Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder in Comparison to the Treatment of Unipolar Depression in a Naturalistic Setting

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is effective in the treatment of depression. However, for the subset of patients with bipolar disorder, less data is available and overall strength of evidence is weaker than for its use in unipolar depression. A cohort of 505 patients (of which 46 had a diagnosis of bipolar disorder) with depression who were treated with rTMS were analyzed retrospectively with regards to their response to several weeks of treatment. Hamilton Depression Rating Scale (HDRS) was assessed as main outcome. Unipolar and bipolar patients with depression did not differ significantly in baseline demographic variables or severity of depression. Both groups did not differ significantly in their response to treatment as indicated by absolute and relative changes in the HDRS and response and remission rates. On HDRS subitem-analysis, bipolar patients showed superior amelioration of the symptom “paranoid symptoms” in a statistically significant manner. In conclusion, depressed patients with a diagnosis of bipolar disorder benefit from rTMS in a similar fashion as patients with unipolar depression in a naturalistic setting. rTMS might be more effective in reducing paranoia in bipolar than in unipolar patients.

Distinct Predictors of Clinical Response after Repetitive Transcranial Magnetic Stimulation between Bipolar and Unipolar Disorders

“…Recent publications have demonstrated no difference in the HDRS score between the groups [ 19 ], but they underline an interest in studying the effectiveness of rTMS in a distinctive manner through these two diagnoses [ 8 ].…”

“…Alhelali et al demonstrated a difference in the effect of rTMS between bipolar and unipolar patients with respect to items 10 and 11 [ 8 ]. Similarly, we observed a difference in the effect of rTMS with respect to the anxiety sub-score while grouping the items together.…”

“…Besides their medical diagnosis, the distinction between unipolar and bipolar disorders is not well defined since the bipolar population remains relatively small but is also very complex in its classification (Bipolar type 1, Bipolar type 2, Cyclothymic disorder, Mixed episodes, Rapid cycling, and Psychotic features), often consisting of very few individuals in very large cohorts [ 7 ]. Considering the growing interest in the use of rTMS for the treatment of bipolar disorder [ 8 ], we believe that it would be crucial to distinguish populations that are treated in identical ways with standardized instruments but have clinically different diagnoses. In this study, we focused on the potential factors predicting clinical response to rTMS to add to the limited literature, particularly with respect to the distinction between bipolar and unipolar disorders.…”

A new approach for the treatment of subthreshold bipolar disorders: Targeted high dose levothyroxine and repetitive transcranial magnetic stimulation for mitochondrial treatment

“…Systematic review and meta-analysis of rTMS for Bipolar Depression indicated that it is safe and effective with low-risk side effects ( 24 , 25 ). Furthermore, depressed patients with a diagnosis of BD benefit from rTMS in a similar fashion as patients with unipolar depression in a naturalistic setting ( 26 ).…”

Brain Stimulation and Neuroplasticity—Series II

“…Concerning rTMS, Alhelali et al [ 11 ] investigated the effects of rTMS in a large cohort of patients with unipolar and bipolar depression ( n = 505). High-frequency rTMS protocols were applied over the left or right dorsolateral prefrontal cortex or the medial prefrontal cortex (mean number of sessions: 18–19).…”