Can TMS Make Anxiety Worse?

Yes, transcranial magnetic stimulation (TMS) can make anxiety worse for some people temporarily, especially during the first few weeks of treatment. While that can feel unsettling, it doesn't necessarily mean anything is wrong or that treatment isn't working. In many cases, it's just a short-lived part of the brain's adjustment process and improves as treatment continues, says Jessica Criser, PMHNP-BC, a psychiatric nurse practitioner at Radial.

Quick answers

• A temporary anxiety increase can happen, especially during the first few weeks of TMS.
• For many people, anxiety improves as the brain adjusts to TMS.
• Don't stop treatment on your own—if you’re concerned about the anxiety you’re experiencing, tell your care team. They can help determine what's normal and what may need extra attention.

Why TMS can temporarily increase anxiety

If you've noticed your anxiety feels a little higher after starting TMS therapy, you're not imagining it. A small number of people experience a temporary increase in anxiety during the first few weeks of treatment.

Part of the reason is that TMS is designed to change patterns of brain activity that may have been blunted by depression. Michael Denoyer, MHS, PA-C, a physician assistant at Radial, compares that blunting process to a river whose natural flow has gradually been blocked by a dam.

"With TMS, we're trying to break that dam down," he says. "And when we do, there can be a flood of emotions. That’s representative of higher anxiety or even lower mood (aka a ‘TMS dip’) until the water stabilizes."

"Sometimes anxiety can increase just because your brain is used to what's normal for it," adds Criser. As the brain adjusts to new stimulation, temporary anxiety, restlessness, or emotional ups and downs can occur. And for some people, the unfamiliar experience of TMS itself—like the tapping feeling or loud noises—can add to those feelings early on.

The reassuring part is that this TMS side effect is usually short-lived. Denoyer says any increased anxiety often stabilizes within a few days. 

And for many people, that's not where the story ends according to research published in Neuropsychiatric Disease and Treatment. As the brain adapts to the stimulation, pre-treatment anxiety levels often begin to improve as well. Criser says those changes typically become more noticeable around halfway through your course of treatment.

How to tell a normal adjustment from a response worth flagging

A temporary increase in anxiety is often part of the adjustment process, but it's still worth mentioning to your care team, according to Denoyer. 

After all, not every increase in anxiety is caused by TMS. He says providers look at factors like sleep, stress, medication changes, and how symptoms are trending over time to better understand what's driving the change.

Still, it's important to pay attention to how you're feeling. If your symptoms continue to intensify, feel significantly different than usual, or are accompanied by paranoia, hallucinations, severe agitation, or a dramatic decrease in sleep, Criser says it's important to contact your provider right away.

Most importantly, don't feel like you have to figure it out on your own. Keep your care team in the loop about what you're experiencing. They can help determine whether it's a normal part of the adjustment period or something that deserves a closer look.

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