Clinical applications of transcranial magnetic stimulation in bipolar disorder.

Alexandra K Gold,Gustavo Kinrys,Marco Antonio Caldieraro,Andrew A Nierenberg,Antonio Egidio Nardi,Ana Claudia Ornelas,Patricia Cirillo

doi:10.1002/brb3.1419

Abstract

BackgroundMany patients with bipolar disorder (BD) fail to experience benefit following traditional pharmacotherapy, necessitating alternative treatment options that will enable such patients to achieve remission. Transcranial magnetic stimulation (TMS) is a relatively new, noninvasive neuromodulation technique that involves the application of magnetic pulses on hyperactive or hypoactive cortical brain areas. We evaluated the existing literature on TMS as a treatment for BD across varied mood states.MethodsWe searched PubMed up to October 2018 for original data articles published in English that evaluated outcomes in a bipolar sample across depressive, manic, mixed, and maintenance phases of BD.ResultsClinical trials of TMS for BD particularly suggest the potential of repetitive TMS for reducing depressive symptoms. Studies of TMS for mania have yielded more mixed findings. Few studies have evaluated TMS in other phases of the bipolar illness. TMS is generally associated with mild side effects though, in a few studies, it has been shown to contribute to a manic switch in previously depressed bipolar patients.ConclusionsTranscranial magnetic stimulation is a promising approach for treating patients with BD who have failed to respond to pharmacological or psychosocial treatment. Future research should more clearly elucidate which TMS protocols may be most effective for a given bipolar patient.

Highlights

Pharmacological agents have been effectively applied across all phases of the bipolar illness and, are considered a first‐line treatment for bipolar disorder (BD; Fountoulakis et al, 2017)
The limitations of pharmacotherapy suggest the importance of alternative treatment options that will help patients with BD achieve and sustain remission (Martin et al, 2005)
Most research has focused on repetitive transcranial magnetic stimulation (rTMS) for patients in a bipolar depressive episode

Summary

Introduction

Pharmacological agents have been effectively applied across all phases of the bipolar illness and, are considered a first‐line treatment for bipolar disorder (BD; Fountoulakis et al, 2017). Many patients with bipolar disorder fail to respond acutely to adequate pharmacotherapy (Geddes & Miklowitz, 2013). The limitations of pharmacotherapy suggest the importance of alternative treatment options that will help patients with BD achieve and sustain remission (Martin et al, 2005). Many patients with bipolar disorder (BD) fail to experience benefit following traditional pharmacotherapy, necessitating alternative treatment options that will enable such patients to achieve remission. TMS is generally associated with mild side effects though, in a few studies, it has been shown to contribute to a manic switch in previously depressed bipolar patients. Conclusions: Transcranial magnetic stimulation is a promising approach for treat‐ ing patients with BD who have failed to respond to pharmacological or psychosocial treatment. Future research should more clearly elucidate which TMS protocols may be most effective for a given bipolar patient

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