Treatments for Anxiety Disorders

We have come a long way in treating Anxiety Disorders, but treatment has become more stagnant in the most recent decades. As with depression and other mental health conditions, medication and therapy remain the mainstay for treatment. Similar to depression, however, these treatments only prove effective for some and side effects commonly occur with medication use. And when you add up all the anxiety disorders, they actually affect more people than depression.

Read more: TMS vs medication →

In light of this, TMS is being researched as an effective treatment for many anxiety disorders. A number of studies are smaller in size compared to those for Major Depression treatment, but the evidence base is growing in recent years. As of 2018, Brainsway and Magventure have obtained FDA approval for the treatment of OCD. There are a number of positive studies supporting TMS use for Generalized Anxiety and PTSD as well or for treating Anxious Depression. There are separate pages devoted to OCD and PTSD treatment, so we will spend time here focusing on Generalized Anxiety Disorder-GAD.

Can TMS Worsen Anxiety?

Early in treatment, anxiety can infrequently increase with treatment. This is usually mild and temporary and can actually be an indication that treatment is working. Lowering treatment intensity, taking titration of intensity more slowly, or adding in additional protocols can help mitigate anxiety should this occur. Any anxiety typically resolves in time even without any adjustment to protocol. There is good evidence supporting TMS as an effective treatment for anxiety and we have experienced similar improvements in anxiety symptoms along with depressive symptom improvement. TMS does also have FDA approval for treating OCD, which is an anxiety spectrum disorder itself.

TMS Treatment for Generalized Anxiety In Denver

As noted, there are a number of very positive studies when it comes to treatment of GAD with TMS.² The best studies have shown response (partial benefit) in 80-100% of patients and remission (complete resolution) in 33% to 85% of patients. These are very strong numbers. Most of the treatments for GAD focus on right-sided targets for treatment location and often use a lower frequency treatment aimed at decreasing hyperactive brain loops. Most other aspects of treatment remain the same as with TMS therapy for depression, however.

As with TMS for depression, there are no systemic side effects and the treatment is safe and typically well-tolerated. The procedure still harnesses magnetic waves to influence the electrical connections in the areas of the brain that are responsible for anxiety symptoms. One way to conceptualize treatments is similar to cognitive behavioral therapy for anxiety - CBT. In CBT you are slowly reshaping maladaptive patterns of thinking and/or behavior that contribute to depression or anxiety. Similarly, in TMS, we are rewiring these pathways, but at a much faster means and rate and with indirect electrical stimulation. TMS represents a unique and medication-free means for addressing anxiety. Anxiety relief can typically occur in four to six weeks with TMS therapy.

As described above, only TMS for OCD is currently approved by the FDA. Off-label treatment can be pursued for other anxiety symptoms and these conditions often co-occur with Major Depressive Disorder, however, in some 50% of individuals. Inspire TMS Denver does not charge for add-on treatments when this occurs and offers competitive pricing when self-pay may be pursued for anxiety management alone. At Inspire TMS Denver we always tailor treatment according to individual patient needs. More questions about TMS Therapy for Anxiety or other information on this page? Contact us here to see about a free phone consultation.

Don't Worry, Be Happy

The clinical definition of anxiety by the Encyclopedia of Mental disorders is summarized below,

 ‘Anxiety is an unpleasant emotion triggered by anticipation of future events, memories of past events, or ruminations about the self’.

Anxiety can present in many different ways. Some anxiety sufferers appreciate more worry and repetitive thinking about stressors or events, while others may appreciate a more physical sensation such as an upset stomach or a racing heart. 

Although typically viewed as an undesired emotion, anxiety or fear is not all bad and can help drive behavior in a positive manner.  

Healthy Fear Keeps Us Alive

Fear serves to activate our brain into an immediate survival reaction, flooding the body with adrenaline and cortisol in preparation for fight or flight mode. This may be appropriate in times of danger. Less severe anxiety such as that which we feel before a test or a job interview may drive us to study more or spend time preparing for the interview. Without this anxiety, we might be less likely to take action.

Unhealthy Fear

When the brain mistakenly perceives fear everywhere and all the time, however, the body is kept in a heightened state of vigilance. Further, the maladaptive neural connections do not signal the end of any threat and keep the body in a state of high alert. When anxious thoughts are repeated, they strengthen the dysfunctional neural pathways and increase even more anxious thoughts. The brain becomes out of calibration, adopting and reinforcing the new, dysfunctional pathway.

It is at this point that anxiety becomes a disorder and is often found hand in hand with depression and/or other mental health disorders

It affects daily life, relationships, and work; as well as prevents natural adaptation to unfamiliar situations, such as starting a new job. As all can attest to, life is always changing. If your mechanism for accommodating to change becomes a constant state of anxiety, this becomes insurmountable. Small stressors and changes in day-to-day life become overwhelming.

Anxiety Disorders

There are many disorders in which anxiety is the predominate driver and below are some of the more common conditions:

GAD affects over 3% of American adults and is often diagnosed with Major Depression Disorder MDD or other anxiety conditions.¹

Panic Disorder-PD

Disabling panic attacks can invade the mind and body without any apparent trigger, but often occur in certain settings. In an effort to avoid attacks, sufferers begin to change their normal activities, which then only then reinforces the fear, increasing the probability of an attack, and a classic 'catch-22' cycle. Panic attacks are very frightening and can feel as if you are having a heart attack or dying.

It also displays many of the same symptoms as GAD and affects close to 3% of US adults. Again, Panic Disorder tends to co-occur with other disorders such as Social Anxiety Disorder and Major Depression.

Social Anxiety Disorder-SAD

Social Anxiety Disorder affects almost 15 million Americans, or some 7% of the population, causing extreme distress in social settings. Fear of being judged, of not being physically or intellectually good enough, or acute embarrassment, can activate symptoms of, or even trigger, a full-blown panic attack. Sufferers typically then avoid any social situations, even shopping or going to work. Again, avoidance adds to the fear and becomes self-perpetuating and increases vulnerability to depression and other physical and mental disorders. 

Posttraumatic Stress Disorder-PTSD

Another disorder often described along the anxiety spectrum is Posttraumatic Stress Disorder (PTSD). PTSD affects some 3.5% or more of the US adult population each year. PTSD is recognized commonly amongst veterans but can also be caused by a wide variety of events such as assault, accidents, or childhood or domestic abuse.

It can also occur in secondary victims close to murder and rape victims. The strongest indicator for the development of PTSD is the occurrence of childhood sexual abuse and is often labeled as Complex PTSD. 

Learn more about TMS for PTSD specifically here.

Obsessive Compulsive Disorder-OCD

As the condition suggests, the mind becomes obsessive about specific subjects, experiencing repetitive thoughts and mental images that trigger anxiety or disgust.

Obsessions then trigger compulsive behaviors that are perceived to mitigate the perceived fear. Practicing ‘rituals’ gains short-term relief from anxiety but reinforces a self-perpetuating cycle.

Read more: TMS therapy for OCD →