Does Deep TMS Treatment Work For Bipolar Depression?

In 2008, the FDA approved transcranial magnetic stimulation (TMS) as a treatment for depression. However, the FDA has not fully approved it for treating bipolar disorder (BD) but is recognizing treatment options for treatment-resistant depression patients struggling with BP1 disorder. Originally, there was concern about the potential of triggering manic episodes in patients with BP; research has now shown the risks of inducing mania are comparable to that of any SSRI medication triggering a manic episode.

Mania may occur in <1% of the patients with BP, indicating no statistical significance from others seeking TMS with unipolar depression. Studies have indicated that TMS can serve as an effective and safe treatment for individuals with bipolar as long as the treatment is closely monitored. Here are some of the most recent research and information you should know about TMS, BD, and associated depression:

What is TMS?

TMS uses MRI-like magnetic pulses to stimulate specific parts of the brain to treat particular disorders. These pulses encourage cell growth, healing, and regeneration to reestablish healthy functioning. When treating depression, TMS experts direct the magnetic field over the left dorsolateral prefrontal cortex (DLPFC). In most BP patients, treatment bilaterally to the dorsal lateral prefrontal cortex can effectively address symptoms and is likely the best target region.

Research Supports TMS For BD

In 2018, researchers found that TMS had effects that alleviated depression while also enhancing cognition in those struggling with BD. This relief was reflected in higher energy levels, enhanced mood, increased concentration, and overall ability to complete daily life tasks. In 2019, a review of published studies on TMS and BP indicated that individuals saw improvements in their depressive symptoms. However, during this review, results were inconclusive on the positive impacts on TMS and mania. Further studies are being conducted to clarify TMS’ impact in this regard.

Different researchers conducted a literature review in 2020. Their results suggested that TMS can significantly reduce BD symptoms of both mania and depression. In 2021, Dr. Camprodon published yet another review in the Journal of the American Medical Association. Dr. Camprodon concluded we need more research and evidence for the optimal technique for using TMS to treat BD.

TMS treatment is complex as there are different frequencies, rates, and regions of the brain to target. Researchers and providers must determine the best length of treatments, whether maintenance therapy is required or recommended, and what medications patients can safely take while undergoing TMS. For example, patients receiving TMS for depression sometimes use it additively to magnify or speed up the response to antidepressants in dire cases.

Customized TMS Therapy for Bipolar Disorder

Well-trained TMS therapy practitioners will monitor you for shifts in energy level, mood, and sleep patterns. In some cases, treatment protocols may vary to reduce stimulation intensity or modify the type of stimulation. It is important to ensure your treatment center has experience working with patients with BP, allowing for a customized approach that does not compromise the safety and efficacy of care.

While TMS has yet to receive FDA approval, NeuroStim TMS has treated many individuals with a BP diagnosis comfortably, often finding that those with bipolar depression have a better response rate than those with unipolar depression. Large-scale studies have yet to show this, but the ideology is that the brain of a BP individual has more flexibility in terms of switching between stages and, as such, can shift from depression to feeling better more readily. Essentially, the brain is primed for the best success at TMS working.

Why Take The Risk?

The current treatment protocol for BD consists of antidepressants to treat depression and a mood stabilizer to prevent manic episodes. Finding the right combination of medications to relieve both sets of symptoms effectively can be difficult, time-consuming, and risky. Many medications can be extremely harmful and have more risk of disorders like Stevens-Johnson syndrome.

If your BD is more treatment-resistant, the tried-and-true mood stabilizer is lithium, which often has toxic effects. It’s especially harmful to your thyroid and kidneys, so close monitoring is required while on the medication. Because most of these medications are so harsh, they are unsafe to take while pregnant or contraindicated with other health concerns. They never come with the guarantee to work forever; many become tolerant, need to switch medications, and eventually run out of options to try. Currently, there is no cure for BD.

Because TMS is non-invasive (a quick outpatient treatment with a temporary external device) and non-systemic (applied directly to your brain via your scalp), it’s the most promising treatment for BD, offering more benefit than harm. The FDA-granted breakthrough device designation indicates enough interest and evidence that the treatment works but not enough for formal approval yet.

A Hopeful Future

As more researchers publish their findings, TMS will likely earn FDA approval for bipolar depression or BD as a whole, which would be the closest thing to a cure the bipolar community has seen yet. But if you can’t wait, TMS providers can utilize the breakthrough device designation to help you while waiting for the latest cutting-edge treatment option.