If you are wondering about pursuing TMS to treat anxiety or just want more information about alternatives for difficult to treat anxiety, then you have come to the right place. We will discuss what TMS therapy is and the science behind it, the pros and cons, cost and insurance coverage and how to get started with TMS therapy for anxiety at A Better Day Psychiatry.
What is TMS Therapy?
Transcranial magnetic stimulation is an intervention that uses targeted electromagnetic pulses to the prefrontal cortex to treat disorders including depression, anxiety, OCD, smoking cessation, and more. TMS Therapy has been around since 1985 but it more recently gained FDA approval to treat anxious depression in 2021. Since then, TMS has been increasingly being used to treat anxiety.
How Does TMS Help With Anxiety Symptoms?
TMS for anxiety targets the right dorsolateral prefrontal cortex (as opposed to the left DLPFC for depression). This area of the brain is important for emotional regulation, executive functioning and importantly is interconnected to deeper brain regions such as the limbic system and amygdala, which are involved in regulating fear and emotions. Over the course of 4-6 weeks the repeated stimulation of these areas leads to neuroplasticity and “rewiring” of overactive fear circuits in the brain as well as strengthening of the connection to the brain that promotes emotional regulation.
Given the great results that have been achieved for anxious depression, there are numerous studies that are looking into TMS for generalized anxiety disorder and these preliminary studies are showing reduction in anxiety symptoms to full remission in some cases. TMS for PTSD is a significant area of study to help regulate mood, reduce re-experiencing symptoms such as nightmares and flashbacks, and decrease hypervigilance and hyperarousal. This treatment modality is particularly exciting as it is a non-invasive, non-medication treatment for people who have experienced traumas and not responded to traditional interventions.
FDA Approvals & Insurance Coverage Explained
Currently, TMS is only FDA cleared for Major Depressive Disorder, Obsessive-Compulsive Disorder, and Major Depressive Disorder with anxious depression from the ages of 15 and older (15 for MDD and 18 for OCD). As discussed above though, there are growing and substantial research with promising results for TMS for generalized anxiety disorder, TMS panic disorder, TMS for social anxiety disorder as well as a wider range of psychiatric disorders including bipolar disorder, addiction and substance use, ADHD, ASD, eating disorders, ASD, and more.
One tip for navigating insurance is that at present, insurances will only cover TMS treatment for anxiety if there is also a diagnosis of major depressive disorder, hence the MDD with anxious depression that has FDA clearance. If you do not meet criteria for MDD, your insurance may not cover the treatment.
Benefits and Success Rates of TMS for Anxiety
There are numerous benefits of using TMS for anxiety. You can achieve reduction in worry, rumination, and physiological arousal in a non-invasive, non-systemic, targeted and well tolerated treatment. There is the potential for lasting relief, improved quality of life, and it can be an effective approach for treatment-resistant anxiety similar to what we discussed in our treating depression without medication blog. Response rates (or a reduction in symptoms by at least 50%) for TMS for anxious depression are 50-60%, and remission rates (no longer meeting criteria for the disorder) are 30-40%. In a 2024 multi-center study from the Netherlands, TMS outperformed antidepressants for treating anxiety.
What to Expect During a TMS Course
When treating TMS for anxiety, there is an initial mapping session where a psychiatrist places a coil (device that delivers the electromagnetic pulses) along the side of your head and delivers single pulses to find the location of the right DLPFC. The pulses feel similar to a rubber band snap and will induce a thumb-twitch, which helps determine the correct treatment location. Once the location of the DLPFC is determined, you then proceed with treatment, usually with the first session occurring right after the mapping session. Most protocols covered by insurance will then include a total of 30-36 treatment sessions ranging from 10-30 minutes daily for 6-7 weeks. The TMS treatments do not involve any anesthesia, and you are able to drive yourself to and from the treatments and proceed with your day as normal outside of the sessions. Similar to antidepressants, it may take 4-6 weeks before results start to appear. Typically, the greater the number of treatments, the greater the improvement. There are accelerated protocols as well that can be completed within a week, though those are not covered by insurance.
Side Effects & Safety
TMS is a very safe treatment for anxiety as long as you are appropriately screened beforehand by a medical professional for a history of seizures, metal devices or implants from the neck up. The overall seizure rates from TMS are 0.31 per 10,000 sessions. Other side effects may include headaches, muscle twitches or tension, change in energy, sleep, or appetite. There can be worsened mood or irritability. Overall TMS is well tolerated with very low dropout rates.
Cost, Financing, and Navigating Insurance with TMS for Anxiety
TMS costs roughly $200-300/session with the total treatment ranging from $6000-10,000 if paying out of pocket
Our billing department at ABD will check your benefits and then handle any pre-certifications or authorizations of medical necessity that need to be approved prior to treatment then discuss any deductibles, co-payments, co-insurance etc. that your plan requires
TMS Therapy is FSA and HAS eligible
Given the TMS therapy cost can be significant if not covered by insurance, we offer financing and payment plans to make this important treatment accessible to anyone.
Why Choose A Better Day Psychiatry for TMS in Golden, Colorado
Ready to discover how TMS for anxiety can help you live with more calm and confidence? Schedule a free consultation with A Better Day Psychiatry today and take your first step toward relief.