TMS for Anxious Depression: What Patients Need to Know

Depression does not always feel like sadness alone. For some people, low mood, loss of interest, and fatigue occur alongside persistent worry, physical tension, racing thoughts, or difficulty calming down. When these symptoms overlap, treatment planning should address the full diagnosis rather than focus on one symptom in isolation.

Understanding how anxious depression differs from depression without prominent anxiety is an important first step. Those distinctions can shape the evaluation, the goals discussed with a clinician, and how progress is measured over time.

What Is Anxious Depression and How Is It Different from Standard Depression?

Anxious depression describes Major Depressive Disorder (MDD) that occurs alongside meaningful anxiety symptoms. A person may experience persistent sadness, loss of interest, low energy, or hopelessness while also dealing with excessive worry, restlessness, fear, irritability, or physical tension. The anxiety is not simply a reaction to feeling depressed. It can become a significant part of the clinical picture and should be assessed as part of the overall diagnosis.

How common is anxious depression?

Anxiety and depression frequently overlap. One review reports that approximately 60% to 90% of patients with depression experience moderate to severe anxiety symptoms. Research also indicates that about 50% of people with MDD experience an anxiety disorder during their lifetime. Anxiety disorders themselves are widespread, affecting an estimated 40 million adults in the United States. These figures help explain why clinicians commonly evaluate both mood and anxiety symptoms rather than treating them as separate concerns.

Assessment may include questions about sleep, concentration, motivation, worry, panic, physical tension, and how symptoms affect work, relationships, and daily responsibilities. Tools such as the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) can help clinicians track depression and anxiety symptoms over time. But they do not replace a comprehensive evaluation.

How does it differ from depression without significant anxiety?

Standard depression can be deeply disabling, but anxious depression often carries a higher overall symptom burden. Anxiety may intensify insomnia, difficulty concentrating, avoidance, agitation, and fear about treatment or the future. When both symptom groups are active, functioning can decline more sharply, and improvement in one area may not fully resolve the other. For example, mood may begin to lift while persistent worry continues to interfere with sleep and daily life.

For that reason, treatment planning often needs to address both parts of the diagnosis. Depending on a person’s history and clinical needs, this may involve psychotherapy, medication management, lifestyle support, and an interventional treatment such as TMS. A clinician may consider TMS therapy for depression when depression has not improved adequately with standard treatments, while also monitoring anxiety symptoms throughout care. A personalized evaluation can clarify whether a combined treatment approach is appropriate and identify realistic goals without promising a specific outcome.

Is TMS Approved for Anxious Depression?

Repetitive transcranial magnetic stimulation (rTMS) has been FDA approved for medication-resistant depression since 2008. That clearance established TMS as a treatment option for depression, but anxious depression involves a major depressive disorder diagnosis alongside significant anxiety symptoms. For that reason, it is important to distinguish the broader FDA clearance for depression from device-specific clearance related to anxious depression.

BrainsWay Deep TMS is the first TMS system specifically FDA-cleared for anxious depression. Its H1 Coil is designed to deliver Deep TMS to brain regions involved in mood regulation. While treatment planning remains individualized to each person’s symptoms, medical history, and diagnosis. A clinician can explain what the device’s clearance means for your care and whether this approach is appropriate for your treatment goals.

What the research shows about baseline anxiety

High anxiety does not necessarily make someone a poor candidate for Deep TMS. A peer-reviewed study published in PubMed Central found that Deep TMS using the H1 Coil was effective for comorbid anxiety in people with major depressive disorder. The study also reported that outcomes were not adversely affected by high baseline anxiety.

In fact, higher baseline anxiety was predictive of a successful H1-Coil outcome in that analysis. This finding differs from some earlier research on medication and superficial TMS, where anxiety has been reported as a negative predictor of effectiveness. It does not mean that Deep TMS guarantees improvement, or that anxiety alone determines treatment response. It does mean that anxious symptoms should not automatically rule out evaluation for this option.

FDA clearance is not the same as a personal recommendation

FDA clearance identifies how a device may be used based on available evidence. It does not replace a clinical evaluation or promise a particular result. A qualified provider will review your depression and anxiety diagnoses, prior treatment experience, medications, health history, and practical ability to attend sessions before recommending a treatment plan. If you are considering TMS for anxious depression, ask which system is being used. What evidence supports its use, and how the plan will address both sets of symptoms.

How Does Deep TMS Target Both Anxiety and Depression Symptoms?

Deep TMS is designed to influence brain networks involved in mood regulation, motivation, threat detection, and fear responses. The H1-Coil design can reach deeper and broader neural circuits than superficial TMS, which may be relevant when depression and anxiety symptoms occur together. Rather than treating each symptom as entirely separate, a clinician can assess how the symptoms interact and use that evaluation to guide treatment planning. Research on H1-Coil Deep TMS found that treatment outcomes were not adversely affected by high baseline anxiety. And higher baseline anxiety was associated with a more favorable outcome prediction in that study. Read the research on Deep TMS and comorbid anxiety.

Reaching circuits involved in mood and fear

Depression may involve changes in networks associated with mood, reward, concentration, and energy. Anxiety can involve heightened threat monitoring and fear responses. These networks overlap, so stimulation that reaches deeper targets may help address a broader pattern of symptoms than an approach focused only on a superficial cortical area. The treatment is not intended to erase difficult emotions or guarantee a specific outcome. Instead, it delivers repeated magnetic stimulation while the care team tracks symptoms and adjusts the plan when appropriate. This is one part of understanding how TMS therapy works.

What a typical treatment schedule looks like

A standard course usually includes sessions lasting about 20 to 40 minutes, four or five times per week, for approximately four to six weeks. The exact schedule depends on the protocol, clinical assessment, and individual response. Theta burst stimulation is a newer option that can take about 10 minutes per session and is generally provided daily for several weeks. A shorter session does not necessarily mean fewer treatment visits, so the clinician will explain which approach fits the patient’s diagnosis and goals. The Anxiety and Depression Association of America outlines common TMS protocols.

Safety and clinical monitoring

TMS is noninvasive and does not require anesthesia. With modern safety techniques, the reported risk of seizure or loss of consciousness is less than 0.1%. The care team still reviews medical history, medications, and risk factors before treatment, then monitors comfort and symptoms throughout the course. Patients should report unusual effects promptly so the treatment team can respond appropriately.

What Clinical Evidence Supports TMS for Anxious Depression?

Clinical evidence for TMS in anxious depression is especially relevant because treatment response needs to be evaluated across both anxiety and depressive symptoms. Measures such as the GAD-7 and PHQ-9 can help clinicians track those symptom domains separately rather than relying on a single overall impression. The evidence below supports Deep TMS as a treatment option, but individual results vary and should be discussed with a qualified clinician.

Clinical findings related to Deep TMS and anxious depression

Evidence comparison	Finding	What it means
Active Deep TMS vs. sham	Active treatment produced a significantly larger improvement in anxiety scores than sham treatment, with an effect size of 0.34 and p = 0.03.	The difference supports a treatment effect beyond the expectation or attention associated with receiving care.
Follow-up at 16 weeks	The improvement in anxiety scores remained significant at 16 weeks, with an effect size of 0.35 and p = 0.04.	The observed benefit was sustained during the study follow-up period, rather than appearing only immediately after treatment.
GAD-7 and PHQ-9 tracking	A clinical summary reports an average reduction of 50% or more in both GAD-7 anxiety scores and PHQ-9 depression scores after a full TMS course.	Using both measures can show whether anxiety, depression, or both are improving. This finding is from a clinical summary, not a guarantee for every patient.
Treatment-resistant depression	One clinical summary reports that approximately 80% of patients with treatment-resistant depression show some level of improvement with TMS.	Improvement may include meaningful symptom change without implying complete remission or a uniform response.

The pivotal randomized controlled trial found that active Deep TMS improved anxiety scores more than sham treatment, and the difference remained measurable at 16 weeks. Read the published study for the full methods and limitations. The broader clinical summaries of GAD-7, PHQ-9, and treatment-resistant depression outcomes should be interpreted in context, since study design, patient selection, treatment protocol, and follow-up can affect results.

For background on mechanisms, candidacy, and expected treatment planning, read our guide to TMS therapy for depression. A comprehensive evaluation can help determine whether Deep TMS fits your diagnosis, symptoms, prior treatment history, and goals.

Is TMS Right for You If You Have Both Anxiety and Depression?

TMS may be worth discussing when you have a depression diagnosis alongside persistent anxiety symptoms. Especially when medication has not provided adequate relief or has caused difficult side effects. The combination can make daily life feel especially demanding, with low mood, worry, irritability, sleep disruption, or difficulty concentrating reinforcing one another. A clinical assessment is necessary to determine whether TMS fits your diagnosis, treatment history, medications, and overall goals.

When Deep TMS may be worth considering

One encouraging finding is that high baseline anxiety does not necessarily make Deep TMS less appropriate. Research on the H1 Coil found that higher baseline anxiety was associated with a more successful outcome, unlike some earlier findings involving medication or superficial TMS. This does not predict an individual result, but it suggests that significant anxiety should be part of the evaluation rather than an automatic reason to rule treatment out. Read the research on comorbid anxiety and Deep TMS.

TMS is also non-invasive and performed while you are awake, without general anesthesia or sedation. With modern safety techniques, the reported risk of seizure or loss of consciousness is less than 0.1%. Although your clinician should review your medical history and any factors that may affect treatment safety. A typical course involves regular weekday visits over several weeks, so schedule and transportation are practical factors to consider.

What a consultation can clarify

During an evaluation, a clinician can review your depression and anxiety symptoms, previous medication trials, current medications, relevant medical history, and any prior therapy. They can also explain whether Deep TMS, another treatment approach, or a combination of care makes the most sense. Published summaries report that about 80% of people with treatment-resistant depression show some improvement with TMS, but improvement varies and no treatment can guarantee a specific outcome. Learn more about TMS for treatment-resistant depression.

Relief Mental Health offers Deep TMS at 12 locations across Illinois, Wisconsin, Colorado, and New Jersey. If you are considering treatment for co-occurring anxiety and depression, you can request a consultation to discuss whether an individualized assessment is appropriate for you.

Frequently Asked Questions

Can TMS help with anxiety and depression at the same time?

It may. Deep TMS using the H1 Coil has been studied for comorbid anxiety in people with Major Depressive Disorder. And research found that outcomes were not adversely affected by higher baseline anxiety levels. Treatment planning should assess both symptom groups rather than focusing on depression alone. A clinician can determine whether TMS fits your diagnosis, symptoms, treatment history, and overall care plan.

Is TMS approved specifically for anxious depression?

Traditional repetitive TMS has FDA approval for medication-resistant depression, while evidence continues to inform how Deep TMS may address anxiety symptoms occurring alongside depression. FDA clearance and clinical appropriateness are not the same question, so ask the treatment team which device, protocol, and diagnosis are relevant to your care. They can also explain alternatives and how TMS may fit with medication or therapy.

How long does a TMS treatment course take?

Many standard TMS protocols use sessions lasting about 20 to 40 minutes. Scheduled four or five times weekly for four to six weeks, according to the Anxiety and Depression Association of America (ADAA). Some theta burst protocols take about 10 minutes and are provided daily for several weeks. Your schedule depends on the selected protocol and clinical recommendations.

Is TMS safe if I have significant anxiety?

Significant anxiety does not automatically rule out TMS. Modern safety techniques are associated with a seizure or loss-of-consciousness risk of less than 0.1%, according to the ADAA. Your clinician should review your medical history, medications, implants, and other safety considerations before treatment. Report any relevant diagnosis or medication change so the team can make an informed recommendation.

Ready to Explore Your Next Step?

If anxiety and depression symptoms are affecting your daily life, a consultation can help you discuss your diagnosis. Treatment history, and whether Deep TMS may be appropriate for your needs. To schedule a consultation, call Relief Mental Health at (855) 205-4764.