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New perspectives in the treatment of bipolar affective disorder using transcranial magnetic stimulation

Przemysław Hałasiński1, Max Tschuschke1, Dominika Chuda1, Bartłomiej Ast1, Natalia Sak1, Igor Piotrowski12


Bipolar affective disorder (BPAD) is a recurrent, severe mental disorder characterized by periods of mania and depression. Treatment of bipolar disorder includes, among others the use of classic mood stabilizers, second-generation antipsychotics, benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), psychotherapy, electroconvulsive therapy and transcranial magnetic stimulation (TMS). TMS uses in its operation a magnetic field induced between two magnetic coils. The most frequently used treatment of this disorder is rTMS (repetitive TMS–rTMS), characterized by high frequency values ​​with low amplitude. In the case of manic episodes, rTMS is recommended as the third-line therapy, and in the case of depression, the second-line therapy. Additionally, it has been shown that using 110% of the motor threshold is the most effective in relieving depression symptoms in BPAD. The use of TMS is based on an individual approach to the patient. TMS therapy is characterized by a high level of safety and non-invasiveness.

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  1. Vaingankar JA, Rekhi G, Subramaniam M, et al. Age of onset of life-time mental disorders and treatment contact. Soc Psychiatry Psychiatr Epidemiol. 2013; 48(5): 835–843.
  2. Rodrigues AA, Rosa AR, Kunz M, et al. Bipolar disorder: staging and neuroprogression. Psychiatr Pol. 2014; 48(2): 231–243.
  3. Vieta E, Berk M, Schulze TG, et al. Bipolar disorders. Nat Rev Dis Primers. 2018; 4: 18008.
  4. Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Ther Adv Psychopharmacol. 2018; 8(9): 251–269.
  5. Rush AJ. Toward an understanding of bipolar disorder and its origin. J Clin Psychiatry. 2003; 64 Suppl 6: 4–8; discussion 28.
  6. Baldessarini RJ, Tondo L, Vazquez GH, et al. Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients. World Psychiatry. 2012; 11(1): 40–46.
  7. Freund N, Juckel G. Biolar disorder: its etiology and how to model in rodents. In: Kobeissy FH. ed. Psychiatric disorders: methods and protocols. Springer, New York 2019: 61–77.
  8. Miklowitz DJ, Johnson SL, Miklowitz DJ, et al. The psychopathology and treatment of bipolar disorder. Annu Rev Clin Psychol. 2006; 2(2): 199–235.
  9. McIntyre RS, Berk M, Brietzke E, et al. Bipolar disorders. Lancet. 2020; 396(10265): 1841–1856.
  10. Budziński B, Leszczyński J, Jaracz J. Znaczenie psychoedukacji w terapii choroby afektywnej dwubiegunowej. Psychiatria. 2016; 13(1): 31–38.
  11. Wieczorek T, Kobyłko A, Stramecki F, et al. Transcranial magnetic stimulation (TMS) in treatment of psychiatric disorders — review of current studies. Psychiatr Pol. 2021; 55(3): 565–583.
  12. Chail A, Saini RK, Bhat PS, et al. Transcranial magnetic stimulation: A review of its evolution and current applications. Ind Psychiatry J. 2018; 27(2): 172–180.
  13. Klomjai W, Katz R, Lackmy-Vallée A. Basic principles of transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS). Ann Phys Rehabil Med. 2015; 58(4): 208–213.
  14. Mathers CD, Lopez AD, Murray CJL. The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001. In: Lopez AD, Mathers CD, Ezzati M. et al. ed. Global Burden of Disease and Risk Factors. World Bank, Washington (DC) 2006.
  15. Dong M, Lu Li, Zhang L, et al. Prevalence of suicide attempts in bipolar disorder: a systematic review and meta-analysis of observational studies. Epidemiol Psychiatr Sci. 2019; 29: e63.
  16. Steel Z, Marnane C, Iranpour C, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014; 43(2): 476–493.
  17. Fabbri C. The role of genetics in bipolar disorder. Curr Top Behav Neurosci. 2021; 48: 41–60.
  18. Barnett JH, Smoller JW. The genetics of bipolar disorder. Neuroscience. 2009; 164(1): 331–343.
  19. Mirakhur A, Moorhead TW, Stanfield AC, et al. Progressive gray matter loss in patients with bipolar disorder. Biol Psychiatry. 2007; 62(8): 894–900.
  20. Soares JC, Kochunov P, Monkul ES, et al. Structural brain changes in bipolar disorder using deformation field morphometry. Neuroreport. 2005; 16(6): 541–544.
  21. Magioncalda P, Martino M. A unified model of the pathophysiology of bipolar disorder. Mol Psychiatry. 2022; 27(1): 202–211.
  22. Łojko D, Suwalska A, Rybakowski J. Bipolar and related disorders and depressive disorders in DSM-5. Psychiatr Pol. 2014; 48(2): 245–260.
  23. Dias VV, Brissos S, Carita AI. Clinical and neurocognitive correlates of insight in patients with bipolar I disorder in remission. Acta Psychiatr Scand. 2008; 117(1): 28–34.
  24. Święcicki Ł. Farmakoterapia depresji u pacjentów z chorobą afektywną dwubiegunową. Psychiatria. 2014; 11(2): 71–80.
  25. Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985; 1(8437): 1106–1107.
  26. Jalinous R. Technical and practical aspects of magnetic nerve stimulation. J Clin Neurophysiol. 1991; 8(1): 10–25.
  27. Lefaucheur JP, André-Obadia N, Antal A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol. 2014; 125(11): 2150–2206.
  28. Groppa S, Oliviero A, Eisen A, et al. A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol. 2012; 123(5): 858–882.
  29. Milev RV, Giacobbe P, Kennedy SH, et al. CANMAT Depression Work Group. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. Can J Psychiatry. 2016; 61(9): 561–575.
  30. Brunoni AR, Chaimani A, Moffa AH, et al. Repetitive transcranial magnetic stimulation for the acute treatment of major depressive episodes: a systematic review with network meta-analysis. JAMA Psychiatry. 2017; 74(2): 143–152.
  31. Peng Q, Juzeniene A, Chen J, et al. Lasers in medicine. Rep Prog Phys. 2008; 71(5): 056701.
  32. Yatham L, Kennedy S, Parikh S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018; 20(2): 97–170.
  33. Praharaj SK, Ram D, Arora M. Efficacy of high frequency (rapid) suprathreshold repetitive transcranial magnetic stimulation of right prefrontal cortex in bipolar mania: a randomized sham controlled study. J Affect Disord. 2009; 117(3): 146–150.
  34. Dolberg OT, Dannon PN, Schreiber S, et al. Transcranial magnetic stimulation in patients with bipolar depression: a double blind, controlled study. Bipolar Disord. 2002; 4 Suppl 1: 94–95.
  35. Nahas Z, Kozel FA, Li X, et al. Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy. Bipolar Disord. 2003; 5(1): 40–47.
  36. Dell'osso B, D'Urso N, Castellano F, et al. Long-term efficacy after acute augmentative repetitive transcranial magnetic stimulation in bipolar depression: a 1-year follow-up study. J ECT. 2011; 27(2): 141–144.
  37. Kazemi R, Rostami R, Khomami S, et al. Bilateral transcranial magnetic stimulation on DLPFC changes resting state networks and cognitive function in patients with bipolar depression. Front Hum Neurosci. 2018; 12: 356.
  38. Tavares DF, Myczkowski ML, Alberto RL, et al. Treatment of bipolar depression with deep TMS: results from a double-blind, randomized, parallel group, sham-controlled clinical trial. Neuropsychopharmacology. 2017; 42(13): 2593–2601.
  39. Rapinesi C, Kotzalidis GD, Ferracuti S, et al. Sapienza Centre for Research on Personalised Mental Health. Add-on high frequency deep transcranial magnetic stimulation (dTMS) to bilateral prefrontal cortex in depressive episodes of patients with major depressive disorder, bipolar disorder I, and major depressive with alcohol use disorders. Neurosci Lett. 2018; 671: 128–132.
  40. Nguyen TD, Hieronymus F, Lorentzen R, et al. The efficacy of repetitive transcranial magnetic stimulation (rTMS) for bipolar depression: A systematic review and meta-analysis. J Affect Disord. 2021; 279: 250–255.
  41. McGirr A, Karmani S, Arsappa R, et al. Clinical efficacy and safety of repetitive transcranial magnetic stimulation in acute bipolar depression. World Psychiatry. 2016; 15(1): 85–86.
  42. Rossi S, Antal A, Bestmann S, et al. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clin Neurophysiol. 2021; 132(1): 269–306.
  43. Fitzgerald PB, Hoy K, McQueen S, et al. A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression. Neuropsychopharmacol. 2009; 34(5): 1255–1262.
  44. Goetz SM, Lisanby SH, Murphy DLK, et al. Impulse noise of transcranial magnetic stimulation: measurement, safety, and auditory neuromodulation. Brain Stimul. 2015; 8(1): 161–163.
  45. Koponen LM, Nieminen JO, Ilmoniemi RJ. Multi-locus transcranial magnetic stimulation-theory and implementation. Brain Stimul. 2018; 11(4): 849–855.
  46. Stultz DJ, Osburn S, Burns T, et al. Transcranial magnetic stimulation (TMS) safety with respect to seizures: a literature review. Neuropsychiatr Dis Treat. 2020; 16: 2989–3000.
  47. Lerner AJ, Wassermann EM, Tamir DI. Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics. Clin Neurophysiol. 2019; 130(8): 1409–1416.
  48. Chen R, Gerloff C, Classen J, et al. Safety of different inter-train intervals for repetitive transcranial magnetic stimulation and recommendations for safe ranges of stimulation parameters. Electroencephalogr Clin Neurophysiol. 1997; 105(6): 415–421.
  49. Lempert T, Bauer M, Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol. 1994; 36(2): 233–237.
  50. Rossi S, Hallett M, Rossini PM, et al. Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009; 120(12): 2008–2039.
  51. Edgcomb JB, Tseng CH, Kerner B. Medically unexplained somatic symptoms and bipolar spectrum disorders: a systematic review and meta-analysis. J Affect Disord. 2016; 204: 205–213.
  52. Gold AK, Ornelas AC, Cirillo P, et al. Clinical applications of transcranial magnetic stimulation in bipolar disorder. Brain Behav. 2019; 9(10): e01419.
  53. Konstantinou G, Hui J, Ortiz A, et al. Repetitive transcranial magnetic stimulation (rTMS) in bipolar disorder: A systematic review. Bipolar Disord. 2022; 24(1): 10–26.