Anxious Depression
Depression with prominent anxiety — historically the hardest subtype to treat with medications.
Anxious depression — major depressive disorder with high comorbid anxiety — has historically been the most treatment-resistant subtype. Antidepressants and figure-8 TMS both perform worse in patients with elevated baseline anxiety. Deep TMS is the only TMS system FDA-cleared specifically for this presentation.
In pooled analyses, higher baseline anxiety actually predicts a *better* response to BrainsWay H1 — the opposite of what is observed with SSRIs and figure-8 coils. The mechanism is thought to involve the broader medial prefrontal field of the H1 coil reaching anxiety-relevant networks that the focal figure-8 field cannot.
FDA status
FDA-cleared (BrainsWay H1, 2021 — first TMS system cleared for the indication)
Standard protocol at IPMG TMS
20–30 sessions over 4–6 weeks · H1, 18 Hz
- Effect size 0.55 on anxiety (HAM-A)Pooled RCT analysis demonstrating superiority over figure-8 coils.Pell et al., J Clin Med 2022
- Higher baseline anxiety → larger responseInversion of the typical pattern seen with antidepressants and figure-8 TMS.
Who this is for.
- Adults with MDD and elevated baseline anxiety
- Patients who failed SSRIs/SNRIs because anxiety symptoms intensified
- Patients who did not respond to figure-8 TMS
Eligibility is finalized at consultation. We screen carefully for contraindications — see the Safety page.
Talk with the IPMG TMS team.
A consultation is the right next step. We will review your prior treatments, confirm whether you meet the FDA-cleared criteria for this indication, and walk you through what your insurance covers.