TMS FOR BIPOLAR

What is Bipolar Disorder?

Bipolar disorder or as used to be called manic-depressive illness is a mental illness characterized by mood swings alternating between “highs” which are manic or hypomanic episodes that can last days followed by “lows” which are major depressive episodes that can last weeks or months. These mood swings are severe enough to cause disruption in the patient's life and function at work and in social and personal relationships. That extreme change of the mood between the two spectrums explains the previous name of manic depressive (referring to two extremes of episodes). Bipolar Disorder Type I is characterized by more severe manic episodes. Bipolar Disorder Type II is characterized by attenuated less severe hypomanic episodes.

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How common is Bipolar Disorder?

About 46 million people around the world have bipolar disorder. (Our World in Data, 2018). About 2.8% of U.S. adults have bipolar disorder (Harvard Medical School, 2007). The prevalence of bipolar disorder is similar in females and males (2.8% and 2.9%, respectively). (National Institute of Mental Health, 2017). The average age of onset is 25 years old. (National Alliance on Mental Illness, 2017)

If untreated, how dangerous is Bipolar Disorder?

Of all mood disorders, those with a diagnosis of bipolar disorder were found to have the highest likelihood of being classified with “severe” impairment (82.9%). (Archives of General Psychiatry, 2005). On average, bipolar disorder results in 9.2 years reduction in expected life span (National Institute of Mental Health, 2017). The risk of suicide is high in people with bipolar disorder.

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Medication treatment for bipolar disorder.

Pharmacological agents have been effectively applied across all phases of bipolar disorder and, thus, are considered the first‐line treatment for bipolar disorder (BD; Fountoulakis et al., 2017). However, pharmacotherapy for BD has some notable limitations. Many patients with bipolar disorder fail to respond acutely to adequate pharmacotherapy (Geddes & Miklowitz, 2013). For those patients who do experience symptomatic improvements following pharmacological treatment, many experience frequent and intolerable side effects that lead to medication non-adherence and/or discontinuation (Matson et al., 2006; Shah, Grover, & Rao, 2017)

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Does TMS Therapy help with Bipolar Disorder?

The short answer is; Yes. To be more specific; TMS therapy can help bipolar disorder during a depressive episode that is resistant to medications and psychotherapy. In open-label studies, the response rate for bipolar depression is comparable to that of unipolar depression. A double-blind, randomized, parallel-group, sham-controlled clinical trial published in 2017 evaluated 43 patients randomized into two groups to evaluate the effect of dTMS for treating bipolar depression. The group receiving the actual dTMS had a higher response than the group receiving a sham (placebo)

A meta analysis published in 2019 concluded that 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.

In March of 2020, the FDA gave a breakthrough device designation for TMS for Bipolar Depression. The breakthrough designation is a process that will expedite the FDA review of the clinical trial program evaluating TMS for bipolar disorder. If TMS therapy is approved for bipolar depression, it could provide an option for those patients who do not respond to medications.