Quick facts
- Used for
- Bipolar depression that has not responded to medication and psychotherapy.
- Not used
- During a manic episode.
- FDA status
- Not a cleared indication; use is off-label. FDA breakthrough designation in 2020.
- Monitoring
- We watch for early manic symptoms and pause TMS if they appear.
- Led by
- Dr. Khaled Bowarshi, dual board-certified psychiatrist.
- Locations
- Wesley Chapel and Tampa, Florida.
Does TMS work for bipolar disorder?
TMS can help bipolar disorder during a depressive episode that has not responded to medication and psychotherapy. In open-label studies, the response rate for bipolar depression is comparable to that of unipolar depression.
For years, a bipolar diagnosis was considered a reason not to use TMS, because of conflicting data when TMS first received FDA clearance for major depressive disorder. We still do not recommend TMS during a manic episode. Many experts now look favorably at TMS during a depressive episode.
TMS for bipolar depression is not currently an FDA-cleared indication. Your psychiatrist will discuss the evidence, benefits and risks with you.
What is bipolar disorder?
Bipolar disorder, once called manic-depressive illness, involves mood swings between highs (manic or hypomanic episodes that can last days) and lows (major depressive episodes that can last weeks or months). The swings can disrupt work, relationships and daily life.
Bipolar I disorder involves more severe manic episodes. Bipolar II disorder involves less severe hypomanic episodes.
How common is it?
About 2.8% of U.S. adults have bipolar disorder, according to the National Institute of Mental Health, with similar rates in women and men. The average age of onset is about 25.
Why look beyond medication?
Medication is the first-line treatment for bipolar disorder across all phases. But many patients do not respond fully to medication, and others stop because of side effects. For those patients, a non-drug option for bipolar depression is valuable.
What the research shows
A double-blind, randomized, sham-controlled trial published in 2017 randomized 43 patients with bipolar depression to deep TMS or sham. The group that received real stimulation had a higher response than the sham group.
A 2019 meta-analysis concluded that trials of TMS for bipolar disorder suggest repetitive TMS can reduce depressive symptoms, while studies of TMS for mania have been more mixed. In 2020 the FDA granted a breakthrough device designation for TMS in bipolar depression, which speeds review of the clinical trial program.
What to expect at our clinic
Dr. Bowarshi, a board-certified psychiatrist, evaluates every patient and coordinates TMS with your current medications. We watch closely for any early signs of manic symptoms during treatment and pause TMS if they appear.
Next steps
Treatment starts with a full psychiatric evaluation. Call (813) 867-2378 to schedule in Wesley Chapel or Tampa.
Frequently asked questions
Sources and further reading
- Bipolar Disorder. National Institute of Mental Health
- Bipolar Disorder: statistics from the National Comorbidity Survey Replication, 2001–2003. National Institute of Mental Health
- Trapp NT, et al. Consensus review and considerations on TMS to treat depression. Clin Neurophysiol. 2025;170:206–233. Clinical TMS Society / NNDC / IFCN
- Brain Stimulation Therapies. National Institute of Mental Health
Medical information on this page is educational and not a substitute for professional advice. Individual results vary.