Treating anxiety with TMS - the evidence

NHS Choices recommends trying to treat your anxiety with psychological therapy before anything else. The aim is to learn to cope with your anxiety so that when you experience the inevitable symptoms you’ve come to recognise; you will know how to handle them.

GPs tend to offer different forms of therapy, with some recommending books or computer programmes as a first point of call. Others might suggest group courses. Cognitive behavioural therapy (CBT) is commonly recommended for GAD and teaches positive coping strategies.

If psychological therapy hasn’t worked for you, there are several medications that you may be prescribed, each with their own benefits and side effects to consider. Although benzodiazepines, like Diazepam, are very effective in treating anxiety, they become addictive quickly. Benzodiazepines shouldn’t be used for longer than four weeks because they start to lose their effectiveness the more the body learns to rely on them.

• Selective serotonin reuptake inhibitors (SSRI) – like Sertraline, Escitalopram or Paroxetine. If one SSRI doesn’t work for you or causes unwanted side effects, your GP can recommend a different dose or prescribe a different SSRI;
• Serotonin and noradrenaline reuptake inhibitors (SNRI) – like duloxetine or venlafaxine;
• Pregabalin – this is an anticonvulsant drug, which can benefit anxiety.

Around 50% of patients don’t respond to any of the recommended treatment. If you don’t respond to any medications you’re prescribed with, your GP is likely to refer you to a psychological team who can suggest combinations of drugs and therapy or combinations of more than one drug.

A systematic review by Zhang et al. (2025) summarised evidence from multiple studies of rTMS in patients with GAD. Both low-frequency stimulation of the right dorsolateral prefrontal cortex (DLPFC) and high-frequency stimulation of the left or right DLPFC significantly reduced anxiety symptoms, with improvements sustained at follow-up. Meta-analytic evidence (Vergallito et al. 2021) found that rTMS significantly reduced anxiety symptoms in 154 patients with GAD (effect size = 0.64, p < .001) and improved co-occurring depression. These findings support rTMS as a safe and effective intervention for GAD, particularly for patients with did not respond to medication or psychotherapy.

At Smart TMS, we analysed 248 patients treated for generalized anxiety disorder. Approximately three out of four patients (71%) experienced at least a 20% improvement in symptoms, as measured by a reduction in GAD-7 scores. Over half of the patients (59%) achieved remission and no longer met the clinical threshold for generalised anxiety disorder, while one in four (27%) reported a near-complete resolution of their anxiety symptoms. These outcomes are favourable compared to results in published clinical studies.

Generalised Anxiety Disorder can significantly disrupt daily life and may not always respond to first-line treatments. We recommend following NICE guidelines for initial care. For patients with persistent, treatment-resistant symptoms, TMS offers a well-supported, effective alternative to reduce anxiety and improve quality of life. Discussing TMS with your healthcare provider can help decide if it is a suitable part of your treatment plan.

To find out more, contact our team of patient advisors. They can talk through the treatment and possible  outcomes and answer any questions you have.

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