Citation

Hett D, Marwaha S. Ther. Adv. Psychopharmacol. 2020; 10.

Copyright

(Copyright © 2020, SAGE Publishing)

DOI

10.1177/2045125320973790

PMID

unavailable

Abstract

Bipolar disorder (BD) is a debilitating mood disorder marked by manic, hypomanic and/or mixed or depressive episodes. It affects approximately 1-2% of the population and is linked to high rates of suicide, functional impairment and poorer quality of life. Presently, treatment options for BD are limited. There is a strong evidence base for pharmacological (e.g., lithium) and psychological (e.g., psychoeducation) treatments; however, both of these pose challenges for treatment outcomes (e.g., non-response, side-effects, limited access). Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, is a recommended treatment for unipolar depression, but it is unclear whether rTMS is an effective, safe and well tolerated treatment in people with BD. This article reviews the extant literature on the use of rTMS to treat BD across different mood states. We found 34 studies in total (N = 611 patients), with most assessing bipolar depression (n = 26), versus bipolar mania (n = 5), mixed state bipolar (n = 2) or those not in a current affective episode (n = 1). Across all studies, there appears to be a detectable signal of efficacy for rTMS treatment, as most studies report that rTMS treatment reduced bipolar symptoms. Importantly, within the randomised controlled trial (RCT) study designs, most reported that rTMS was not superior to sham in the treatment of bipolar depression. However, these RCTs are based on small samples (NBD ⩽ 52). Reported side effects of rTMS in BD include headache, dizziness and sleep problems. Ten studies (N = 14 patients) reported cases of affective switching; however, no clear pattern of potential risk factors for affective switching emerged. Future adequately powered, sham-controlled trials are needed to establish the ideal rTMS treatment parameters to help better determine the efficacy of rTMS for the treatment of BD. © The Author(s), 2020.

Language: en

Keywords

human; suicide; Review; quality of life; bipolar disorder; treatment; insomnia; depression; anxiety; functional magnetic resonance imaging; psychosis; major depression; bipolar depression; disease severity; repetitive transcranial magnetic stimulation; mood disorder; risk factor; psychoeducation; headache; sleep disorder; nuclear magnetic resonance imaging; seizure; drug efficacy; mania; electrostimulation; electroencephalography; Beck Depression Inventory; clinical decision making; dizziness; bipolar mania; brain depth stimulation; electrophysiology; Montgomery Asberg Depression Rating Scale; transcranial magnetic stimulation; nerve cell plasticity; Young Mania Rating Scale; transcranial direct current stimulation; nerve cell network; BOLD signal; cognitive behavioral therapy; Hamilton Depression Rating Scale; rTMS; dorsolateral prefrontal cortex; magnetic stimulation