A retrospective analysis of bipolar depression treated with transcranial magnetic stimulation
Open accessAbstract
Introduction: Treatment options are limited for patients with bipolar depression. Antidepressants added to mood stabilizers even carry risks of precipitating mixed/manic episodes. Transcranial magnetic stimulation (TMS) may provide a safe and effective option for these patients. Methods: Database analysis of the TMS Service at Sheppard Pratt Health System identified patients with bipolar disorder type I (BD1) or II (BD2) in a pure depressive phase at initiation of TMS. Records were reviewed for response and remission rates based on MADRS scores, time to effect, and adverse events, notably treatment‐emergent affective switching. All had failed at least two prior treatments for depression, were currently on at least one mood stabilizer and off antidepressants. Stimulation parameters targeted left dorsolateral prefrontal cortex: 120% motor threshold, 10 pulses per second (pps) × 4s, intertrain interval (ITI) 26s, 75 trains (37.5 min/session) for 3,000 pps total, 5 sessions/week for 30 total treatments, or until remission criteria were met. Results: A total of 44 patients with BD were identified, representing 15% of the total TMS population. 77% of those who completed a course of TMS met response criteria, and 41% of subjects who completed at least 25 treatments met remission criteria. Subjects with BD1 were more likely to respond, remit, or suffer an adverse event than those with BD2. No patient met clinical criteria for a manic/mixed episode, but four (10%) discontinued due to concerns of activation. Conclusions: TMS is effective in the bipolar depressed population where episode focused intervention can be specifically offered. Risk of psychomotor agitation must be closely monitored.
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There is not yet a TMS protocol for treating bipolar disorder that is in widespread clinical use, with recent protocols showing mixed results.
“There is not yet a TMS protocol for treating bipolar disorder that is in widespread clinical use, with recent protocols showing mixed results (Goldwaser et al., 2020; McGirr et al., 2016; McGirr et al., 2021; Myczkowski et al., 2018).”
From A double-blind, randomized, sham-controlled clinical trial of cerebellar intermittent theta burst stimulation for bipolar disorder: Safety, tolerability, mood and cognitive effects (2025) · cites this paper as Goldwaser et al., 2020
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- Authors
- Goldwaser, E. L., Daddario, K., & Aaronson, S. T.
- Affiliations
- University of Maryland Medical Center (US)
- Sheppard Pratt Health System (US)
- Corresponding author
- Aaronson, Scott T.
- Venue
- Brain and Behavior
- Publisher
- Wiley
- Published
- 2020-11-10
- Volume
- 10
- Issue
- 12
- Pages
- e01805-e01805
- ISSN
- 2157-9032 (ISSN-L)
- 2162-3279
- PMC
- PMC7749511
- OpenAlex
- W3105555739
- Cited by
- 15
- References
- 33
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 3
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Brain and Behavior (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- bipolar depression, transcranial magnetic stimulation, bipolar I disorder, bipolar II disorder, treatment-resistant depression, dorsolateral prefrontal cortex stimulation, treatment response and remission, psychomotor agitation, mood stabilizers
- MeSH terms
- Bipolar Disorder, Humans, Retrospective Studies, Treatment Outcome, Prefrontal Cortex, Transcranial Magnetic Stimulation
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