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Can TMS Help with Bipolar Depression?
Daniel Hageman
2021-11-23T22:58:40Z
Medically reviewed on by
Regional Medical Director Greater St. Louis
Can TMS Help with Bipolar Depression?
Transcranial magnetic stimulation (TMS) isn’t cleared—either by the U.S. Food and Drug administration or health insurance carriers—to treat bipolar disorder. However, research shows promise for the use of TMS to address the depressive symptoms associated with bipolar depression.
Bipolar depression is a complex diagnosis, which is why it’s important to use a trusted, experienced TMS provider who can determine which treatment is appropriate for you.
What is Bipolar Disorder?
Bipolar disorder is a mental health condition that used to be known as manic-depressive disorder. It’s not as common as major depressive disorder. About 2.8% of American adults have a bipolar diagnosis, compared to 7.1% of adults with depression.
As the name implies, bipolar disorder is typified by drastic shifts in mood and energy—they’re so extreme, in fact, that these mood swings disrupt normal life. Highs, referred to as hypomania or mania, are periods of excessive euphoria. The lows, or depression, are similar to what you’d experience with major depressive disorder: intense sadness, lack of motivation, hopelessness, isolation, and, in serious cases, thoughts of self-harm or suicide.
Trauma or stress, brain function, or family history may all play a role in whether someone has bipolar disorder, although there isn’t one known cause at this time. Manic or depressive episodes can last at least a week or more, but symptoms and frequency of mood swings may be less for one person than another.
There are three main types of bipolar disorder:
- Bipolar I is marked by a manic episode, in which an uncontrollable high lasts for at least a week. It alternates with either depression or hypomania, a milder form of mania that is more subdued and lasts only a few days.
- Bipolar II alternates between depression and hypomania, without a more intense manic episode.
- Cyclothymia characterized by spells of milder depression and manic-like symptoms.
Signs of Bipolar Disorder
Given the marked contrasts between depressive and manic episodes, it’s understandable that they have very distinct symptoms. During depressive states, people may experience:
- Weight gain from overeating. Or, sometimes weight loss from loss of appetite.
- Exhaustion from too much or too little sleep.
- An inability to mentally focus or accomplish simple tasks.
- A loss of interest in hobbies, relationships, and normal activities that they used to find pleasurable.
- Feelings of worthlessness or self-loathing.
- Suicidal ideation.
During manic states, patients may experience:
- Decreased need for sleep.
- Excessive talkativeness.
- High energy.
- Euphoria, or an unusual level of happiness.
- Irritability.
- Racing thoughts and speech.
- Trying to accomplish several tasks at once.
- Risky behavior that could harm themselves and/or others.
- An elevated sense of self.
What is the Difference Between Bipolar Disorder and Depression?
The most important difference is that depression is considered a unipolar condition. Instead of cycling between high and low states as people do with bipolar disorder, a major depressive disorder only triggers the lows. Treatment plans will differ depending on whether someone is diagnosed with bipolar disorder or major depressive disorder. It’s important to have a qualified professional make the correct diagnoses to ensure your treatment plan will be effective. TMS can be a valuable treatment option for someone suffering from the symptoms of bipolar depression.
Is TMS Approved for Bipolar Disorder?
As of now, there is not enough research data to recommend TMS therapy for bipolar disorder, according to the FDA. For now, using TMS to treat bipolar disorder is “off-label” because it is not approved by the FDA.
What Are the Treatment Options for Bipolar Depression?
Bipolar depression, like unipolar depression, can be treated with medications and psychotherapy. Medications can include antidepressants, mood stabilizers, or antipsychotic drugs, depending on the patient’s condition. Psychotherapy modalities include cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT).
TMS therapy for bipolar depression is another option. This is an effective, FDA-cleared treatment for major depressive disorder, as well as obsessive compulsive disorder, smoking cessation, and anxiety symptoms related to depression.
Magnetic technology is the foundation for
how TMS works. An electromagnetic coil is placed on a patient’s scalp near the left temple. This allows targeted areas of the brain to be stimulated with magnetic pulses. These pulses become electrical currents that activate the brain’s nerve cells to restore proper function and alleviate depression symptoms.
TMS is non-invasive and doesn’t require sedation. In other words, there’s no downtime or recovery period. A course of treatment usually lasts six or more weeks, starting at five sessions per week, with five sessions per week. Each session lasts 18 to 40 minutes, so there’s minimal disruption to your daily schedule.
More than 62% of TMS patients experience significant reduction in symptoms, with 42% of those patients achieving complete remission, according to the
Journal of Clinical Psychiatry. Preliminary
studies indicate TMS treatment for bipolar depression can be helpful.
Greenbrook TMS does not treat patients specifically for bipolar disorder, but rather for symptoms associated with bipolar depression. Find out if TMS therapy is right for you or a loved one.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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