On its own, major depressive disorder (MDD) is an incredibly challenging mental health condition for patients across the globe. Unfortunately, MDD does not often exist in isolation; other comorbidities, such as anxiety can complicate treatment plans. As first-line interventions (including antidepressants) become less effective in patients exhibiting anxious Depression, this often results in disheartening instances of treatment-resistant Depression, or TRD.
As the medical community searches for effective solutions to these challenges, transcranial magnetic stimulation (TMS) has been shown to hold incredible promise for people struggling with Depression. Now, studies are showing the clinical effectiveness of TMS for Depression with anxious distress.
Understanding Depression with Anxiety
Studies estimate that “approximately 50%–75% of individuals with a lifetime history of MDD also have a history of anxiety disorder.” Anxious Depression is defined as MDD with a comorbid anxiety disorder, MDD with a manifestation of anxious symptoms, and/or MDD with anxious distress specified as a qualifier in the DSM-5 (the latter of which is present in around 50%–75% of patients diagnosed with MDD).
The effects of Depression with anxious distress are both psychological and physical, including pervasive feelings of restlessness, worry, difficulty concentrating, exhaustion, and a rapid heart rate—among others. These additional symptomatic burdens often exacerbate the already debilitating effects of Depression, making it even more challenging for struggling individuals to find long-term relief. Over time, these co-occurrences have been proven to lead to symptom severity, a diminished response to antidepressant medication, baseline functional impairment, and in the worst-case scenario, expressions of suicidality.
The Clinical Impact of TMS for Depression with Anxious Distress
By delivering magnetic pulses toward regions in the brain responsible for Depression, TMS works to regulate areas of over- or under-activity and thereby restore neurological balance; this treatment has proven to be life-changing for countless patients who have been unresponsive to other approaches to dealing with MDD.
But what about the efficacy of TMS for Depression with anxiety? Because TMS works to normalize activity in the dorsolateral prefrontal cortex (DLPFC)—an area involved in both Depression and anxiety—many studies suggest that by nature, TMS can lead to a significant reduction in both depressive and anxious symptoms. Recent research published in The Journal of Clinical Psychiatry in 2023 provided a retrospective analysis of clinical data from 43 sites concerning the efficacy of TMS treatments on patients suffering from Depression and comorbid anxiety.
Drawing from the database of the NeuroStar Advanced Therapy System Clinical Outcomes Registry, the study identified 1,820 patients who had been diagnosed with MDD and subsequently evaluated on the Global Anxiety Disorder-7 scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Of those patients, 1,514 individuals were identified as having anxious Depression with a baseline GAD-7 score of 10 or higher, and the remaining 306 measured below this threshold.
After receiving various TMS protocols, patients with anxious Depression experienced an average reduction of 50% or greater in both their GAD-7 and PHQ-9 scores, proving that TMS inspires “clinically meaningful anxiolytic and antidepressant effects” in affected individuals. Both the anxious and nonanxious groups showed dramatic improvement in their PHQ-9 scores, response, and remission following rTMS treatments.
Importantly, the anxious depressed subgroup had overall higher PHQ-9 scores at both baseline and end of treatment (with a mean difference of 2-3 points), meaning that despite offering a similar magnitude of antidepressant effects between the groups, TMS treatments resulted in lower rates of response and remission in patients with anxious Depression. Thus, the study’s findings remain consistent with the pharmacologic literature—because symptoms of anxiety are correlated with more severe instances of Depression, it follows that response and remission rates would be lower amongst this subgroup.
Even so, these findings are incredibly significant; the dual anxiolytic and antidepressant effects of TMS treatments produce an improvement in the symptoms of both diseases that strongly covary, offering new hope to patients and clinicians in the fight against anxious Depression.
Overcome Your Anxious Depression with Mid City TMS
Here at Mid City TMS, our experienced clinicians pride themselves on our contemporary approach to treating patients with anxious Depression using safe, non-invasive TMS technologies that take into account our patients’ holistic medical profiles; we ensure that our care encompasses all aspects of your mental wellness leaving no stone unturned.
Contact us to learn more about how TMS can improve the quality of your life and help you manage both your anxiety and your Depression today.