Everything you need to know about Can TMS Make Anxiety Worse? What's Normal and What Isn't — how it works, what it costs, and how to find a provider who actually knows what they're doing.
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Can TMS make anxiety worse? For most people with depression, anxiety goes down along with mood as the course goes on. But some people do feel more anxious at some point, and we couldn’t find a controlled study that tells us how often. So we won’t give you a number we can’t back up. What we can do is show you what the research does say, what’s usually just a rough patch, and which changes mean you should call your clinic.
Key takeaways
- In studies of people with depression and anxiety, anxiety scores usually fall during a TMS course, not rise.
- The common side effects are scalp discomfort and headache. Anxiety isn’t among the common events NeuroStar lists.
- A short stretch of feeling more wound up, especially early on, is plausible and worth reporting. Tell your clinic even if it seems small.
- Rare but serious: a switch into mania or hypomania, mostly reported in people with bipolar disorder. Racing thoughts with very little need for sleep is a same-day call.
- Don’t stop or change any medication on your own because of how you feel. Your prescriber and TMS clinic should decide that together with you.
What the evidence says about anxiety and TMS
The research mostly points one way. The studies were designed to measure improvement, not to hunt for people who got worse, so they can’t rule out individual rough patches.
- Depression with anxiety. One study of 248 people with treatment-resistant depression included 172 with a diagnosed anxiety disorder. They improved, with 39.5% meeting response criteria and 23.3% reaching remission, and their scores on every anxiety and depression scale the researchers used dropped. There was no sham group, so some of that improvement may be placebo.
- Anxiety on its own. A 2022 meta-analysis of 6 studies in generalized anxiety disorder (152 people) found a large improvement with rTMS. A 2025 meta-analysis of 29 trials reached a similar conclusion for rTMS added to medication. Both flag high variability and a small number of trials. This is off-label: the FDA clearances for TMS are for other conditions, so treating anxiety alone is not what the devices were cleared for.
- Deep TMS. A retrospective analysis of Deep TMS trials, written by authors with ties to the device maker, found better anxiety scores than sham after four weeks. We’ll cover that clearance in a later post on TMS for anxious depression.
If you want the wider picture on anxiety conditions, see our anxiety treatment page.
Why you might feel more anxious at some point
None of these explanations has been tested in a trial that we could find. We’re listing them because they’re reasonable, not because they’re proven.
- Nerves about the treatment itself. The coil clicks and taps against your head. Some people find that unsettling, especially during the first few sessions and the motor threshold session. Most settle in within a week or two. Our guide to what TMS actually feels like walks through it.
- Sleep. Short or broken sleep makes anxiety louder. It also matters for safety: a review of 25 reported TMS seizures listed sleep deprivation as a risk factor.
- Daily life stress. Daily sessions mean daily appointments. Fitting TMS around work and family adds pressure for some people.
- A change in medication. If your doctor adjusts a medication during the course, that can affect how you feel. Mention any change to your TMS team.
- Mood symptoms moving around. Depression and anxiety don’t always improve at the same rate. You may feel more of one while the other eases.
Normal, call your clinic, or get help now
| What you notice | What it usually means | What to do |
|---|---|---|
| Scalp pain or tapping discomfort during sessions, headache afterward | The most common side effects. NeuroStar reports pain at the treatment site and headache as the most common events, with headache about as frequent in sham treatment | Tell the technician. Settings can often be adjusted |
| Nervous before sessions, calmer after | Common early on | Mention it. Ask about breathing or grounding tricks |
| Anxiety clearly above your baseline for several days | Not expected. Needs a look | Call your clinic that week |
| Panic attacks that are new, or worse sleep plus restlessness | Needs review of protocol, sleep and medications | Call your clinic that week |
| Very little need for sleep, racing thoughts, unusually high energy or irritability | Possible mood switch (mania or hypomania) | Call the same day |
| Thoughts of harming yourself | Emergency | Call or text 988 (US), or go to the nearest ER |
The rare serious one: mood switching
TMS can occasionally be followed by a switch into mania or hypomania. A review of the depression trials that reported on it (10 of 53 randomized trials) found a pooled rate of 0.84% with active TMS and 0.73% with sham, not a significant difference. Most of the published cases were in people with bipolar disorder, and many were also taking antidepressants. A later review recommends a mood stabilizer for bipolar depression before TMS, and rechecking for undiagnosed bipolar disorder in people being treated for major depression.
This is why a good intake covers your history of highs, not just lows. If you’ve ever had days of little sleep, unusual energy and big plans, say so. Our post on who should not get TMS covers screening in more detail, and TMS for bipolar depression explains how clinicians approach it.
Seizure risk, in proportion
Anxiety can make people worry about seizures, so here is the scale. NeuroStar’s safety information puts the estimated seizure risk in ordinary clinical use at about 1 in 30,000 treatments. International safety guidelines call the risk low, even in people taking drugs that act on the central nervous system, when standard protocols and coils are used. Clinics screen for seizure history and for alcohol and sleep problems because those raise the odds. We cover the medication side in detail in a later post on medications that affect TMS.
What to do if you feel more anxious
- Say so at the next session, or call before it. Don’t wait until the end of the course. A flat “I’m more anxious than when I started” is useful information.
- Bring numbers if you can. If your clinic uses the GAD-7 or PHQ-9, ask to see your scores over time. Our guide on tracking progress with the PHQ-9 shows how.
- Ask what can be adjusted. Clinics can sometimes change the session pace, how gradually the intensity builds, or the protocol. Ask what’s possible with your device.
- Check your sleep. Tell the team how many hours you’re actually getting.
- Keep your medications as they are until your prescriber says otherwise. Anxiety can be a reason to review medication, but the person prescribing it should make that call.
- Ask about the next step if it doesn’t settle. That might be a different protocol, a pause, or a different treatment. Our post on what to do when TMS isn’t working covers the options.
Getting through this isn’t a failure on your part. Plenty of people finish a course after a bumpy week or two.
Choosing a clinic that will listen
You want a team that asks about anxiety at intake, tracks your scores during treatment, and answers questions on the day, not three days later. Our list of questions to ask a TMS clinic includes how they handle side effects. When you’re ready, find a clinic near you, or take the two-minute candidate quiz to see whether TMS is worth raising with your doctor.
This article is general information, not medical advice. Talk to your doctor about your own situation.
Frequently asked questions
Is feeling anxious during a TMS session normal?
Some nervousness is common, especially at the start. The tapping sound and sensation are unfamiliar. If you feel panicky, tell the technician. They can pause the session. Most people adjust over the first week or two.
Can TMS cause panic attacks?
We found no controlled studies measuring panic attacks as a TMS side effect. Some people do report feeling panicky in the chair. If panic attacks are new or happening outside sessions, tell your clinic promptly so they can review your protocol, sleep and medications.
Will TMS treat my anxiety too?
It might help. Studies in people with depression and anxiety show anxiety scores usually fall as depression improves, and one Deep TMS system carries an FDA clearance for decreasing anxiety symptoms in adults with major depression. Treating an anxiety disorder alone with TMS is off-label, so results aren’t guaranteed.
I feel worse the first week. Should I stop?
Don’t quit on your own. Call the clinic and describe what changed. A few rough days early on don’t mean the course has failed, but a clear step backward should be reviewed. If you ever have thoughts of self-harm, call or text 988 or go to an emergency room.
Should I change my anxiety medication during TMS?
Not without your prescriber. Some medications can affect TMS response or seizure risk, and stopping suddenly can cause its own problems. Bring your full medication list to the clinic and let your prescriber and TMS team coordinate.
