Transcranial Magnetic Stimulation (TMS) for Bipolar Disorder: Does It Work?

What Is Bipolar Disorder?

Bipolar disorder is a mood disorder that causes high levels of mania and low levels of depression. Some of the main features of bipolar include mania, anxiety, depression, suicidal thoughts, and mood swings. There are many types of bipolar disorders and co-occurring mental health conditions. While bipolar disorder cannot be cured, it can be managed well with therapy, medication, support systems, and healthy coping mechanisms. Typical treatments for bipolar disorder can be effective when adhering to your treatment plan and ensuring you are treating the correct mental health disorder.¹

Common symptoms of bipolar disorder include:

• Frequent sadness
• Racing thoughts
• Mood swings
• Poor cognition
• Rapid sleep and appetite changes
• Escalation of certain emotions

What Is Transcranial Magnetic Stimulation?

Transcranial magnetic stimulation (TMS) is a treatment option for mental health conditions such as bipolar disorder, trauma, depression, and chronic pain. The procedure is done in an outpatient setting which lasts on average 30 minutes and is noninvasive. TMS requires you to  sit in a chair while having a magnetic brace placed over your head. During the procedure, you will be awake and not feel any pain or pressure from the device. This treatment works on many mental health conditions by sending magnetic signals to your brain to help restore functional neural pathways and chemical processes which may be impacted by the mental health condition being treated.²

Possible side effects of a TMS session include:

• Headache
• Lightheadedness
• Short-term facial twitching
• Short-term scalp sensitivity
• Short-term hearing sensitivity

Does TMS Work for Bipolar Disorder?

TMS may be effective for treating bipolar disorder as it improves electrical activity in the brain. Depending on the location where the magnetic stimulation is performed on the brain (i.e., frontal cortex, cerebral cortex, etc), symptoms of certain mental health conditions can be neutralized. TMS for bipolar disorder can be effective with one or more sessions and will also depend on the severity of the symptoms and goals of treatment.³

Benefits of TMS for bipolar disorder may include:

• Improved symptoms of depression
• Increased cognitive functioning
• Helps treatment-resistant bipolar disorder and depression
• Supports the efficacy of medication used for bipolar disorder
• Higher symptom remission

How Effective Is TMS for Bipolar Disorder?

TMS for bipolar disorder is an up-and-coming approach that is gaining popularity due to the effectiveness of its treatment on depressive symptoms that come with bipolar disorder. TMS can be felt as early as 2 weeks from the beginning of treatment, whereas medications can take 4-8 weeks to notice benefits. A combination of medication and therapy is a standard approach to bipolar disorder treatment as processing the deep emotions is part of learning how to manage bipolar disorder long term while medication helps to improve symptoms. For those with treatment-resistant bipolar disorder or a co-occurring treatment-resistant depressive disorder, TMS can help to stimulate the brain to help restore cognitive processing, which can make symptom management easier. TMS may not be as effective without these other interventions as part of your treatment plan.³

Who Should Avoid TMS for Bipolar Disorder?

Given that TMS is noninvasive and comes with minimal side effects, it is relatively safe for most people. There are some people who have other pre-existing medical issues which counteract TMS intervention and can make those other conditions worse.

Populations who should avoid TMS treatment for bipolar disorder include:

• Those who are pregnant or breastfeeding
• Anyone with a history of severe headaches or migraines
• Those with a history of seizures
• Someone with metal or screws surgically implanted in their head or neck
• Someone with metal dental fillings, braces, or other devices
• Anyone with a history of traumatic brain injury (TBI)

How to Prepare for a TMS Session

To prepare for TMS, you must talk to your doctor about your entire medical and surgical history to ensure you are a safe candidate for the procedure. You will undergo a complete physical exam as well as a mental health assessment and any additional evaluations based on your doctor’s recommendation. It is essential that you feel comfortable going to your session, and it can be helpful to bring a trusted loved one to be there with you after your session. Take time to ask your doctor some questions about the procedure and what your limitations may be after your session, such as limited driving and screen time. Having all the information ahead of time gives you a chance to prepare and reduce any nervousness or uncertainty around the procedure.

What to Expect From TMS for Bipolar Disorder

Your first session may last anywhere from 20-70 minutes, depending on your treatment goals and the severity of your symptoms. The details of your treatment will be discussed with you in session. You will likely have earplugs given to you to wear for the duration of the treatment. You may be required to remove any earrings or other jewelry for TMS sessions.

You will be asked to sit in a chair and have a metal coil brace placed upon your head. The brace will send electrical signals to your brain. It will be important to ask your doctor if and how you can stop treatment if you are feeling uncomfortable during your session. After your first session and depending on your goals of care, your doctor may be able to give you an idea of how many TMS sessions they expect you’ll require to meet your goals.⁴

How to Find a TMS Therapist for Bipolar Disorder

To find the right therapist that specializes in TMS treatment for bipolar disorder, you may need to research providers and see what their experience is with TMS and using TMS to specifically treat bipolar disorder. When looking for a TMS provider, it is crucial to ensure that your provider has an extensive background in working with bipolar disorder and the symptoms you are looking to treat, so setting up a consult to learn more about any future providers offering this treatment option is essential.

Once you have found a TMS provider, you should discuss your treatment plans with your primary care doctor and therapist, as well as a psychiatrist or neurologist if needed. Your overall health will benefit from ensuring all of your healthcare providers are aware of any treatments you undergo or medications you’re taking.

In My Experience

TMS for bipolar disorder is a newer treatment approach that has a lot to offer to those who have been struggling with ongoing symptoms for years. It can be challenging to access TMS due to the cost, but it is possible to get your insurance to cover these treatments. Talk with your doctor and therapist about navigating this, and don’t give up on your journey to heal. It can take time for TMS to work, but the combination of TMS and other treatment interventions sets you up for the best possible outcome and is worth considering if you’re looking for more support in managing severe bipolar disorder symptoms or symptoms considered treatment-resistant.