Is transcranial magnetic stimulation (TMS) an effective treatment for bipolar disorder?

In his latest online article, renowned consultant psychologist Dr Aleks George Srbinoski offers his expert insight into the use of transcranial magnetic stimulation (TMS) as a treatment for bipolar disorder. He explains the conventional treatments, how TMS works and the scientific basis for the treatment.

How is bipolar disorder conventionally treated?

The three main cyclical phases of bipolar disorder are manic, normal, and depressed mood periods. According to NHS Choices, talking therapy (like CBT) can be used to address the depression associated with bipolar disorder and identify the triggers that can cause a manic or depressed episode.

Anticonvulsant medications (Valproate, Carbamazepine, Lamotrigine) are used to stabilize mood, while antipsychotic medications (Risperidone, Quetiapine, Olanzapine, Aripiprazole) are frequently used to treat the more severe symptoms of mania and as a mood stabiliser.

Lithium is typically used to treat both the manic phase and the depression. It is now known that using just antidepressants alone to treat the depressive phase can lead to an increased risk of a manic episode.

According to most guides, a mood stabiliser is all that is needed to treat depression in people with bipolar disorder. A combination of lithium and valproate is typically used to treat people with rapid-cycling bipolar disorder (rapid mood swings without a normal mood in between), and antidepressants should be avoided.

Overall, although pharmaceutical treatment is helpful for many bipolar patients, it is currently far from ideal for preventing manic and depressed episodes, and drug-related adverse effects are widespread.

Does pregnancy affect the treatment of bipolar disorder?

Numerous medications that are frequently prescribed to treat bipolar disorder are prohibited during pregnancy due to potential harm to the foetus, including valproate, carbamazepine, lithium, lamotrigine, paroxetine, and benzodiazepines. If you find out you're pregnant, you shouldn't stop taking the medicine until you've spoken with your doctor about it.

How does transcranial magnetic stimulation (TMS) work?

Through magnetic fields across the scalp, TMS activates the brain and modifies cortical excitability. The movement of the coil's electric current causes a brief, intense magnetic pulse to be produced, which permeates the scalp and painlessly reaches the targeted cortical region's neurons.

This action gradually permeates further into the brain, affecting the regions associated with depression. Low frequency TMS reduces cortical excitability while high frequency TMS increases cerebral excitability.

Is there scientific evidence that TMS helps bipolar disorder?

Transcranial Magnetic Stimulation (TMS) is considered safe and effective for treating depression, as stated in the 2015 NICE Guidelines. Several studies and controlled trials have shown that it is an effective, safe approach to both unipolar and bipolar depression.

An example is Kazemi's 2016 study, which discovered that right-sided (DLPFC) low-frequency TMS treatment yielded the highest efficacy rates. This approach achieved an 80% treatment response rate and a 40% remission rate.

Dr Aleks George Srbinoski is a highly-experienced consultant psychologist with over 20 years of experience. If you would like to book a consultation with Dr Srbinoski, you can do so today via his Top Doctors profile.