Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Oct;9(10):e01419.
doi: 10.1002/brb3.1419. Epub 2019 Sep 30.

Clinical applications of transcranial magnetic stimulation in bipolar disorder

Alexandra K Gold  1 , Ana Claudia Ornelas  2 , Patricia Cirillo  2 , Marco Antonio Caldieraro  3   4 , Antonio Egidio Nardi  2 , Andrew A Nierenberg  5   6 , Gustavo Kinrys  5   6
Affiliations
Review

Clinical applications of transcranial magnetic stimulation in bipolar disorder

Alexandra K Gold et al. Brain Behav. 2019 Oct.

Abstract

Background: 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. 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.

Methods: We 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.

Results: Clinical 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.

Conclusions: Transcranial 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.

Keywords: bipolar disorder; neuromodulation; transcranial magnetic stimulation.

PubMed Disclaimer

Conflict of interest statement

Ms. Gold receives research support from the National Institute of Mental Health (F31MH116557). Dr. Ornelas has no competing interests to report. Dr. Cirillo has no competing interest to report. Dr. Caldieraro has no competing interests to report. Dr. Nardi has no competing interests to report. Dr. Nierenberg reports the following disclosures: Consultant—Abbott Laboratories, Alkermes, American Psychiatric Association, Appliance Computing Inc. (Mindsite), Basliea, Brain Cells, Inc., Brandeis University, Bristol‐Myers Squibb, Clintara, Corcept, Dey Pharmaceuticals, Dainippon Sumitomo (now Sunovion), Eli Lilly and Company, EpiQ, L.P./Mylan Inc., Forest, Genaissance, Genentech, GlaxoSmithKline, Healthcare Global Village, Hoffman LaRoche, Infomedic, Intra‐Cellular Therapies, Lundbeck, Janssen Pharmaceutica, Jazz Pharmaceuticals, Medavante, Merck, Methylation Sciences, NeuroRx, Naurex, Novartis, PamLabs, Parexel, Pfizer, PGx Health, Otsuka, Ridge Diagnostics Shire, Schering‐Plough, Somerset, Sunovion, Takeda Pharmaceuticals, Targacept, and Teva; consulted through the MGH Clinical Trials Network and Institute (CTNI) for AstraZeneca, Brain Cells, Inc, Dianippon Sumitomo/Sepracor, Johnson and Johnson, Labopharm, Merck, Methylation Science, Novartis, PGx Health, Shire, Schering‐Plough, Targacept and Takeda/Lundbeck Pharmaceuticals, NeuroRx Pharma, Pfizer, Physician's Postgraduate Press, Inc. Grants/Research support—American Foundation for Suicide Prevention, AHRQ, Brain and Behavior Research Foundation, Bristol‐Myers Squibb, Cederroth, Cephalon, Cyberonics, Elan, Eli Lilly & Company, Forest, GlaxoSmithKline, Intra‐Cellular Therapies, Janssen Pharmaceuticals, Lichtwer Pharma, Marriott Foundation, Mylan, NIMH, PamLabs, Patient Centered Outcomes Research Institute (PCORI), Pfizer Pharmaceuticals, Shire, Stanley Foundation, Takeda/Lundbeck, and Wyeth‐Ayerst. Honoraria—Belvoir Publishing, University of Texas Southwestern Dallas, Brandeis University, Bristol‐Myers Squibb, Hillside Hospital, American Drug Utilization Review, American Society for Clinical Psychopharmacology, Baystate Medical Center, Columbia University, CRICO, Dartmouth Medical School, Health New England, Harold Grinspoon Charitable Foundation, IMEDEX, International Society for Bipolar Disorder, Israel Society for Biological Psychiatry, Johns Hopkins University, MJ Consulting, New York State, Medscape, MBL Publishing, MGH Psychiatry Academy, National Association of Continuing Education, Physicians Postgraduate Press, SUNY Buffalo, University of Wisconsin, University of Pisa, University of Michigan, University of Miami, University of Wisconsin at Madison, APSARD, ISBD, SciMed, Slack Publishing and Wolters Klower Publishing, ASCP, NCDEU, Rush Medical College, Yale University School of Medicine, NNDC, Nova Southeastern University, NAMI, Institute of Medicine, CME Institute, ISCTM, World Congress on Brain Behavior and Emotion, Congress of the Hellenic Society for Basic and Clinical Pharmacology, ADAA. Stock —Appliance Computing, Inc. (MindSite); Brain Cells, Inc., Medavante. Copyrights—Clinical Positive Affect Scale and the MGH Structured Clinical Interview for the Montgomery‐Asberg Depression Scale exclusively licensed to the MGH Clinical Trials Network and Institute (CTNI). Speaker Bureaus—none since 2003. Dr. Kinrys has received research support from AstraZeneca, Bristol‐Myers Squibb Company, Cephalon, Elan Pharmaceuticals, Eli Lilly & Company, Forest Pharmaceuticals Inc., GlaxoSmithkline, Sanofi/Synthelabo, Sepracor Inc., Pfizer Inc, UCB Pharma, and Wyeth‐Ayerst Laboratories, Agency for Healthcare Research and Quality (AHRQ) Grant R01 HS019371‐01, and Takeda Pharmaceuticals. He has been an advisor or consultant for AstraZeneca, Cephalon, Eli Lilly & Company, Forest Pharmaceuticals Inc., GlaxoSmithkline, Janssen Pharmaceutica, Pfizer Inc, Sepracor Inc., UCB Pharma, and Wyeth‐Ayerst Laboratories. Dr. Kinrys has been a speaker for AstraZeneca, Forest Pharmaceuticals Inc., GlaxoSmithkline, Sepracor Inc., and Wyeth‐Ayerst Laboratories.

References

    1. Bech, P. , Rafaelsen, O. , Kramp, P. , & Bolwig, T. (1978). The mania rating scale: Scale construction and inter‐observer agreement. Neuropharmacology, 17(6), 430–431. 10.1016/0028-3908(78)90022-9 - DOI - PubMed
    1. Beynel, L. , Chauvin, A. , Guyader, N. , Harquel, S. , Szekely, D. , Bougerol, T. , & Marendaz, C. (2014). What saccadic eye movements tell us about TMS‐induced neuromodulation of the DLPFC and mood changes: A pilot study in bipolar disorders. Frontiers in Integrative Neuroscience, 8, 65 10.3389/fnint.2014.00065 - DOI - PMC - PubMed
    1. Brunelin, J. , Jalenques, I. , Trojak, B. , Attal, J. , Szekely, D. , Gay, A. , … Poulet, E. (2014). The efficacy and safety of low frequency repetitive transcranial magnetic stimulation for treatment‐resistant depression: The results from a large multicenter French RCT. Brain Stimulation, 7(6), 855–863. 10.1016/j.brs.2014.07.040 - DOI - PubMed
    1. Bulteau, S. , Sébille, V. , Fayet, G. , Thomas‐Ollivier, V. , Deschamps, T. , Bonnin‐Rivalland, A. , … Sauvaget, A. (2017). Efficacy of intermittent Theta Burst Stimulation (iTBS) and 10‐Hz high‐frequency repetitive transcranial magnetic stimulation (rTMS) in treatment‐resistant unipolar depression: Study protocol for a randomised controlled trial. Trials, 18(1), 17 10.1186/s13063-016-1764-8 - DOI - PMC - PubMed
    1. Carnell, B. L. , Clarke, P. , Gill, S. , & Galletly, C. A. (2017). How effective is repetitive transcranial magnetic stimulation for bipolar depression? Journal of Affective Disorders, 209, 270–272. 10.1016/j.jad.2016.11.041 - DOI - PubMed

Publication types