There are six recognized types of anxiety disorder, categorized by the situations in which the anxiety emerges. The most common is generalized anxiety, in which symptoms arise throughout the day without regard to what is happening. The other types are agoraphobia (fear of leaving your house or going to unfamiliar places), social anxiety disorder (fear of being in social situations), separation anxiety disorder (fear triggered by being away from familiar people), and other phobias (fears triggered by being around specific triggers such as spiders, heights, or unclean places). Periods of anxiety that escalate to the level of panic within the first few minutes and then last for up to a few hours are called panic attacks or panic disorder.

There are many different options for treating anxiety. However, it is often so persistent that it may be difficult to gain effective control.

Psychotherapy treatment is essential in managing any anxiety problem. Without a therapist’s assistance in exploring the problems with your thought patterns, their origins, and potential strategies for change, your underlying anxiety is unlikely to improve. Unfortunately, many people with anxiety attempt to manage it with medications alone, because they fear that talking about their anxiety will make it worse. Therapy itself may even become a new phobia, making it even more difficult for the individual to make meaningful progress.

Skills training is another important approach to managing anxiety and correcting underlying problems. There are many different forms of therapeutic skills training, but skills training for anxiety often includes biofeedback technology, which allows patients to view their heart rate and breathing rate during practice. This can be helpful in breaking certain physical habits that cause or exacerbate anxiety, such as overbreathing. Even though a feeling of oxygen deprivation is a common symptom of a panic attack, breathing too fast and lowering the body’s carbon dioxide level can actually make anxiety worse. Anxiety can also occur when a person’s heart rate and breathing rate fall out of sync. Biofeedback helps patients practice resynchronizing them. This technique is called Heartmath and is offered as part of every TMS treatment at our center. Other effective methods we provide include progressive relaxation, exposure-response prevention, eye movement desensitization and reprocessing (EMDR), auricular acupuncture or acupressure, and massage.

There are four main classes of anti-anxiety medication treatment. 

1. Benzodiazepines (such as Xanax®, Klonopin®, Ativan®, Valium®, and others). Used as short-term aids, these can reduce anxiety once it appears. They are somewhat helpful in reducing anxiety episodes if taken regularly, but chronic use can lead to increased tolerance, lowered effectiveness, and addiction. Too much of a benzodiazepine can also cause shallow breathing and other complications. 
2. Antihistamine (anti-allergy) medications (such as Benadryl® and many others). These medications can reduce anxiety for a few days, but the body rapidly acclimates to them, reducing their effect. They can also cause significant drowsiness.
3. Sedatives, which make the central nervous system less reactive and thereby reduce anxiety. Sedative anti-anxiety medications come from many classes, including medications used for seizures, antipsychotic medications, and mood stabilizers. Most of these do not cause addiction but may make the patient cognitively or emotionally blunted. 
4. Antidepressant medications, particularly those that impact serotonin levels. These are considered the safest medications for anxiety, and can often block symptoms from emerging. They are not very effective at reducing anxiety once symptoms have already emerged, however, so they may not provide sufficient relief alone. Antidepressant side effects are common and include nausea, weight gain, dry mouth, blurry vision, constipation or diarrhea, and low sex drive or problems with sexual performance.

TMS treatment does not use medication, so medication side effects are not an issue. During treatment, a TMS (MRI) coil is placed over the part of the brain that becomes overactive when someone has anxiety. This part of the brain, the right dorsolateral prefrontal cortex can learn to slow itself down if it is given “inhibitory” pulses of energy. The magnetic energy only goes about an inch to an inch-and-a-half into the brain, in a region the size of a quarter. The rest of the brain and the body are not affected. These inhibitory pulses, applied in daily treatments over about four to six weeks, gradually retrain the relevant region of the brain to self-regulate and reduce overactivity. This in turn reduces both anxiety symptoms and the patient’s need for anxiety medication.

TMS use for anxiety is considered “off-label” by most insurance companies and thus may not be eligible for coverage. However, many people with anxiety also have depression (up to 60%). If this is the case for you, and you meet the standards for TMS depression treatment, then anxiety-focused (right-sided) treatment can be added to your TMS treatment plan at no additional charge and with no need for insurance approval. If you do not suffer from serious depression in addition to anxiety, then private pay for “off-label” treatment can be arranged.