Abstract
Noninvasive brain stimulation, using electromagnetic waves (repetitive transcranial magnetic stimulation (rTMS)) and direct electrical current (transcranial direct current stimulation (tDCS)), is a new frontier in treating psychiatric maladies. While still being developed as viable treatment options, both options have had numerously reported side-effects, with hypomania being a significant concern during investigations. While there has been a relatively rare incidence of hypomania among rTMS/tDCS trials, it still posits an important issue regarding the safety of both treatment modalities. This review studies the reported episodes of hypomania in rTMS and tDCS trials in order to identify any patterns that may cause the same. Such patterns included higher stimulation strengths with long stimulation periods. These factors, if modified, along with an established regimen of screening and prophylaxis against hypomanic risks, may be effective protection against hypomania, as well as to prevent manic episodes.
Highlights
BackgroundNoninvasive brain stimulation is a novel frontier in the treatment of psychiatric pathology, especially depression
It is an umbrella term consisting of multiple methodologies, rTMS and tDCS being the major forms of this new treatment [1,2]
This study reported hypomania in a 57-year-old male with a history of major depression disorder (MDD), who received alternating courses of placebo and active tDCS at the LDLPFC area
Summary
Noninvasive brain stimulation is a novel frontier in the treatment of psychiatric pathology, especially depression. The following is the DSM-IV criteria required for the diagnosis of hypomania: 1) A unique period of persistently elevated, expansive, or irritable mood, lasting throughout a minimum of four days, which is identifiably different from the usual non-depressed mood state 2) During the episode of mood disturbance, three or more of the following symptoms (four, if the mood is only irritable) have persisted and significantly present: - Inflated self-esteem/grandiosity - Decreased need for sleep - More talkative than usual or pressure to keep talking - Flight of Ideas or subjective experience that thoughts are racing - Distractability - Increase in goal-directed activity or psychomotor agitation - Excessive involvement in pleasurable activities that have a high potential for painful consequences 3) The hypomanic episode is associated with a significant change in functioning that is uncharacteristic of the person when not symptomatic 4) The disturbance in mood and the change in functioning are observable by others 5) The hypomanic episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization, and there are no psychotic features 6) The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). Table adapted from [6], Pg 485
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