It depends on whether depression is part of the picture. TMS is FDA-cleared for anxiety symptoms that come with major depression: several systems are cleared "for decreasing anxiety symptoms" in adults with major depressive disorder who have not improved enough on antidepressants. TMS is not cleared for anxiety disorders on their own, such as generalized anxiety disorder (GAD), panic disorder or social anxiety. Used for those, it is off-label, and the research is still at an early stage.
That distinction decides almost everything else: how strong the evidence is, what a TMS team can reasonably offer, and whether insurance is likely to help. This page takes each situation in turn.
Two different situations, side by side
| Depression with anxiety symptoms | Anxiety disorder without major depression | |
|---|---|---|
| FDA status | Cleared on several systems (NeuroStar, BrainsWay, others) | Not cleared; off-label |
| Who it is for | Adults with major depression who have not improved enough on antidepressants in the current episode | No defined population; research settings or individual off-label decisions |
| Evidence | Built on the depression trial base | Small trials, mixed results, low certainty |
| Usual target | Left prefrontal cortex, as for depression | Varies from study to study |
| Insurance | Assessed under depression criteria | Rarely covered |
What "cleared for anxious depression" actually means
BrainsWay's Deep TMS received this wording in August 2021, and NeuroStar in July 2022. More systems have followed, including Apollo in May 2026 and MagVenture's accelerated system, whose indication covers major depression including comorbid anxiety symptoms. The cleared wording is narrow and specific: treating depressive episodes "and for decreasing anxiety symptoms for those who may exhibit comorbid anxiety symptoms" in adults with major depressive disorder who did not improve enough on previous antidepressant treatment in the current episode.
In plain terms, the label recognizes something most people with depression already know: worry, tension, restlessness and dread often travel with low mood. If you qualify for TMS for depression, those anxiety symptoms are part of what the treatment is expected to address and what your team will track. It does not mean TMS is a treatment for anxiety in general. The depression comes first in the criteria.
The treatment itself is the standard depression course: daily sessions over several weeks, usually to the left dorsolateral prefrontal cortex. For the basics, see what TMS therapy is, and for whether you fit the depression criteria, the TMS candidacy checklist.
Is it depression with anxiety, or an anxiety disorder?
Because the label hinges on major depression, the diagnosis matters more than usual. Many people describe themselves as "anxious" when a careful assessment finds a depressive episode underneath, and the reverse happens too. Signs that depression may be driving the picture include:
- loss of interest or pleasure in things you used to enjoy, not only worry about them;
- low mood most of the day, nearly every day, for weeks at a time;
- changes in sleep, appetite or energy that do not lift on calmer days;
- feelings of worthlessness or guilt, or thoughts that life is not worth living.
Signs that an anxiety disorder may be the main problem include worry that has run for months across many topics, panic attacks that come out of the blue followed by fear of the next one, or intense fear of being judged that shapes what you avoid. Many people have both, and that is exactly the group the anxious-depression label was written for.
A psychiatric evaluation sorts this out. Bring a list of what you have tried, for how long and at what dose, and an honest description of what a bad week looks like. If you are already being treated for depression and anxiety is the part that never seems to improve, say so directly; it changes how a TMS team will measure success.
If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.
Anxiety disorders on their own: an honest look at the evidence
Generalized anxiety disorder
GAD has the most research of the anxiety disorders, and it is still mixed. A 2026 systematic review of sham-controlled trials found low-strength evidence that TMS reduced symptom severity and no evidence of benefit for remission, meaning TMS was not shown to make full recovery more likely than sham. A 2025 meta-analysis of 29 trials, most of which added TMS to medication, favored TMS but flagged high variation between studies. The European evidence-based guideline for rTMS does not rate efficacy as definite or probable for any condition outside a short list, and GAD is not on it.
Panic disorder and social anxiety
The evidence is thinner still. A 2026 systematic review of treatments for treatment-resistant GAD, panic disorder and social anxiety disorder in adults found only "inconclusive support" for rTMS, and noted that the studies across all treatments were mostly small with methodological limitations. If a clinic markets TMS as a treatment for panic attacks, ask what it is basing that on.
PTSD and OCD are different stories
Two conditions once grouped with anxiety have their own clearances. For OCD, TMS is cleared as an add-on for adults; see TMS for OCD. For PTSD, the first TMS-based system was cleared in June 2026, also as an add-on for adults, and the wider evidence is reviewed in TMS for PTSD.
Where TMS fits if anxiety is your main problem
For anxiety disorders, the established treatments are well studied and should come first: cognitive behavioral therapy, including exposure-based work, and medication such as SSRIs or SNRIs. TMS is not a substitute for them. Practical steps that usually make more sense before considering off-label TMS:
- A full course of CBT for anxiety, with a therapist trained in exposure for panic or social anxiety.
- A careful medication review: dose, duration, and whether a different class would suit you better (see medication in anxiety and depression care).
- A check for medical contributors, sleep problems, alcohol and caffeine.
- A second look at the diagnosis. Panic, health anxiety and depression overlap more than people think, as this guide to anxiety vs panic disorder shows.
If, after that, a psychiatrist suggests off-label TMS, it should come with a clear explanation of the evidence, the protocol, the cost and how you will both judge whether it worked. Other options for stubborn anxiety are also worth knowing about, including ketamine-based therapy, which has its own evidence questions.
Will TMS make my anxiety worse?
A common worry, and a fair one. The first sessions are loud and the tapping on the scalp is unfamiliar, so some nervousness at the start is normal; it usually settles as the routine becomes predictable. Read what TMS feels like before your first appointment, because knowing what is coming helps.
Scalp discomfort and headache are the most common side effects, and are usually mild and temporary. Anxiety does appear in FDA's voluntary adverse-event database: in an analysis of 200 reports through April 2025, anxiety was the most frequently reported symptom, at 8.2% of reports. Those are unverified reports, not rates, so they cannot tell you how often it happens. They are a good reason to tell your team promptly if anxiety rises during a course, so they can look at sleep, caffeine, medication changes and the treatment itself. The full list is in TMS side effects.
Tracking anxiety during a TMS course
If you are having TMS for depression with anxiety, ask your team to measure both. Depression scales such as the PHQ-9 are routine; adding an anxiety measure such as the GAD-7 at the start, midway and at the end shows whether the anxiety part is moving too. Tracking your progress during TMS explains how these scales work and how to read them.
Keep your own notes as well. Anxiety often improves in ways a questionnaire misses: fewer evenings lost to worry, an easier time falling asleep, getting through a work meeting without rehearsing it all night.
Questions to ask a clinic offering TMS for anxiety
- Is this the cleared anxious-depression use, or off-label treatment for an anxiety disorder?
- Which device and protocol will you use, and which part of the brain will you target?
- What published evidence supports that protocol for my diagnosis?
- How will you measure anxiety, not only depression, and when will we review progress?
- What will it cost if insurance declines, and what happens if I have not improved by the end?
Clear, specific answers are a good sign. Vague claims of high success rates for "anxiety," without saying which condition or which study, are not.
Insurance: what to expect
Coverage follows the cleared use. If you have major depression with anxiety symptoms and meet your plan's depression criteria, TMS is assessed like any depression request. For an anxiety disorder alone, TMS is an off-label use, so coverage is unlikely. Aetna's policy, for example, lists anxiety disorders among the conditions for which TMS is experimental. Ask your plan in writing before starting, and expect to pay out of pocket if you go ahead. The details of how plans decide are in does insurance cover TMS.
For anxiety care more broadly, see the practice's anxiety, health anxiety and panic disorder services. The TMS guide covers the rest of the TMS topics, and the TMS therapy page explains how to begin a conversation about whether it fits you.
Sources
- 510(k) K210201, BrainsWay Deep TMS (MDD with comorbid anxiety symptoms). U.S. Food and Drug Administration, 2021. accessdata.fda.gov
- 510(k) K220127, NeuroStar (MDD with comorbid anxiety symptoms). U.S. Food and Drug Administration, 2022. accessdata.fda.gov
- openFDA 510(k) API, product code OBP, and FDA 510(k) summaries for each K-number. U.S. Food and Drug Administration, 2026. api.fda.gov
- 510(k) K260189, MagVenture Accelerated TMS (aTMS) Therapy System. U.S. Food and Drug Administration, 2026. accessdata.fda.gov
- 510(k) K231926 and 510(k) Summary, NeuroStar Advanced Therapy System. U.S. Food and Drug Administration, 2024. accessdata.fda.gov
- A systematic review of transcranial magnetic stimulation for generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. BMC Psychiatry, 2026. europepmc.org
- Effectiveness and safety of repetitive transcranial magnetic stimulation for generalized anxiety disorder: A meta-analysis and trial sequential analysis of randomized controlled trials. General Hospital Psychiatry, 2025. europepmc.org
- Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018). Clinical Neurophysiology (Lefaucheur et al.), 2020. pubmed.ncbi.nlm.nih.gov
- Integrative Systematic Review on Pharmacological, Psychotherapeutic, and Neurostimulatory Treatment Options in Treatment-Resistant Anxiety Disorders. Psychotherapy and Psychosomatics (Schiele et al.), 2026. pubmed.ncbi.nlm.nih.gov
- 510(k) K260402, Wave Neuroscience MeRT System. U.S. Food and Drug Administration, 2026. accessdata.fda.gov
- Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. Journal of Clinical Psychiatry (Janicak et al.), 2008. europepmc.org
- Postmarketing Safety of Transcranial Magnetic Stimulation: A 10-Year MAUDE Database Analysis of Adverse Events and Technological Advancements. Journal of Clinical Psychiatry (Awan et al.), 2026. pubmed.ncbi.nlm.nih.gov
- Transcranial Magnetic Stimulation and Cranial Electrical Stimulation (Clinical Policy Bulletin 0469). Aetna, 2026. aetna.com
- FDA 510(k) K212289 (NeuroStar Advanced Therapy for OCD) and De Novo DEN170078 (BrainsWay Deep TMS for OCD). U.S. Food and Drug Administration, 2022. accessdata.fda.gov
FAQs
Is TMS FDA-approved for anxiety?
TMS devices are FDA-cleared, not approved. Several are cleared for decreasing anxiety symptoms in adults with major depression. None is cleared for an anxiety disorder on its own, such as GAD or panic disorder.
Can TMS help panic attacks?
The evidence is limited. A 2026 review of treatment-resistant panic disorder, GAD and social anxiety found only inconclusive support for rTMS. CBT and medication remain the standard treatments.
Will insurance cover TMS for generalized anxiety disorder?
Usually not on its own, because it is off-label. If you also have major depression and meet your plan's depression criteria, the request is assessed as a depression treatment.
Do I need to stop my anxiety medication for TMS?
Not as a rule. Many people continue their medications during TMS. Any change should be planned with your psychiatrist; see medications during TMS for the details.
How is TMS for anxiety different from TMS for depression?
For anxious depression it is the same depression treatment. Research on anxiety disorders alone often uses different targets and settings, and none of those protocols is FDA-cleared.
