What is Bipolar Disorder?

The prefix ‘Bi’ indicates two and Bipolar Disorder exhibits two forms of mood in extreme or ‘polar’ opposites. Patients with Bipolar Disorder typically suffer from cycles of depression and mania:

Classic Depressive Disorders are clinically described as ‘unipolar depression’. Bipolar Disorder, historically called Manic Depression, typically triggers cycles of both depression and mania. The depressive episodes are often no different than depression that occurs in unipolar depression, however. These episodes can last for days to weeks or even months, often with intervals of ‘normal’ stabilized mood in between. One cycle may present more frequently than the other, e.g. more frequent problems with depression than mania.

Read more: TMS for Postpartum depression →

More intense episodes of mania are usually diagnosed as Bipolar 1 while less intense episodes (“hypomania”) are diagnosed as Bipolar II. Cyclothymia is a milder form of mood swings.

Symptoms of Bipolar Disorder

Is Bipolar Disorder common?

Globally, there were 46,000,000 estimated cases of Bipolar Disorder in 2017 with a marginally higher prevalence in women vs men. This comes out to just over 1% of the population, with larger rates reported in areas of higher mental health services such as the United States (e.g. 2-3% in the US). When considering Bipolar II and Cyclothymia, the prevalence is even higher. The average age of presentation is 25 years, but can present prior to this or later in life.¹

Causes of Bipolar Disorder

The exact cause of Bipolar is unknown but expert opinion points to a variety of genetic, environmental, and social factors that increase vulnerability to developing the condition.

Bipolar Disorder treatment 

Drug treatment is the mainstay of treatment for Bipolar Disorder and can often be effective once finding the right medication for the individual. Similar to clinical depression, coping strategies, healthy lifestyle decisions, and structure and support also help regulate moods. Mania in particular will often respond well to “mood-stabilizing” medication. Unfortunately, similar to unipolar depression, the depressed phases of Bipolar can often be medication resistant. And the number of FDA approved medications for Bipolar depression is actually quite limited. Many off-label strategies are hence utilized. The medications needed to effectively treat Bipolar mania or depression often also have even more side effects than typical antidepressants, which can lead to stopping treatment.

TMS treatment and Bipolar Depression

Although rTMS-repetitive Transcranial Magnetic Stimulation for Bipolar disorder is not currently cleared by the FDA, a number of studies to date have indicated efficacy in acute bipolar depression and accordingly, the FDA initiated a Breakthrough Device Designation in 2020 to evaluate TMS therapy for Bipolar depression. ¹²³⁴⁵⁶ As the therapy is not currently FDA approved, it is not typically covered by insurance. Out of pocket treatment may be an option that some choose to pursue, however, due to prolonged Bipolar depression and lack of response to standard treatments.

Read More: TMS therapy cost →

Before considering TMS for Bipolar depression, it is also crucial to ensure accurate diagnosis. Some patients may have been diagnosed with Bipolar at some point in their treatment, but the diagnosis may not be entirely clear. Repeat consultation and review of records may argue against the diagnosis and properly identify unipolar Major Depression as the accurate diagnosis. And sometimes an argument can be made to insurance to pursue TMS for Bipolar depression due to previous benefit from TMS treatment or medical necessity secondary to ineffectiveness or intolerance to alternative treatments.

Similar to studies involving unipolar treatment resistant depression, TMS therapy for Bipolar depression has been shown to be well-tolerated and safe. There is some limited evidence that the procedure can potentially precipitate mania in a small number of patients, so this must be monitored closely if pursuing TMS treatment.

Read More: TMS for PTSD →

Individualized TMS

Depending on the diagnoses present for a particular individual, variations to treatment protocols may be implemented and treatment may also be adapted according to an individual’s response. Should you elect to pursue TMS therapy, rest assured that Inspire TMS Denver will tailor treatment protocols to your individual symptoms and situation. We promise to keep you informed and comfortable with your individual care plan. More questions about TMS therapy and Bipolar Disorder? Please contact us to see about a free consultation.