Bipolar disorders are, by nature, challenging to treat. Type 1 and 2 bipolar disorder are characterized by manic episodes, in which the individual may make choices they would not otherwise make, as well as a depressive phase, in which they experience mood changes similar to someone with major depressive disorder. Because of the occurrence of manic swings, treating the depressive phase of bipolar disorder can be tricky. Standard treatment options generally include pairing an antipsychotic to control manic episodes with an SSRI antidepressant to combat depressive episodes. However, it has been observed that the use of SSRIs can trigger manic or mixed episodes.

TMS for Bipolar Disorder

Because bipolar disorder consists of both manic and depressive episodes, the symptoms are often treated separately with medication. However, combining courses of psychopharmaceuticals aimed at two different aspects of bipolar disorder can cause some problems. Thus, some researchers have looked into alternative methods of treating depressive episodes that won’t conflict with the pharmacotherapy aimed at controlling the manic swings. Both bipolar 1 and bipolar 2 are serious conditions with a significant rate of self-harm and suicide, so timely and effective treatment is essential. 

Transcranial Magnetic Stimulation (TMS) is a therapeutic option that has successfully resolved symptoms of treatment-resistant depression for years, in a non-invasive, non-medicinal way. This combination of factors has led researchers to conduct several studies to determine whether TMS might be a suitable way of treating bipolar disorder without triggering manic or mixed episodes. Their findings have been extremely encouraging. 

 In trials, both deep and repetitive TMS therapies proved effective at relieving depressive symptoms of bipolar disorder. When using TMS therapy for bipolar disorder, a patient can receive standard pharmacological treatment for manic symptoms, without interference from antidepressant medication, while simultaneously getting relief from depressive symptoms. 

How Does TMS Therapy Treat Bipolar Disorder?

TMS therapy for bipolar disorder is an outpatient procedure that is less invasive than teeth-cleaning at your local dentist. There is no need for anesthesia of any kind. After the session — which may last around thirty minutes — you are free to go about the remainder of your day as you please. 

The actual treatment consists of a targeted magnetic field that is generated by an array of magnets. The TMS technician can direct the pulses of this magnetic field into specific areas of the brain, which are related to depression. Generally, this means the left dorsolateral prefrontal cortex (DLPFC).The TMS machine targets this area with bursts of magnetic energy that stimulate neuronal action where the neurons were previously quiet. This treatment has been clinically demonstrated to reduce depressive symptoms to remission levels at a rate on par with pharmacotherapy. 

A 2020 study not only found TMS to be effective for relieving depressive episodes in patients with bipolar one and bipolar 2, but it also found it safer and more effective than the common psychopharmacological treatment of an antipsychotic paired with an SSRI (Goldwater et al., 2020).

Another study from 2017 also found that deep transcranial magnetic stimulation (dTMS) treatments are effective amongst bipolar disorder patients in conjunction with pharmacotherapy. The effects of dTMS were observed to fade after the final treatment, however, suggesting that bipolar disorder patients may require ongoing dTMS therapy for long-term relief from depressive episodes (Tavares, et. al., 2017). 

Bipolar disorder can be a debilitating, life-altering condition. The combination of suicidal ideation, impulsive decision-making, and risk-taking behavior can cause significant strain on both the person with bipolar disorder and the people in their support network. Parents, siblings, husbands, wives, and children all bear the burden when bipolar disorder goes untreated or unsuccessfully treated. Because of the condition’s severe nature, the symptoms must be addressed and controlled as completely and as soon as possible. While drugs may do the job for some people, it is essential to know that there are other options. TMS therapy has a strong track record of successfully managing depressive episodes through ongoing treatment, without the risk of an SSRI triggering a manic phase. 

When searching for solutions to the treatment puzzles surrounding bipolar one and bipolar two disorders, it is essential to remember that TMS therapy for bipolar disorder is a viable option that can reduce symptoms to remission levels, decreasing the comorbidities that come with depressive episodes. That means fewer thoughts of suicide, more engagement with the world, fewer sleepless nights, and more meaningful interactions with loved ones. Transcranial magnetic stimulation can ease the strain that comes with this challenging disorder and help restore optimism and joy to the parts of life that make each day worth living. 

References

Goldwaser EL, Daddario K, Aaronson ST. A retrospective analysis of bipolar depression treated with transcranial magnetic stimulation. Brain Behav. 2020;10:e01805. https://doi.org/10.1002/brb3.1805

Tavares, D. F., Mieczkowski, M. L., Alberto, R. L., Valiengo, L., Rios, R. M., Gordon, P., de Sampaio-Junior, B., Klein, I., Mansur, C. G., Marcolin, M. A., Lafer, B., Moreno, R. A., Gattaz, W., Daskalakis, Z. J., & Brunoni, A. R. (2017). Treatment of Bipolar Depression with Deep TMS: Results from a Double-Blind, Randomized, Parallel-Group, Sham-Controlled Clinical Trial. Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology, 42(13), 2593–2601. https://doi-org.proxy1.ncu.edu/10.1038/npp.2017.26