Treating Biopolar Related Depression through TMS

Treating Biopolar Through TMS

Depressed mood is the most common experience for those with bipolar disorder. Depressive days outnumber those of mania by at least three to one. When depression is a prominent symptom, doctors and patients face a difficult choice: add an antidepressant medication, which can worsen the overall illness, or find a way to treat the depression without medication. TMS fills this role by treating the “depressive phase of” bipolar disease with no medication.

TMS is a very effective treatment for depression in bipolar illness. With just a few simple steps, you can find out if you are a good candidate, what the cost will be, and what your treatment schedule would look like.

Bipolar disorders 1

Symptoms

Symptoms in Bipolar depression differ from Bipolar disorder. Whereas Bipolar disorder has periods of “up” and “down”, commonly described as a mania, Bipolar depression is know as being “unipolar”, meaning that people who suffer from biopolar depression typically only suffer from serious and deep depression.

Weight Shifts

Massive shifts in weight gain or loss are common in people who suffer from bipolar depression.

Sleep Issues

Another common symptom is experiencing unhealthy sleep in the form of insomia or hypersomnia.

Energy

Commonly people who suffer bipolar depression experience massive loss of energy.

Suicide

Many people who suffer from bipolar disorder will find that they think of suicide frequently.

Decision Impairment

Frequently people who suffer from bipolar depression will discover difficulty in making decisions.

How we are treating depression
in bipolar patients with TMS?

TMS is a very effective treatment for depression in bipolar illness. With just a few simple steps, you can find out if you are a good candidate, what the cost will be, and what your treatment schedule would look like.

Step 1

Contact us and provide your history of bipolar treatments. We will interview you at no cost to see if you meet medical necessity criteria for your insurance plan and obtain Prior Authorization if available.

Step 2

Come to our clinic for about 15 minutes daily, five times per week, for six weeks. After each treatment session, you will be able to return immediately to work or family life. No medication is involved.

Step 3

Participate in our life skills classes, acupuncture or acupressure, and our biofeedback program sessions at no added cost. TMS works best as part of a comprehensive care package. Weekly psychotherapy with your own therapist is also strongly encouraged and typically leads to better outcomes.

Our experts

John L Fleming
Doctor Profile
John l Fleming, MD. DLFAPA.

Medical Director of SCTMSC, LLC, John is a Board Certified Psychiatrist and a Distinguished Life Fellow of the American Psychiatric Association. He has over 40 years’ experience treating depression and related conditions and is recognized as a leader in the psychiatric profession. Since 2011 he has been a certified Provider Trainer and TMS provider for three different TMS treatment systems. His experience base includes psychopharmacology of complex conditions. psychotherapy of individuals and couples and the medical aspects of psychiatric illness. He has annually been selected by his peers as one of America’s Best Doctors since 2005.

About Melissa Hammock
Melissa Hammock, M.A., M.Ed., LMFT

Services Director of SCTMSC, LLC, Melissa received her master’s degree in Marriage and Family Therapy from Azusa Pacific University and her master’s in special education from California State University, Los Angeles. Melissa is a Certified Life Coach and a member of the International Positive Psychology Association. Melissa is also a Certified TMS Provider.

Melissa has been in private practice in Colorado Springs since 1981, working with adults, adolescents, and couples. Melissa specializes in the treatment of depression, anxiety, ADHD, and trauma-based disorders. She has received training in EMDR, Cognitive Therapy, Family Systems Therapy, Energy Therapies, Interpersonal Therapy and Accudetox. Melissa is a Licensed Marriage and Family Therapist. She has been involved with TMS treatment since 2011.

About Joe Hammock
Joe Hammock, M.A., PhD, Licensed Clinical Psychologist

Clinical Director of SCTMSC, LLC and Certified TMS Provider since 2011, Joe is a licensed psychologist and member of the American Psychological Association. He is a graduate of Fuller Graduate School of Psychology, and additionally holds an MA from Fuller Theological Seminary. He is certified by the International EMDR Association and is a Certified TMS Provider.In his thirty years of practice in Colorado, he has specialized in the treatment of trauma-based disorders, depression, anxiety disorders, and dissociative disorders. He also has extensive experience in psychological evaluations, CBT, EMDR, forensic psychology, and is frequently consulted as an expert witness.

FAQ

Bipolar disease (also known as bipolar disorder, formerly manic depressive illness) is a mood disturbance. A person with bipolar disorder experiences distinct mood episodes. These are periods of normal mood, periods of depression, periods of mania/hypomania, and finally, mixed episodes, in which the patient has all the symptoms of depression and all the symptoms of mania all at the same time. Everyone with bipolar disorder has depressed, manic, and normal moods, but not all have mixed episodes.

If the depressive periods are prominent, these are very uncomfortable. Both patients and family members say that the depression of bipolar disorder is much harder to handle than the manic periods of the illness. Depression is miserable and leads to loss of effective participation in life, work, home duties, and relationships. Worse, the existence of continuing depression often means that the bipolar illness itself may be growing more unstable. This indicates more frequent and intense periods of depression “and”mania to come.

For all these reasons, it is important to treat depressive symptoms effectively as part of an overall bipolar disease treatment plan, but for reasons to be discussed below, it is best to do so without the use of antidepressants if possible.

Depression is an extended period of low mood. Mania refers to a period of elevated mood, which can be either euphoria and intense social activity or intense irritability not accompanied by depression. The key symptom in mania is a markedly reduced need for sleep occurring at the same time as the manic mood change. Additional symptoms may include inability to self-regulate impulses, leading to spending sprees, hypersexual behaviors, substance use or unregulated eating (note to editor binge eating is a very different condition so phrase not appropriate here) . Mania may or may not be accompanied by hallucinations, delusions, or other significant symptoms of emotional dysregulation. Mania that is mild and lasts between four and seven days is termed “hypomania” (little mania). More severe mania, or mania that lasts longer than seven days, is simply called mania.

The different types of bipolar disease are characterized by how long the mania lasts 

Bipolar Disease Type I: This type consists of periods of mania lasting longer than seven days, periods of depression of any length  or if there are any periods of psychosis coinciding with mania.  

Bipolar Disease Type II: This type consists of periods of mania lasting between four and seven days and periods of depression of any length, with no psychotic experiences. 

Bipolar Disease Type III: This term refers to a condition in which mania occurs only while the patient is taking an antidepressant medication. In some cases, this may only be a medication side effect. In others, such mania is the first sign that a patient previously diagnosed with major depression on its own is beginning to develop Bipolar I or II.  Developing Bipolar III is extremely serious, which is why using antidepressants to treat bipolar disorder is a risky and weighty decision. 

Mood stabilizing medications are the mainstay of bipolar disorder treatment. These include lithium and the anti-seizure medications Depakote®, Lamictal®, Trileptal®, and Tegretol®. Atypical antipsychotic medications can also be used for mood stabilizing, including Abilify®, Latuda®, Rexulti®, Risperdal® Seroquel® and others. Fortunately for many patients, such mood stabilizing medications not only reduce or eliminate mania, they can often do the same for depression. The problem comes when depression persists so that some form of treatment of the depression is needed. 

The use of antidepressants is to be avoided in treating bipolar disorder if at all possible. Antidepressants can trigger mania (classified as Bipolar III), or make existing mania more intense. Even if antidepressants do not cause changes to mania, and even if it helps reduce depression,there is good evidence that the use of antidepressants over time can make bipolar disorder more unstable, with more frequent, longer lasting, and deeper mood episodes of all types. This risk increases with the number of months that antidepressants are used, even if mood stabilizers are also used. 

 

Despite this risk, persistent depression is such a frequent problem that about 80% of patients with bipolar disorder have been treated with antidepressants at some point. 

As observed in many published studies, TMS can effectively treat the depressive episodes of bipolar disease. 

Although research is ongoing, available data indicates that TMS, unfortunately, does not reduce existing mania. However, there are only a handful of reports of TMS possibly triggering mania — a very low incidence rate compared with antidepressant treatment. This means that patients with bipolar disorder should continue taking mood stabilizers to control mania, but may be able to  use TMS instead of antidepressants. New TMS procedures are also constantly being evaluated, so it may yet be possible at some point in the future to use TMS to treat the whole condition, including both manic and depressive aspects.

There is no current evidence that TMS treatment of depressive episodes can worsen the long-term course of bipolar disease. TMS use can definitely reduce exposure to antidepressant medications, however, which are known to pose a risk of long-term harm to patients with bipolar disease. 

Modern medical literature makes it clear that TMS can be a safe and effective treatment for bipolar illness. Indeed, there are strong arguments for why TMS might be the safest as well as most effective treatment for depression associated with bipolar disease. Unfortunately, TMS treatment of bipolar disorder cases is still considered “off-label” in the US. Most insurance companies will only pay for TMS treatment of major depression and exclude the treatment of bipolar disease, although some companies are beginning to show some flexibility.

TMS is approved to treat depression associated with bipolar disorder in the European Union, and hopefully, the US FDA may  approve its use here within the next year or so.

Increasingly, we are seeing some insurance companies approve requests for TMS coverage for patients with bipolar disorder. For patients whose coverage providers will not approve this “off label” use, but who wish to pursue this treatment for bipolar disorder out of pocket, we do offer special reduced rates. Contact us and let us work with you to see what might be possible.

Mental Health Assessment

Do you believe that you suffer from depression or anxiety? Check out our online assessments for a quick online self-assessment to see if you suffer from a mental health related issue and to see if you qualify for treatment with TMS.

What the Patients Think

Cindy Testimonial
Cindy – 22

The Southern Colorado TMS Center is truly the most caring, compassionate mental health facility I have ever known. You always hear stories about why people have gone into the mental health field, but these folks truly live it. Everyone who works for SCTMSC (and I mean everyone), exudes warmth and empathy. They walk the walk. One of my family members utilized several of their services, and I got to witness firsthand how they deal with patients. I would highly recommend them to anyone suffering from depression, because they not only offer treatments but expect patients to participate fully in their recovery.

Patients Review
Pam – 25

Dear TMS staff, I want to express my thanks for all your sincere help while I went through a very difficult time. Every time I went to the center the staff was so kind and understanding. The educational classes in the evening were wonderful and I have learned so much about depression. I still look at the handouts you provided. I have gotten into meditation and continue to educate myself about depression and anxiety. If I watch “Friends” on the TV, I will always think of my experience at the Southern Colorado TMS Center!! Thank you for doing your job so well.

Patients Review 4
Barb – 46

All the staff at SCTMSC are very caring during all of the components of the TMS treatment. From dealing with insurance companies to adjusting one’s treatment time due to conflicts with your schedule; they are all wonderful. I would recommend TMS treatments to any person suffering MDD, as I have for many years. From my experience, TMS helped me far more than an anti-depression medication or CBT.

Patients Review 2
FB – 35

Dear TMS Team, I just wanted to say that 6 months after treatment, I am doing well. I have a new life and I am living it up. It is like being young again as I am finding my way again. I am so grateful to Dr. Fleming, Camice, Dawn and all the folks who helped me to get here! But especially to Dr Fleming.

Patients Review 3
Michelle – 37

Dear Dr. Hammock, I am so incredibly grateful and appreciative for all the time and attention you gave to my husband and me. Thank you, thank you for caring so much abut the individual person. I am also grateful that you took the time to help us separate out how we view ourselves in relation to our understanding of God’s love for us verses our symptoms of major depression; neither of us had realized or thought about that. That was incredibly insightful of you and so thoughtful of you to help us get to the root of it. Thank you for helping so many people. I can tell, that you and your team do a lot of good with very sincere hearts. It shines through unmistakably.

Drug free solutions for optimized brain function

We focus on delivering real solutions for our patients. We know that patients can have real life-changing results through applying TMS.

Other Conditions

Depression in Adults

TMS treats depression without medication or medication side effects.

Depression in Adults

Many people suffer from depression. However, through the application of TMS they may find relief.

Post Partum
depression

Many mothers can suffer depression as a result of hormonal changes during or after pregnancy. TMS can help treat this type of depression effectively.

Post Partum
depression

TMS effectively treats depression during and after pregnancy, without the use of medication.

Depression in
Adolescents

TMS can effectively treat depression in teens.

Depression in
Adolescents

As a teen goes through difficult changes in their adolescent years, they can experience serious depression. TMS can help teens who suffer from depression.