuropsychiatric Disease and Treatment. 2019;15:2743-2761.
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Strawn JR, et al. Repetitive Transcranial Magnetic Stimulation for Generalized Anxiety Disorder: A Systematic Literature Review and Meta-Analysis. International Journal of Neuropsychopharmacology. 2022;25(2):144-155.
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BrainsWay. FDA Clears Deep TMS System for Comorbid Anxiety Symptoms. HCPLive. 2024.
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Burguete-Castillejos LF, et al. Repetitive transcranial magnetic stimulation for the treatment of anxiety disorders: A systematic review. Revista Mexicana de Neurociencia. 2022;23(1).
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APA Services. FDA clears transcranial magnetic stimulation for youth, and a shorter version for adults. December 2025.
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Cognitive FX. Does TMS Work for Anxiety? What the Research Says. Accessed June 2026.
Frequently Asked Questions
Is TMS FDA-approved for anxiety?
TMS is not FDA-approved as a standalone treatment for generalized anxiety disorder or primary anxiety disorders. It is FDA-cleared for major depressive disorder, OCD, and in 2024 received expanded clearance for decreasing comorbid anxiety symptoms in adults with MDD who have not responded to antidepressants. Research on TMS for primary anxiety disorders is ongoing.
What does TMS do for anxiety?
TMS uses magnetic pulses to stimulate the dorsolateral prefrontal cortex (DLPFC), a brain region involved in both mood regulation and anxiety control. In depression, left DLPFC stimulation is the standard target. For anxiety, right DLPFC stimulation has shown particular promise in studies. The DLPFC has direct connections to the amygdala, which governs fear and emotional memory, which is thought to explain why TMS can reduce anxiety symptoms even when used primarily for depression.
Can TMS help with anxious depression?
Yes. For patients with both depression and significant anxiety symptoms, TMS consistently reduces anxiety alongside depression. BrainsWay's Deep TMS system received FDA clearance in 2024 specifically for decreasing comorbid anxiety symptoms in MDD patients who have not responded to prior antidepressants. Multiple studies of standard TMS for depression also show meaningful reductions in anxiety measured by GAD-7 and Hamilton Anxiety scales.
What TMS protocol is used for anxiety?
For anxiety comorbid with depression, standard left DLPFC protocols are used, and they reduce both. Some research has focused specifically on right DLPFC stimulation at low frequency (1 Hz) for primary anxiety, based on the inhibitory effects of this protocol on the overactive anxiety circuitry in the right hemisphere. For OCD, BrainsWay's Deep TMS at the medial prefrontal cortex is the FDA-cleared protocol.
Is TMS available without a prior antidepressant failure?
For depression, insurance typically requires documented prior antidepressant failures before covering TMS, and some insurers are expanding to allow TMS earlier. For anxiety as a primary indication (not FDA-cleared), TMS is generally only available via off-label use or clinical trials. Patients with anxious depression meeting MDD TMS criteria may be eligible through that pathway.
What are the alternatives to TMS for treatment-resistant anxiety?
Alternatives include switching to a different medication class (SNRIs, buspirone, pregabalin, or hydroxyzine for shorter-term needs), combining medication with structured psychotherapy (CBT for anxiety has strong evidence), augmentation with low-dose atypical antipsychotics in some treatment-resistant cases, and referral to specialized anxiety programs. Deep brain stimulation and ketamine are investigational for anxiety.
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