Anxiety is one of the most common mental health conditions in the world, and new treatment options like Transcranial Magnetic Stimulation (TMS) have given hope to people who haven’t found relief with medication. But as more patients try TMS, a common question arises: Can TMS make anxiety worse?
The short answer is sometimes, but only temporarily. Some people feel more anxious or restless during the early stages of treatment, but these effects usually fade as the brain adjusts. Over time, TMS can actually reduce anxiety and depression symptoms and improve long-term mental health.
This article explains why TMS may initially worsen anxiety, how the treatment works, and why it remains one of the most promising noninvasive approaches for mood disorders today.
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TMS Treatment Overview
Transcranial Magnetic Stimulation (TMS) is a noninvasive therapy that uses a magnetic field to activate specific parts of the brain involved in mood regulation. During each treatment session, an electromagnetic coil is placed near the scalp. The coil sends gentle, repetitive magnetic pulses to stimulate nerve cells in areas linked to depression and anxiety.
TMS targets the dorsolateral prefrontal cortex (DLPFC), a region often underactive in people with treatment-resistant depression and certain anxiety disorders. When stimulated, this brain area becomes more active, helping restore balance in brain circuits that control mood, motivation, and stress response.
There are different forms of therapy, including repetitive Transcranial Magnetic Stimulation (rTMS), which delivers repeated pulses over time to train the brain to regulate emotions more effectively.
Unlike antidepressant medications, TMS doesn’t require drugs or anesthesia. It’s also well-tolerated, with fewer side effects than most pharmacological treatments.
Can TMS Make Anxiety Worse?
Yes, but only for a small number of patients and usually only at the beginning. Some people notice increased anxiety, irritability, or restlessness during the first few TMS sessions.
This temporary anxiety happens as brain activity begins to shift. TMS changes how certain regions of the brain communicate, which can briefly disrupt emotional balance before improvements occur.
According to a 2023 study published in the Journal of Affective Disorders, about 15–20% of patients report mild increases in anxiety during the first week of treatment. However, these symptoms typically fade as the brain adjusts to stimulation.
Most patients eventually report positive results, including better mood stability, fewer anxious thoughts, and reduced depressive symptoms.
Why TMS May Worsen Anxiety Symptoms
Understanding why anxiety might temporarily increase can help patients prepare for the experience. Here are the most common reasons this happens:
1. Brain Adjustment
TMS directly affects brain activity in regions tied to emotion regulation, such as the prefrontal cortex and limbic system. As these areas adjust, some people experience temporary overstimulation, which can feel like anxiety or restlessness.
2. Sensory Discomfort
Each treatment session produces a tapping sensation and a clicking sound. For individuals sensitive to sensory input, this can feel uncomfortable or cause tension during early sessions.
3. Emotional Activation
TMS stimulates pathways connected to memory and emotion. As these circuits become active, buried or suppressed feelings may surface. This release can feel overwhelming at first, but is often part of the healing process.
4. Sleep and Hormonal Changes
TMS can affect sleep quality and stress hormones like cortisol early on. Disrupted sleep or changes in daily rhythm can temporarily heighten anxiety symptoms.
It’s important to note that these reactions are normal and short-lived. They signal that TMS works by changing brain networks associated with emotional control and anxiety response.
The Importance of TMS for Anxiety Treatment
Even though some patients experience short-term anxiety, the importance of TMS for anxiety cannot be overstated. This effective treatment offers a safe, drug-free solution for people who haven’t responded to traditional methods.
Here’s why TMS is so valuable:
1. Targets the Root Cause
By focusing on the dorsolateral prefrontal cortex (DLPFC), TMS directly improves communication in the brain circuits responsible for mood and anxiety control. This allows for deeper, more sustainable healing compared to medication alone.
2. Effective for Multiple Conditions
TMS isn’t just for depression. Studies show promising results in treating post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and treatment-resistant depression. These conditions often overlap, and TMS can address shared pathways in the brain.
3. Fewer Side Effects
Unlike antidepressant medications, which can cause fatigue, nausea, or sexual side effects, TMS side effects are usually mild and temporary, like scalp tingling or light headaches.
4. Supports Long-Term Recovery
Over time, rTMS helps retrain the brain to function more efficiently. Patients often experience long-term improvements in emotional stability and cognitive clarity. Some even describe feeling like their “old self” again after several weeks of consistent sessions.
Managing Anxiety During TMS Treatment
Some patients experience what professionals call a “TMS dip.” This refers to a temporary period during treatment, often around weeks two or three, when symptoms like anxiety, irritability, or low mood seem to worsen before improving. This dip can feel discouraging, but it’s a normal and temporary response as the brain adjusts to changes in neural activity.
TMS Dip Management
If anxiety feels more intense during early sessions, there are practical steps you can take to manage it:
- Stay consistent: Continue attending your scheduled treatment sessions, even if symptoms feel worse temporarily. Stopping early can interrupt progress.
- Communicate openly: Tell your provider about any mood changes or anxiety spikes. They can adjust intensity, coil position, or frequency to ease discomfort.
- Prioritize self-care: Get enough sleep, maintain stable blood sugar, and stay hydrated to help the brain recover between sessions.
- Use relaxation techniques: Breathing exercises, mindfulness, and grounding strategies can reduce stress during the dip period.
- Lean on support systems: Talk with support groups, family, or friends who can provide reassurance and accountability.
Remember, your provider’s goal is to help you feel comfortable and supported throughout every treatment session.
When to Talk to Your Doctor
While temporary anxiety is normal, certain signs may require additional support. Contact your provider if you experience:
- Persistent anxiety lasting beyond two weeks.
- Severe panic episodes or worsening restlessness.
- Intense mood swings, insomnia, or irritability.
- Worsening depression or thoughts of self-harm.
Early communication allows your treatment team to modify your treatment plan to make it safer and more effective.
Finding Hope in TMS Treatment
It’s understandable to worry that TMS might make your anxiety worse. But for most people, this reaction is short-lived and temporary. The therapy’s ultimate goal is to help your brain regain stability and control over anxiety and depression.
Over the long term, transcranial magnetic stimulation (rTMS) offers a path toward lasting relief, especially for those who haven’t responded to antidepressant medications or traditional therapy.
By reshaping how the brain communicates, TMS helps reduce emotional distress and supports ongoing mental health recovery. With consistent sessions and a supportive care team, patients often find new confidence, clarity, and calm after completing treatment.
If you or someone you know is considering TMS treatment, talk to a mental health professional to see whether it fits your treatment plan. With the right guidance, repetitive transcranial magnetic stimulation can be a powerful step toward emotional stability and long-term healing.