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TMS Now Shown To Also Be Effective In Anxious Depression

In a recent study, published in the Journal of Clinical Psychiatry, the effectiveness of TMS for depressed patients with and without anxiety was compared. The results indicate that it is highly effective for both depression and anxiety.

Most depressed people have a clinically significant amount of anxiety, so this is an important question to answer. Since TMS has been FDA approved for depression and not anxiety (although this is still being researched), it was not a guarantee that it would work as well.

The study was a retrospective analysis of over 11,000 cases, so this was not the strongest study design, but the huge sample size was a strength. They saw a comparable decrease in depression rating scales whether anxiety was present or not. However, since the anxious depressed patients started out with higher levels of depression, the percent of patients who achieved remission or response was somewhat lower in the anxious depression group.

A major finding was that the anxiety scores went down to a marked degree. On average, anxiety scores were cut in half. 50% of subjects saw their anxiety drop to the “response” level, and 30% went into remission. If depression responded, then usually so did anxiety.

Many clinicians, including ourselves at Southeastern Psychiatric Associates, will opt for right sided TMS in patients with a lot of anxiety. TMS can be given at 10 pulses per second, in which case it stimulates the adjacent brain region, or at 1 per second which makes it inhibitory. Interestingly, 10 per second on the left side has been shown to work as well as 1 per second on the right. Since the left sided treatments can sometimes be a bit activating, it has been theorized that right sided may be a better option for anxious people. Depending on the circumstances the clinician may even opt for both left and right sided treatments administered on the same day.

It is important to note that this was not a study about treating patients who only had an anxiety disorder.

TMS may be the next best step for you. TMS is covered by almost all Insurance companies.


Doctor Warstadt is one of the partners at Southeastern Psychiatric Associates, and has been with the practice since 1989. He includes both psychotherapy and psychopharmacology in his practice, often weaving both together. He was deeply involved in bringing TMS to the group beginning in the fall of 2015. He was trained in TMS theory and technique by Dr. Linda Carpenter, one of the pioneers in the field, and is a member of the Clinical TMS Society.


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