A systematic review of transcranial magnetic stimulation for generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder

BACKGROUND: The evidence base addressing transcranial magnetic stimulation (TMS) for behavioral health conditions other than treatment-resistant depression is not well established. This systematic review evaluated the efficacy and safety of TMS for persons with generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). METHODS: PubMed, the Cochrane Library, and PsycINFO were searched for English language studies published from inception through July 7, 2025. Eligibility criteria included randomized, sham-controlled trials (RCTs) enrolling participants with GAD, OCD, and PTSD and measuring outcomes included remission, response, change in disease severity, and adverse events (AEs). One reviewer extracted data, and a senior reviewer checked for accuracy. Two reviewers completed independent risk-of-bias and strength-of-evidence (SOE) assessments. We conducted quantitative syntheses when appropriate. RESULTS: We identified 20 RCTs of TMS evaluating efficacy and 18 RCTs evaluating safety. Few studies reported follow-up beyond 12 weeks and several trials had high risk-of-bias. For remission, we found no evidence of benefit for TMS compared with sham for any condition. However, compared to sham, active TMS produced greater clinical response for OCD (Pooled RR, 1.74 [95% CI 1.06 to 2.84; 11 RCTs]; moderate SOE) and improvements in symptom severity for all three conditions (low SOE). There was no difference between active and sham TMS for serious AEs (low SOE) or total AEs (moderate SOE). Few studies reported follow-up beyond 12 weeks and many trials had high risk of bias and small sample sizes. CONCLUSIONS: TMS probably improves clinical response in OCD and may improve symptom severity in GAD, OCD, and PTSD. Further research should determine optimal brain targets and TMS treatment parameters and assess the durability of outcomes at longer term follow-up times, to better support clinical decision making and coverage determinations. CLINICAL TRIAL NUMBER: Not applicable.