Introduction
Transcranial magnetic stimulation (TMS) is a non-invasive procedure that stimulates specific areas of the brain using magnetic fields. It does not involve surgery or sedation, and it can be used to treat a variety of neurological and mental health disorders. One of these is bipolar disorder - a mental health condition characterised by extreme fluctuations in mood, with episodes of depression and mania. These mood episodes are often so severe that they interfere with daily life, relationships, and overall well-being; therefore, effective treatment is essential.
This is where TMS comes in, as it offers an alternative or adjunct to traditional treatment methods like medication and talking therapies. Consequently, if you are living with bipolar disorder, it gives you more options for managing your symptoms.
Understanding TMS
What TMS involves
TMS therapy is an intensive treatment option that typically involves undergoing five therapy sessions per week for approximately six to eight weeks. During a session, a small electromagnetic coil is placed against your scalp near the area of the brain that needs stimulation. The coil delivers short bursts of magnetic pulses that pass through the skull and stimulate brain cells that regulate mood.1 These pulses are painless and generally well-tolerated by most patients.
How TMS works in treating mental health conditions
The area of the brain typically targeted by TMS therapy for depression and bipolar depression is the left dorsolateral prefrontal cortex (DLPFC) - a region responsible for various functions, including mood regulation. The magnetic pulses delivered by TMS rebalance abnormal brain circuitry and increase the brain’s ability to form new pathways. This effectively ‘resets’ the networks that regulate mood, thus supporting emotional stability. In this way, TMS can be a powerful treatment option for conditions such as depression and bipolar disorder.
TMS differs from traditional medicinal options as it offers targeted treatment to the brain. This decreases the likelihood of unwanted side effects throughout the body - offering a more focused and potentially more effective treatment approach for conditions like bipolar disorder.
TMS as a treatment option for bipolar disorder
Overview of traditional treatments
Bipolar disorder is typically managed using a combination of treatment methods - including mood stabilisers, antidepressants, antipsychotics, psychotherapy, and lifestyle changes. This traditional approach to managing bipolar disorder is often effective at controlling mood swings and reducing the frequency and severity of manic and depressive episodes. However, due to the systemic nature of medications, you may experience unwanted side effects throughout your body. For example, antipsychotics can cause symptoms such as weight gain, tremors, and loss of menstrual periods in women.
TMS as an alternative treatment
TMS offers an alternative solution for treating bipolar disorder if you have not responded well to traditional therapies. In addition, it is associated with fewer side effects as it specifically targets the brain rather than the whole body. However, evidence suggests it works most effectively as a treatment option when combined with traditional medications.2,3 This makes it a useful tool for enhancing treatment outcomes and providing a more comprehensive approach to managing bipolar disorder.
How TMS sessions work
What to expect during a TMS session
During a TMS session, you will be sat in a comfortable chair in a specialised treatment room. You will be asked to remove any jewellery and items such as mobile phones and debit cards from your pockets as these can interfere with the magnetic field. The electromagnetic coil will then be carefully placed against your scalp in the area that needs targeting, and you will be given earplugs for comfort and hearing protection. While the treatment is taking place, you will hear a series of clicking sounds and feel a tapping sensation on your scalp where the coil is placed; this may feel unusual, but it should not be painful. The session should last around 10-30 minutes.
Once the treatment is over, you may be offered a drink or something to eat. You should be able to continue your daily activities like normal after a TMS session; however, you should not drive yourself home after your first session.
Patient experience during TMS treatment
As previously stated, you will hear clicking sounds and feel tapping on your head during treatment. This is normal and nothing to be concerned about. During your TMS session, you will be fully awake and alert; you may pass the time by talking to the healthcare provider administering your treatment, listening to music, or watching videos. Alternatively, you may choose to sit in silence and relax while the treatment takes place. Overall, your TMS session should be a comfortable and relaxed experience.
Benefits and potential risks
Benefits of TMS for bipolar disorder
Aside from its effectiveness in stabilising mood and improving quality of life for people living with bipolar disorder,2,3 TMS has some key benefits as a treatment option:
- It is non-invasive
- It does not require sedation or anesthesia
- It does not cause systemic side effects commonly associated with medications4
- It is generally painless and administered in a relaxed environment
- It can complement and enhance the effects of traditional treatments, namely pharmacotherapy and psychotherapy
Common side effects and how they are managed
While TMS is generally well-tolerated, you may experience side effects during or after treatment. Common side effects include scalp discomfort from the coil, lightheadedness, muscle twitching in the scalp, mild headaches, and tiredness. These effects are usually temporary and can be managed with over-the-counter painkillers such as paracetamol; adjustments can also be made to the TMS device’s settings to minimise discomfort during treatment.
If you experience any side effects or concerns, you must communicate these with your healthcare provider so that they can make appropriate adjustments to ensure a comfortable treatment experience.
Risks associated with TMS treatment
In rare cases, more severe side effects can occur. Around one in 60,000, patients experience seizures during treatment; the risk of seizures is especially high in individuals with a history of epilepsy or similar disorders. To mitigate this risk, your healthcare provider will carefully screen your medical history to establish whether TMS is a suitable treatment option.
Considerations and precautions
Eligibility criteria for TMS treatment
You must meet specific eligibility criteria before undergoing TMS treatment for bipolar disorder. Healthcare providers will typically assess factors such as the severity of your symptoms, previous treatment history, overall health status, and any contraindications to TMS. Contraindications include a diagnosis of epilepsy, a history of seizures, and the presence of non-removable metal in or near your head, such as metallic implants in your ears or facial tattoos with metallic ink.
Importance of consulting healthcare professionals
Before pursuing TMS as a treatment option for bipolar disorder, you must consult with healthcare professionals who specialise in treating mental health conditions. They can provide you with valuable information about the potential benefits and risks of the treatment, as well as address any questions or concerns you may have. This will enable you to make an informed decision about your mental health treatment plan.
Summary
TMS is a non-invasive procedure that uses magnetic pulses to stimulate specific areas of the brain associated with mood regulation. This makes it a potentially effective treatment for bipolar disorder, offering a targeted approach - unlike traditional medications and psychotherapy. It can be used as an alternative to these conventional therapies or, more likely, as an adjunct - contributing to a more comprehensive treatment plan for bipolar disorder.
The effectiveness of TMS in managing bipolar disorder has been demonstrated in several studies, and it has also exhibited minimal side effects. Therefore, it may be worthwhile to explore TMS as a treatment option if you live with bipolar disorder. If this is something that you are considering, it is essential that you first seek professional advice to ensure it is an appropriate option for you.
References
- Siebner HR, Hartwigsen G, Kassuba T, Rothwell JC. How does transcranial magnetic stimulation modify neuronal activity in the brain? Implications for studies of cognition. Cortex. 2009;45(9): 1035–1042. https://doi.org/10.1016/j.cortex.2009.02.007.
- Tavares DF, Myczkowski ML, Alberto RL, Valiengo L, Rios RM, Gordon P, et al. Treatment of bipolar depression with deep tms: results from a double-blind, randomized, parallel group, sham-controlled clinical trial. Neuropsychopharmacology. 2017;42(13): 2593–2601. https://doi.org/10.1038/npp.2017.26.
- Tran NN, Hutto S, Thompson LR, Hawkins A. Transcranial magnetic stimulation in bipolar ii disorder treatment: a case report. Cureus. 15(9): e45918. https://doi.org/10.7759/cureus.45918.
- Kemp DE. Managing the side effects associated with commonly used treatments for bipolar depression. Journal of Affective Disorders. 2014;169 Suppl 1: S34-44. https://doi.org/10.1016/S0165-0327(14)70007-2.
