TMS For Bipolar Disorder

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By Dr. David Woo - March 10, 2022

Bipolar disorder is a disabling condition that affects approximately 2.8% of adults in the US.(1) People with bipolar disorder experience extreme mood swings that range from lows (referred to as depression) to highs (called mania or hypomania). These mood swings can make it difficult for someone with bipolar disorder to manage a job, school, and relationships.

Traditionally, bipolar disorder is treated with talk therapy and medication, but not everyone will see an improvement in their symptoms with these treatments. When this occurs, this is referred to as treatment resistance.(2)

A new type of treatment, called transcranial magnetic stimulation or TMS, may help treat symptoms of bipolar disorder in patients who do not respond to medication.

What Are the Symptoms of Bipolar Disorder?

People with bipolar disorder tend to alternate between periods of extreme emotional highs and periods of extreme emotional lows. These periods are referred to as “mood episodes.” The symptoms that someone with bipolar disorder experiences depends on the type of mood episode that they are going through.

Symptoms associated with a manic episode(3,4,5)	Symptoms associated with a depressive episode(3,4,5)
Feeling “jumpy,” “wired,” or unusually upbeat Feelings of euphoria (exaggerated feelings of positivity and self-confidence) Increased sex drive Impulsive and poor decision making Loss of appetite Racing thoughts and talking very fast Needing less sleep	Depressed mood, feelings of hopelessness, worthlessness, and worry Insomnia or hypersomnia Fatigue Trouble concentrating and talking very slowly Difficulty making decisions Decreased or loss of sex drive Contemplating or planning suicide

How often someone with bipolar disorder experiences mood swings or a cycle varies from person to person. It’s important to understand that a person’s mood swings may not follow a defined pattern; for example, a manic episode may not always follow a depressive episode. It’s also possible for patients to be symptom-free for years before a new cycle starts.

Transcranial Magnetic Stimulation for Bipolar Disorder

Transcranial magnetic stimulation (TMS) is a medication-free, non-invasive treatment that uses magnetic pulses to electrically stimulate regions of the brain associated with mood. TMS is proven to help improve symptoms in people with mood disorders, like depression, when other treatments don’t.

In 2020, TMS was declared a “breakthrough device” by the FDA’s Breakthrough Device Program for the treatment of bipolar disorder.(6) While this is not considered full FDA approval and more studies are needed to fully understand and identify the treatment parameters for TMS for bipolar depression, current studies suggest that TMS is promising as a safe and effective treatment for bipolar disorder, as long as patients are being closely monitored by their doctor throughout the course of treatment.(7,8) Research shows that TMS can also improve cognitive function in individuals with bipolar disorder.(9)

Bipolar Disorder Treatment and Mania

Antidepressants, while a common treatment for bipolar disorder, have a small risk of triggering mania in patients with bipolar disorder.(10) To reduce the risk of switching into mania, antidepressants are generally combined with a mood stabilizer.

Some studies show that TMS may also have a small risk of inducing mania in patients with bipolar disorder; however, researchers have not identified a clear pattern of risk factors that may contribute to this risk.(11,12)

People with bipolar disorder who are candidates for TMS must be closely monitored by their doctor for signs of:

A decreased need for sleep
Excess energy
Unusual or excessive elevation in mood

When performed under the close supervision of a psychiatrist, TMS is a safe and effective treatment for bipolar disorder for candidates.

Talk to Your Doctor About Whether TMS Is Right for You

If you experience symptoms of bipolar depression, get help. A licensed therapist can help you understand your symptoms and what treatment options are best for you. Your doctor can also help you understand if you are a candidate for TMS. To make an appointment with a licensed healthcare professional at Madison Avenue TMS & Psychiatry, contact us online or call (212) 731-2033.

Resource:

1. Bipolar Disorder: Statistics. National Institutes of Mental Health. Publication Date Unknown. Link. Accessed February 18, 2022.

2. Tavares TF, Myczkowski ML, et al, Treatment of bipolar depression with deep TMS: results from a double-blind, randomized, parallel group, sham-controlled clinical trial. Neuropsychopharmacology. 2017;42(13):2593-2601. Link. Accessed February 1, 2022.

3. Bipolar Disorder. Mayo Clinic. Publication Date Unkown. Updated on February 16, 2021. Link. Accessed February 15, 2022.

4. Bipolar Disorder. Cleveland Clinic. Publication Date Unknown. Updated January 27, 2018. Link. Accessed February 15, 2022.

5. Bipolar Disorder: Overview. National Institute of Mental Health. Publication Date Unknown. Updated January 2020. Link. Accessed February 15, 2022.

6. Camprodon JA. Therapeutic Neuromodulation for Bipolar Disorder-The Case for Biomarker-Driven Treatment Development. JAMA Netw Open. 2021 Mar 1;4(3):e211055. Link. Accessed February 16, 2022.

7. Nahas Z, Kozel FA, Li X, Anderson B, George MS. Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy. Bipolar Disord. 2003;5(1):40-7. Link. Accessed February 18, 2022.

8. Tavares DF, Myczkowski ML, Alberto RL, Valiengo L, Rios RM, Gordon P, de Sampaio-Junior B, Klein I, Mansur CG, Marcolin MA, Lafer B, Moreno RA, Gattaz W, Daskalakis ZJ, Brunoni AR. Treatment of Bipolar Depression with Deep TMS: Results from a Double-Blind, Randomized, Parallel Group, Sham-Controlled Clinical Trial. Neuropsychopharmacology. 2017;42(13):2593-2601. Link. Accessed February 2018, 2022.

9. Myczkowski ML, Fernandes A, Moreno M, Valiengo L, Lafer B, Moreno RA, Padberg F, Gattaz W, Brunoni AR. Cognitive outcomes of TMS treatment in bipolar depression: Safety data from a randomized controlled trial. J Affect Disord. 2018;235:20-26. Link. Accessed February 18, 2022.

10. Patel R, Reiss P, Shetty H, et al. Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study. BMJ Open. 2015;5(12):e008341. Link. Accessed February 18, 2022.

11. Gold AK, Ornelas AC, Cirillo P, et al. Clinical applications of transcranial magnetic stimulation in bipolar disorder. Brain Behav. 2019;9(10):e01419. Link. Accessed February 18, 2022.

12. Hett D, Marwaha S. Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder. Ther Adv Psychopharmacol. 2020;10:2045125320973790. Published 2020 Nov 18. Link. Accessed February 18, 2022.

Dr. David Woo

Dr. David Woo is the owner and head clinical psychiatrist at Madison Avenue TMS and Therapy in New York City. Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.

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