Transcranial Magnetic Stimulation goes far beyond depression. What scientific research reveals about TMS for anxiety, OCD, and addictive disorders—and what that means for Portuguese patients.
TMS for anxiety is one of the areas with the most growing scientific evidence. When you search for “TMS for anxiety” or “TMS treatments available in Portugal for anxiety,” the results available online are often generic or outdated. In fact, when people talk about TMS in Portugal, the conversation almost always centers on depression. This is understandable—the first regulatory approval was granted for treatment-resistant major depression. But limiting TMS to depression would be like describing a precision instrument solely by its first approved indication.
The MAGNITUDE clinical trial, published in *Brain Sciences* in 2025 (Rech et al.), represents just the latest chapter in a scientific history that encompasses obsessive-compulsive disorder, generalized anxiety disorder, social anxiety disorder, addictive disorders, and pathological gambling. At The Clinic of Change in Lisbon, we work with clinically grounded protocols for several of these conditions.
What can you do about anxiety when conventional treatments aren't enough?
Anxiety—in its various forms—is the most prevalent psychiatric disorder in Portugal and Europe. Generalized anxiety, social anxiety, panic disorder, and anxiety comorbid with depression affect a significant proportion of the population. For many, cognitive-behavioral therapy and medication are sufficient. For others, symptoms persist, significantly impacting their quality of life.
Social anxiety, in particular, is one of the most underdiagnosed conditions: it is characterized by an intense and persistent fear of social situations, accompanied by an anticipation of being judged or feeling embarrassed. In fact, it goes far beyond shyness—it is a disorder that can profoundly limit relationships, work, and daily life. TMS for social anxiety is one of the areas with a growing body of evidence, although formal regulatory approval is still in the works.
TMS for anxiety: what does the science say?
Although formal regulatory approval of TMS for anxiety is still pending, the scientific evidence supporting its clinical use is substantial. For example, recent meta-analyses demonstrate a significant reduction in anxiety symptoms with rTMS (Repetitive Transcranial Magnetic Stimulation), particularly in generalized anxiety disorder and in anxiety comorbid with depression. The review by Garnaat et al. (Brown University, 2019) confirms that, in many cases, the response to TMS includes a concurrent improvement in anxiety symptoms, even when the protocol was designed for depression.
The practical questions patients most often ask about TMS for anxiety—“how does it work,” “which clinics offer it in Portugal,” “how much does it cost”—have straightforward answers: the mechanism is the same as for depression (neuromodulation of the prefrontal cortex), and specialized clinics in Lisbon already offer this treatment protocol.
Obsessive-Compulsive Disorder: Regulatory Approval
Obsessive-Compulsive Disorder (OCD) is one of the most disabling psychiatric conditions, with a lifetime prevalence of 2 to 3 percent. However, the standard treatment—cognitive-behavioral therapy with exposure and response prevention, combined with high-dose SSRIs (selective serotonin reuptake inhibitors)—fails to provide an adequate response in about two-thirds of patients.
In 2018, the FDA approved Deep TMS for the treatment of OCD, based on the trial by Carmi et al. (American Journal of Psychiatry, 2019), which demonstrated a clinically significant reduction on the Y-BOCS scale compared to sham stimulation. The UK’s NICE has also issued formal guidelines (IPG676, 2020). The MAGNITUDE trial (Rech et al., 2025) further strengthens this evidence. From a neurobiological perspective, TMS acts on the orbito-frontal-striatal circuits—precisely those implicated in the pathophysiology of OCD.
Addictive Disorders and Impulse Control
A systematic review published on PubMed in 2024 (Bormann, Oesterle, and Arndt) identified clinical trials that evaluated the combination of TMS with pharmacological treatment for substance use disorders. The results suggest that TMS plays an adjunctive role in reducing cravings and modulating reward circuits. Thus, TMS does not replace established treatments for addiction—it enhances them.
In 2025, Gavazzi et al. published a groundbreaking study on pathological gambling in *Brain Sciences*: Theta Burst stimulation of the supplementary premotor area produced a measurable improvement in inhibitory control. According to the authors themselves, this is the first study to report this result, and points to TMS as a potential treatment modality for this disorder.
Is TMS for anxiety covered by health insurance in Portugal?
This is one of the most frequently asked questions by people considering TMS for anxiety in Lisbon. The honest answer: insurance coverage for TMS is still evolving in Portugal. Currently, some health insurance plans cover TMS for approved indications—primarily treatment-resistant depression. For anxiety, coverage is less consistent and depends on the insurer and the specific plan.
At The Clinic of Change, the team can help clarify the details of your plan before you begin treatment. Still, for those who have been living with severe anxiety for years, the cost of treatment must be weighed against the cost—both financial and in terms of quality of life—of continuing without an adequate solution.
When to seek specialized help
Seek professional help if:
- You have been diagnosed with OCD and have not responded adequately to cognitive-behavioral therapy and/or SSRIs;
- Suffers from severe anxiety—including social anxiety or generalized anxiety—that significantly impacts daily life;
- Search for clinics in Portugal that offer TMS for anxiety under psychiatric supervision;
- Would you like to know the cost of TMS for anxiety in Lisbon and whether your insurance covers this treatment?
- You are dealing with an addictive disorder and want to explore evidence-based adjunctive approaches.
TMS for anxiety and POC is not a one-size-fits-all solution—but for a growing number of patients, it is the evidence-based treatment they deserve to know about.
How can The Clinic of Change help?
At The Clinic of Change in Lisbon, we use clinically validated TMS protocols for anxiety and OCD. Each case begins with an evaluation consultation with a specialized psychiatrist, who determines eligibility, the treatment protocol, and the duration of the treatment cycle. Treatment is provided on an outpatient basis, with continuous supervision by a psychiatrist and integrated psychological support. Direct access, with no waiting list.
Schedule your appointment.
Because scientific evidence is constantly advancing—and Portuguese patients deserve access to what it reveals.
Sources:
Rech, L. et al. (2025). MAGNITUDE: TMS for Treatment-Resistant OCD. Brain Sciences, 15(2), 106.
Carmi, L. et al. (2019). Efficacy and Safety of Deep TMS for OCD. American Journal of Psychiatry, 176(11), 931–938.
Gavazzi, G. et al. (2025). Theta Burst TMS Improves Inhibitory Control in Gambling Disorder. Brain Sciences, 15(5), 448.
Bormann, N. L., Oesterle, T. S., & Arndt, S. (2024). Combining TMS with pharmacotherapy for substance use disorders. PMID: 38273429.
Garnaat, S. L. et al. (2019). Updates on TMS Therapy for Major Depressive Disorder. Psychiatric Clinics of North America, 41(3), 419–431.
NICE IPG676 (2020) | NICE IPG477. nice.org.uk
This article is for informational purposes only and is not a substitute for a personalized medical consultation. Please contact us.
