TMS for Bipolar Depression

Transcranial magnetic stimulation (TMS) is a potentially effective therapy to treat the depression symptoms of bipolar disorder. It uses electromagnetic currents to stimulate areas of the brain associated with the disease. For people with treatment-resistant bipolar depression, this technique could have the power to control their symptoms and transform their lives. However, more research needs to be carried out about its capabilities before it becomes an approved treatment.

What is Bipolar Disorder?

Bipolar disorder (BD) – formally known as a manic depressive disorder – is a mental health condition associated with periods of depression and mania (extreme highs) that can last from hours to months at a time. The disorder causes unusual changes in energy levels, activity levels, concentration, and mood swings.

Manic and depressive episodes can both negatively impact important parts of a person’s life. This includes their personal relationships, job, schooling, and social obligations. Bipolar disorder can manifest at any age, though most commonly occurs in a person’s late teens or early twenties.

Bipolar disorder is caused by chemical imbalances in the brain. The neurotransmitters norepinephrine and serotonin seem to play key roles in the development of the disorder, though the imbalance of other molecules can also have consequences on the likelihood of developing the disorder.

There are three different kinds of bipolar disorder:

• Bipolar I disorder: defined by a manic episode that lasts at least one week, followed by a period of depression symptoms.
• Bipolar II disorder: alternates between depressive and manic episodes, with less intense mania compared to bipolar I (hypomania).
• Cyclothymic disorder: a milder form of the disorder, defined by its milder depressive and manic-like symptoms.

Although the symptoms of each type present with different distinctions, they all cause individuals to display periods of depressive and manic episodes.

Bipolar Depression

Bipolar depression refers to the depressive symptoms of bipolar disorder. In general, these episodes are longer lasting and more common than periods of mania, commonly making them more disabling than manic symptoms. It also usually takes longer for people to recover from depressive episodes than manic ones.

During depressive episodes, a bipolar individual will feel consumed with sadness and hopelessness. Symptoms will last for at least two weeks and include:

• Depressed mood lasting most of the day where the person will feel sad and empty
• Tearfulness
• Agitation
• Poor concentration
• Difficulty making decisions
• Fatigue
• Low self-esteem
• Loss of interest or pleasure in activities that used to be enjoyable
• Reduction in physical movements
• Sleeping difficulties
• Changes in appetite
• Significant weight loss or gain
• Feelings of worthlessness or inappropriate guilt
• Thinking about self-harm, death, or suicide

Bipolar Mania

Manic symptoms are the other side of bipolar disorder. During bipolar mania, bipolar patients display an extremely high mood, where they feel elated and energized. Hypomania is a less severe form of bipolar mania, though can still significantly alter a person’s life.

Some symptoms of bipolar mania include:

• Periods of feeling extremely “up” and elated
• Energized behavior
• Persistent movement and restlessness
• Overly talkative
• Speech disruptions, including rapid speech, incoherence, and clang associations
• Racing thoughts
• Increased productivity
• Enhanced creativity
• Sudden shifts to irritability or anger
• Little need for sleep without fatigue
• Grandiosity
• Increased religious activity
• Inappropriate behavior
• Partaking in risky behavior
• Extreme impulsivity
• Hypersexuality
• Psychosis: delusions, hallucinations, paranoia

What is the Difference Between Bipolar Disorder and Unipolar Depression?

The key difference between the two conditions is that bipolar disorder involves cycling between high and low states, whereas unipolar depression (major depressive disorder) only involves lows. Depending on the diagnosis given, the treatment for each will be very different.

Treatment for Bipolar Disorder

There are multiple kinds of therapeutic approaches needing to be taken when treating bipolar disorder. For most people, this includes medication – such as antipsychotics and antidepressants – and psychotherapy. Because the symptoms of a depressive and manic episode are polar opposites, treatment for bipolar can be difficult. For example, giving a patient antidepressants to treat their depressive symptoms can bring out a manic mood swing.

Despite its difficulties, treating bipolar depression and mania in this way can allow people to manage their symptoms and fulfill their lives without too much disruption from their disorder. However, this is not the case for all bipolar patients.

Treatment-resistant bipolar disorder is a term used when someone has minimal or inadequate response to standard treatment. As the condition is potentially life-threatening, people with this type of mood disorder require extremely careful management.

Transcranial magnetic stimulation (TMS) is another therapeutic approach that has shown some success in managing treatment-resistant bipolar depression. The technique has already been successfully used for the treatment of other mental health conditions, leading people to believe it could also be an option for bipolar disorder.

What is Transcranial Magnetic Stimulation (TMS) Therapy?

TMS is a non-invasive brain stimulation technique. It utilizes magnetic fields to stimulate electrical activity in precise areas of the brain. The aim of the therapy is to correct the electrical dysfunction in these targeted areas and relieve symptoms of the mental health condition.

The signals are transferred via an electromagnetic coil that is placed on the side of a person’s head. The pulses of magnetic stimulation activate nerve cells in certain regions of the brain, changing their activity to restore proper function – this may be exciting or inhibiting neurons.

There are different kinds of TMS available, though the most common is repetitive transcranial magnetic stimulation (rTMS). This utilizes rapid pulses in a “train” that are presenting at a similar frequency and duration and are spaced equally apart.

What Mental Disorders can TMS Treat?

TMS treatment has been shown to successfully treat a range of mental health conditions to varying levels. Using TMS to treat major depressive disorder has been thoroughly researched and has been used to transform people’s lives with treatment-resistant versions of the condition. A clinical trial published in the Journal of Clinical Psychiatry reported that over 62% of people who underwent TMS for unipolar depression experienced a significant reduction in their symptoms. Impressively, 42% of those also achieved full remission after other treatments had failed to work.

TMS has also been successfully employed to treat obsessive-compulsive disorder (OCD), migraines, anxiety disorder, and other brain conditions.

Does TMS Help with Bipolar Disorder?

There have been multiple studies reporting on the results of TMS treatment for bipolar disorder. In 2019, a review of all published studies on this topic in medical journals concluded that people’s depressive symptoms were widely improved using this technique. Although, there were mixed results on improvements to mania symptoms. The author deduced that more research needs to be carried out in order to make a solid conclusion about the success of TMS for bipolar, though it is likely that it is appropriate for people living with the depressive symptoms of the disorder – bipolar depression.

More research also needs to be carried out about the finer details of the technique. A study noted that experts need to better understand the TMS frequencies most suited to target the brain regions associated with bipolar disorder.

Is TMS FDA Approved to Treat Bipolar Depression?

Despite some positive results being recorded and TMS being used to treat other mental disorders, it has not yet been approved by the Food and Drug Administration (FDA) to treat bipolar disorder. However, in 2020 the FDA gave TMS a “breakthrough device designation” for bipolar disorder treatment. This means that although it does not get an approved formal treatment status, there is strong evidence to support its use.

TMS Side Effects

TMS is a non-invasive technique that is deemed safe by experts. Many people favor repetitive TMS over traditional treatments due to its little-to-no side effects. For example, medications used to treat bipolar disorder can have serious side effects, such as involuntary movements, sexual problems, and liver damage. It can also take years for individuals to find the right kind of medication that works best for them and be able to stabilize on it.

Although there are many positives to deep transcranial magnetic stimulation treatment, it is important to be aware of the potential risks it may pose for someone with bipolar disorder. These include:

• Pain during the procedure
• Brief headache
• Dizziness
• Anxiety
• Insomnia
• Inducing manic episodes

Who Should Not Get TMS Treatment?

The vast majority of people can receive TMS for bipolar depression, though it is unsafe for people with non-removable metallic objects less than 30cm from the treatment coil. These objects include:

• Aneurysm clips or coils
• Cochlear implants
• Stimulators
• Implanted electrodes
• Stents in the head
• Metal fragments

How to Prepare for a TMS Session

Prior to the first TMS treatment for bipolar disorder, a medical professional should carry out a series of tests to make sure the procedure is safe to go ahead with. This could include performing a physical and psychiatric evaluation, reviewing medical history, and checking for any implanted metal devices. Before your treatment, it is important to remove any metal jewelry, including piercings, necklaces, and rings.

What to Expect from a TMS Session

In a clinical practice, a trained professional will guide the person undergoing treatment to a chair and hand them earplugs. Once seated, the medical staff will position a coil-like device on the left side of the patient’s head just around their hairline.

The first session will consist of trying to find the correct intensity of the magnetic signal to use. This is done by slowly increasing the strength of the pulses until a slight twitch in the hands can be seen. This level, called the resting motor threshold (RMT), will be taken forward into subsequent sessions. This is the minimum stimulation intensity needed to produce motor-evoked potentials, such as face muscle spasms or hand movements.

Due to the magnetic pulses, it is common to experience a tapping session on the head during treatment. These are normal and nothing to worry about.

How Long Does a TMS Session Take?

Each sitting will last around thirty to sixty minutes and should be carried out around five times per week. Overall, bipolar patients need around twenty sessions over six or more weeks to successfully treat bipolar disorder. However, this number varies between individuals.

After the Session

A huge positive of this non-invasive therapy compared to other approaches is that it doesn’t require sedation and causes little disruption to a person’s schedule. After a session, people can go back to their usual day-to-day activities – including driving and working. There may be some mild side effects such as a headache, though these can be treated with over-the-counter painkillers.

How Much Does TMS Treatment Cost?

Some studies and comparisons with treatment for major depressive disorder symptoms show it could cost around $300. This may change after FDA approval.

Does Insurance Cover TMS for Bipolar Depression?

As this treatment for bipolar depression has not yet been approved, insurance companies have not yet confirmed whether they will cover the procedure. However, many cover the costs of TMS therapy for unipolar major depression, so there is a possibility they will also do so for other psychiatric disorders.

How to Get TMS for Bipolar Disorder

Currently, the only way to receive TMS for bipolar disorder is to participate in a study. It is possible to find clinical trials that are recruiting via your doctor or the internet.

However, it may be possible to gain TMS therapy to treat bipolar depressed patients to manage their depressive episodes.

Contact Us

Experiencing bipolar depression can be hugely disruptive to a person’s life and be extremely isolating. However, the disorder is more common than most people think. According to the National Institute of Mental Health, over 4% of adults experience bipolar disorder at some point in their lives, and it affects millions of Americans each year.

GIA Chicago is a specialist mental health treatment center based in a relaxing and beautiful neighborhood in Chicago. Our expert staff is trained to treat a range of mood disorders using a variety of evidence-based approaches that can be tailored to best suit each individual’s needs. As treating bipolar disorder is complex, we ensure our clients receive holistic therapies tackling all aspects of the condition.

Bipolar depression can be debilitating and potentially life-threatening so it is important that expert help is sought for the condition. Although we do not use TMS to treat bipolar disorder, we do use the technique to manage its depressive symptoms. Contact us today to find out more about our treatment options for bipolar disorder.