Transcranial Magnetic Stimulation for Bipolar Depression: A Clinical Perspective

Abstract

1 provided an overview of available research reports on transcranial magnetic stimulation (TMS) for bipolar illness. In that edition, we also introduced the rationale for pursuing TMS for treatment-resistant bipolar depression. Notably, only two pharmacologic treatments are currently FDA-approved for acute treatment of bipolar depression, despite the disproportionate amount of time spent in depression by most patients with bipolar illness. This is in marked contrast to the sizeable number of pharmacologic agents that have come on the market in the past two decades for treatment of mania, and similarly in contrast to the large number of agents approved for unipolar depression. It also appears that traditional antidepressants may have much more limited value than previously assumed for many patients suffering from bipolar disorders. Thus, clinicians may to turn to TMS as an alternative for patients with treatment-resistant bipolar depression when antidepressants have not been adequately effective or tolerated. This companion article to last month’s edition offers realworld, clinical observations regarding the practical use of TMS in treating bipolar depression. Although research and clinical experience to-date suggest the application of TMS for bipolar depression is promising, its use also presents a number of clinical challenges unique to bipolar illness (Table 1) and raises several questions to be addressed through future investigation (Table 2). Thus far, our clinical experience echoes the promise seen in earlier studies. We have treated 11 patients with bipolar illness (bipolar II, 9; bipolar not otherwise specified After participating in this CME activity, the psychiatrist should be better able to: • Determine which patients with treatment-resistant bipolar depression may be appropriate candidates for transcranial magnetic stimulation (TMS). • Assess clinical challenges in the use of TMS for bipolar depression. • Appraise the potential role of TMS in the integrated treatment of bipolar disorder.