What to know about TMS for bipolar

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TMS stands for transcranial magnetic stimulation. It is a noninvasive technique that uses magnetic fields to stimulate the brain’s electrical activity in certain areas. In targeting different areas of the brain, a doctor may be able to provide potential benefits to different conditions.

Researchers have shown that doctors can use TMS in the treatment of several mental health conditions, such as depression and OCD, and other brain-related conditions, such as migraine.

BD is a mental health disorder. It can present differently and may cause unusual changes in:

• energy levels
• mood
• concentration
• activity level and overall ability to complete daily tasks

There are three types of BD:

• bipolar I disorder
• bipolar II disorder
• cyclothymic disorder

While each type of BD has important distinctions, a person living with any of the three types goes through periods of depression or depressed mood and manic episodes.

TMS has shown some promising results in the treatment of BD. In a 2019 review of published studies on the use of TMS for BD, researchers noted the following:

• People living with depressive symptoms saw improvements in their symptoms across multiple studies.
• People living with mania symptoms had mixed results across multiple studies.
• Only a few studies have looked at people living with BD during phases outside of manic or depressive states, making a conclusion difficult.

In 2021, experts noted that more research is necessary to understand the best frequencies to use and areas to target with TMS for the treatment of BD. Still, as the experts pointed out, in 2020 the FDA gave TMS a “breakthrough device designation” for the treatment of BD. While this is not a formal approval for treatment, it does indicate that sufficient evidence supports its use, and it signals that the organization may expedite the review of TMS treatments for BD.

Studies appear to indicate that TMS may benefit people living with bipolar depression. A 2019 review of studies found that studies looking at repetitive TMS for depressive symptoms showed potential, while studies looking at its use in manic episodes were mixed.

This suggests that TMS may be most appropriate for people living with depressive symptoms of BD. The researchers also noted that the procedure may work for people who have not responded to psychological or pharmacological intervention for the disorder.

In a 2020 study, researchers observed 44 people living with depressive symptoms of BD who underwent TMS. They did not have any subjects who fit the criteria with mania. They noted the following results:

• 77% met their response criteria
• 41% of those who had at least 25 treatments met remission criteria

Of those that started the study, four (representing 10% of the study participants) discontinued the use of treatment due to concerns about activating mania.

Experts generally consider TMS safe and noninvasive, but as with other procedures, there are certain risks a person should be aware of. These risks can include:

• inducing a manic episode
• brief headache
• dizziness
• pain (during the procedure)
• anxiety
• insomnia

Currently, the FDA has not approved TMS for the treatment of BD.

Information on exactly what a person will need to do for TMS is limited. A person should follow instructions from the researchers in any studies they join.

Still, the use of TMS for depression may provide some idea of what a person will need to do to prepare for the procedure. Prior to the procedure, it is likely that a doctor will review certain information with the person by:

• performing a physical examination
• conducting a psychiatric evaluation
• reviewing personal and family history
• reviewing any implanted metal plates or devices, such as pacemakers

TMS is a minimally invasive outpatient procedure.

For the procedure, a person will likely sit in a chair with earplugs. Once they are seated, a doctor or researcher will attach a coil-like device near the hairline. The device will then emit magnetic pulses that may feel like a tapping sensation.

Each session will likely last from 30–60 minutes. A person may need 25 or more sessions to treat BD, though the exact number of sessions required will vary from person to person.

Researchers have described TMS as a “promising approach” when used to treat BD. In particular, studies have pointed out its potential use in people living with depressive BD symptoms who have not responded well to other forms of treatment.

Other studies have shown that, at least in depression symptoms, TMS can be quite effective in treating BD.

All studies have indicated a need for additional research to fully understand TMS’s effectiveness and safety in people living with BD.

TMS is currently not available in the United States for the treatment of BD. An older study indicated that each session could cost around $300.

Costs will likely change upon approval of TMS for BD treatment. Insurance and Medicare may cover the costs once approval for the procedure occurs.

Currently, a person will need to participate in a study to receive TMS for BD.

To find an active study, a person can contact their primary care doctor and ask about any recruiting studies they may be aware of.

A person can search for TMS treatment for BD studies on ClinicalTrials.gov. This site provides a list of clinical trials that a person may be able to join.

TMS may provide an effective form of therapy for BD. Currently, the FDA does not approve TMS as a treatment for BD, but studies have shown that it may provide effective therapy for people with depressive symptoms who have not had success with other treatments.