TMS & Other Therapies

TMS for Anxiety: Everything You Need to Know


Transcranial Magnetic Stimulation (TMS) therapy has been recognized by some clinicians as being the future for the treatment of depression. For many individuals TMS has been shown to be more effective than medication at treating symptoms of depression. But TMS is not only used to treat depression. It has been shown to have the potential to be a promising treatment for a whole host of different medical issues. In particular it has shown promise as a treatment for a myriad of neurological conditions such as Alzheimer’s disease, epilepsy, and schizophrenia. 

It has also been shown to be an effective tool in psychiatry! TMS has been used as a treatment for behavioral health conditions, such as PTSD, depression, obsessive compulsive disorder (OCD), bi-polar disorder, and even generalized anxiety disorders!  The good news about TMS being such an effective treatment for depression is good news for anybody suffering from anxiety. Nearly half of those in America who are diagnosed with depression are also diagnosed with some sort of anxiety disorder and vice versa. Due to this, the promising results from the use of TMS for depression points to positive outcomes for using TMS as a treatment for anxiety as well.

Picture girl in crowd
Although those who suffer from mental illnesses often feel alone, anxiety is actually the leading cause of disability in the United States.

So What Exactly is Anxiety Anyways?

Americans Articulate Feelings of Anxiety but Actually Do Little to Alleviate Them

Some form of an anxiety disorder is the most common cause of mental illness in the United States. Discounting the child population, anxiety affects 18.1% of the population every year. Or in other words, 40 million American adults suffer from anxiety or an anxiety disorder every single year. Although anxiety disorder can be treated quite effectively by modern medicine only 36.9% of those who suffer from Anxiety see a doctor or receive treatment. Which means over 25 million Americans don’t receive any treatment for their anxiety. While there is no guarantee cause of anxiety or an anxiety disorder, there are effective treatments. Everything from genetics, the neurochemistry in your brain, your personality type, or traumatic events in your life can cause the onset of an anxiety disorder.

However it’s not quite so simple as saying that 40 million American adults suffer from anxiety every year. There are actually a myriad of different types of anxieties and disorders that develop because of them. In order from the most common to the least common, the different types of anxiety disorders that are most common in the US are listed below.  

1- Specific Phobias

Surprisingly to this writer the most common form of anxiety is that of individuals with what are called specific phobias. These are predominantly commonly heard of phobias. Such as a fear of public speaking, a fear of flying, a fear of inclosed spaces, a fear of spiders and scorpions, fear of blushing, fear of becoming ill, and a fear of driving. Almost 19 million American adults suffer from some form of a specific phobia which accounts for nearly 9% of the U.S. population.

2- Social Anxiety Disorder (SAD)

The second most common type of anxiety disorder in the United States is called Social Anxiety Disorder (SAD) and it affects nearly 15 million adults. Close to 7% of the adult U.S. population!

According to an ADAA survey from 2007, 36% of people with social anxiety disorder reported that they experienced symptoms for 10 years before they sought out professional help.

People with social anxiety disorder report an intense anxiety or fear of being judged and/or negatively evaluated. They believe they will be rejected in social situations due to their anxiety of being perceived in a poor light. They are concerned with appearing misinformed, awkward, unattractive, or uninteresting when they are in social situations. This includes a psychosomatic reaction when such social situations cannot be avoided. The physical symptoms include an elevated heart rate, nervousness, sweating, or even full blown panic attacks. Although most individuals with SAD report that they were very shy when they were children, this disorder is not as simple as shyness as it has quantifiable psychological and emotional effects.

social anxiety blue head in crowd
Social anxiety causes individuals to be extremely uncomfortable and self conscious in social settings.

3- Major Depressive Disorder (MDD)

The third most common form of an anxiety disorder in the US in Major Depressive Disorder (MDD). This disorder is actually the leading cause of all disabilities in the United States for those aged between 15 and 45. It affects more than 16 million adults every year in the United States and 6.7% of people in the United States suffer from it every single year.

4- Posttraumatic Stress Disorder (PTSD)

The fourth most common type of anxiety disorder that adults suffer from in the United States in Posttraumatic Stress Disorder (PTSD).  Probably the most commonly heard of events that trigger PTSD in the United States are war and military conflicts along with the torture that goes along with them. However, PTSD can actually be caused by a whole wide variety of factors and events including serious accidents, physical or sexual assault, childhood or domestic abuse, serious health problems that lead to hospitalization, child birthing experiences such as a miscarriage, and anything else that causes unusually high levels of stress and anxiety. The strongest indicator for the development of PTSD is the occurrence of childhood sexual abuse. However, The causal factors for PTSD are so wide ranging that it affects 7.7 million adults. That’s close to 4% of the U.S. population every single year.

5- Generalized Anxiety Disorder (GAD)

The fifth most common form of anxiety disorder in the United States is Generalized Anxiety Disorder (GAD). GAD often occurs simultaneously in those who suffer from Major Depressive Disorder. GAD affects 6.8 million adults every year. That’s a little over 3% of the U.S. population, yet only 43.2% who suffer from the disorder are receiving treatment.

Perhaps one reason so few of those suffering from GAD seek treatment is because it can be difficult to diagnose, The disorder has a mixed and eclectic list of symptoms that make it hard for a psychiatrist to pin down, let alone someone at home who is suffering from the disorder. The symptoms include a disruption in normal thought processes such as persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events. 

Overthinking plans and solutions to all possible worst-case outcomes. Perceiving situations and events as threatening, even when they aren't. Difficulty handling uncertainty. Indecisiveness and fear of making the wrong decision. Inability to set aside or let go of a worry. Inability to relax, feeling restless, and feeling keyed up or on edge. Difficulty concentrating, or the feeling that your mind "goes blank."

In addition to the common psychological symptoms of GAD there are also numerous physical signs and symptoms. These can include everything from fatigue to trouble sleeping. Additionally it's not uncommon for symptoms like, muscle tension or muscle aches, trembling, feeling twitchy, nervousness or being easily startled, sweating, nausea, diarrhea or irritable bowel syndrome, or irritability to be reported by those suffering from GAD.

Anxious person holding legs
Only 43% of those suffering from a Generalized Anxiety Disorder seek treatment.

6- Panic Disorder (PD)

The sixth most common anxiety disorder in the US is called Panic Disorder and it affects 6 million adults, or a little under 3% the U.S. population. When a person experiences panic attacks commonly they are known to have a panic disorder. Panic attacks typically begin suddenly, without warning. A panic disorder is diagnosed in patients who experience “spontaneous seemingly out-of-the-blue panic attacks” who became increasingly fearful that they will suffer another attack

Panic attacks have many variations, but symptoms usually include a sense of impending doom or danger. A fear of loss of control or death. Or even a feeling of unreality or being detached from the reality around you. A rapid, pounding heart rate, sweating, trembling, shaking, a shortness of breath or tightness in your throat. They can even include pretty extreme physical symptoms such as chills, hot flashes, nausea, abdominal cramping, chest pain, a headache, dizziness, lightheadedness or faintness, or even a numbness or tingling sensation.

One of the difficult things about suffering from a panic disorder is that it can cause other disorders to develop. Such as a feeling of generalized anxiety that you will have another panic attack, or a specific phobia about doing the thing you were participating in the last time you had an attack, or even outright avoidance of social situations to avoid having an attack in front of other people.

Person huddled in anxiety
Anxiety attacks can cause those who suffer from them to entirely avoid social situations. 

The final two most common types of anxiety disorders in the US are Persistent depressive disorder, or PDD, (formerly called dysthymia) and Obsessive-Compulsive Disorder (OCD). PDD is a form of depression that happens continuously for at least two years. And it affects nearly 1.5% of the U.S. population of those that are over the age of 18, or roughly 3.3 million Americans. OCD is a little less common as it only affects 1% of the adult population in the United States.

So What Is Transcranial Magnetic Stimulation and How Does it Help?

A Marvel of Modern Medicine using Magnets to Manipulate Mental Health

Transcranial Magnetic Stimulation has only been approved by the United States Federal Government for psychotherapy since 2008. However, the idea dates back nearly 150 years. In 1881 English physicist Michael Faraday first observed that you could create a magnetic field by sending a pulse of electrical current passing through a wire coil. He also observed that the magnetic field created by the first coil could be influenced and manipulated by introducing another coil, or any other conductor of electricity, nearby. By introducing another electrical coil nearby another magnetic field would be created. The interaction between these two magnetic fields is what has allowed his mechanical experiments during the industrial revolution in the 20th Century to become a miracle of modern medicine during the technological revolution in the 21st Century. 

However, it wasn’t until the 1980s  that psychiatrists P. A. Merton & H. B. Morton first stimulated a specific portion of the brain using Transcranial Electrical Stimulation (TES). Although this was a massive step forward for the field of psychiatry, the use of electrical currents was uncomfortable and painful for the patients. The first person to begin exploring alternatives to TES was Anthony Baker at the University of Sheffield in England in 1985. Due to the underlying physical connection between electricity and magnetism, Baker was able to surmise that in the same way that Transcranial Electrical Stimulation could be used to stimulate specific parts of the brain, Transcranial Magnetic Stimulation might be able to do the same thing. By exploring how the use of magnetic fields influence the electrical signals and impulses in the brain, he was able to create the first function and stable Transcranial Magnetic Stimulation device.

person holding up sign that says help
The vast majority of those suffering from mental health issues in the US go undiagnosed because they do not seek treatment.

However, the devices' therapeutic use, their use in psychotherapy and treatment of depression, wasn’t discovered right away. Early on the devices were really just used as diagnostic tools that would allow scientists to monitor the activity in different portions of the brain. In 1991 the journal Neurology published an article title Induction of Speech Arrest and Counting Errors With Rapid-Rate Transcranial Magnetic Stimulation by Alvaro Pascual-Leone. This article kicked off nearly two decades of research, clinical experiments, and conferences amongst the scientific community. The research continued to build and build, along with the scientific consensus. After it was discovered that TMS could be “leveraged for therapeutic applications in neurology, psychiatry and rehabilitation” the United States Federal Government approved the devices for psychotherapy in 2008. 

How Are Magnetic Fields Used to Treat Anxiety?

Targeting the Magnetic Field At The Cellular Architecture That Creates Anxiety

In general an anxiety disorder occurs from an excessive or over stimulating the part of the brain that underlies our fight-or-flight response. Or in other words, the part of the brain that controls fear. Thus far, studies have shown an outstanding result from the application of TMS for those who suffer from depression. They have also shown a significant benefit for individuals who have been diagnosed with any kind of depression cross diagnosed with a form of anxiety. In the cases of those who suffer from anxiety and depression, symptoms of BOTH disorders have been shown to have been reduced through TMS.

Although several brain circuits are activated simultaneously when a person finds themselves in a fight or flight scenario, the amygdala is responsible for the fastest response to danger. The amygdala communicates with the hypothalamus, located down  at the very base of the brain. Since the hypothalamus is responsible for releasing hormones, when the amygdala alerts it of danger it promptly releases hormones that increase blood pressure and raise the heart rate. The hormones help the muscles tense up to get the body ready for a fight or a run. This whole process takes place subconsciously. Allowing us to jump out of the way of a dangerous situations before we are consciously aware of what is happening. This is a useful feature of human biology because it serves as a survival mechanism. Helping us avoid getting hunted in nature or killed in society.

Unfortunately the same portion of the brain that controls our fight or flight response, the amygdala, also works with and communicates with other structures in the brain that control and store our emotional memories. These memories can include almost anything, but they certainly include memories of different frightening events and scenarios in our lives. It is theorized that the amygdala may be so sensitive in people with anxiety disorders that it just overreacts all the time. Setting off our flight or fight response in totally normal situations that don’t actually threaten our physical well being. This inadvertently triggers the circuits in our brain that we rely on in times of emergency and stress to provide us with the appropriate response. Over a lifetime this kind of overactive amygdala causes anxiety to become attached to completely non-harmful situations, thoughts, and even memories. Although none of these things pose an actual danger to the person suffering from anxiety, the neural pathway is primed and ready to go. Due to this the brain, or more specifically the amygdala creates its own fears out of nothing and this causes a person with anxiety to suffer fight or flight responses in their neurochemistry for practically no reason.

Photo of left brain vs right brain
By focusing magnetic fields on certain portions of the brain, doctors are able to influence the sensitivity of different sections.

TMS uses concentrated magnetic fields to target certain portions of the brain. Due to the underlying connection between magnetism and electricity, scientists are able to manipulate the amount of neural activity that happens in different portions of the brain by using these magnetic fields. By targeting the dorsolateral prefrontal cortex of the brain, scientists and doctors are able to raise or lower the amount of activity that is happening in and around the amygdala. 

Being able to increase other neural activity in the brain, or reduce the activity in the amygdala, doctors are able to allow their patients to more efficiently regulate the stress and anxiety they suffer from. By making the amygdala less sensitive it is less likely to alert the hypothalamus of a fight or flight scenario, and therefore the hypothalamus is less likely to release the hormones that drive us into heightened states of stress and anxiety.

Remember! Outside of the underlying brain chemistry there are a wide variety of factors that can cause you to suffer from anxiety.The totality of a person’s Life experiences must be taken into consideration when attempting to treat their mental health. Severe or constant stress in your life can produce a hyperactive anxiety reaction. You might even be predisposed to anxiety if you have personality traits like being shy. Psychotherapists help patients to recognize, analyze, and address what contributes to their anxiety.

Many people who are suffering from some form of  an anxiety disorder also have another psychological disorder or physical illness occurring simultaneously. For instance Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to a Generalized Anxiety Disorders. This means it is possible/likely you will suffer from symptoms from both disorders at the same time. 

The most common pairing of disorders are Major Depressive Disorder and Generalized Anxiety Disorder. Nearly half of all of those diagnosed with one, are diagnosed with the other. This can make the symptoms more severe and more difficult to recover from. It’s essential to speak with your doctor about all of your symptoms and disorders. Only treating one part of a problem can’t fix it, so make sure you talk honestly with your physician or psychiatrist so that you can be treated for every disorder or ailment you are suffering from in order to live a wholly happy and healthy life.

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