TMS is a non-invasive method to stimulate nerve cells in superficial layers of the brain. Traditionally, studies assessing the effectiveness of TMS have been limited by small samples, a range of stimulation parameters and most studies lack long-term follow up assessments. Control comparisons also differ – ‘sham’ TMS may involve tilting the stimulation coil against the scalp by 45 or 90 degrees, thus reducing the degree of brain stimulation, or use of a “placebo” coil of identical appearance. These placebo methods usually involve a ‘click’ noise but no magnetic field and no twitching sensation on the scalp. Comparison groups may receive active TMS applied to other brain regions. The effects of differing dosage and duration of concurrent medication on TMS response is unclear.

What is the evidence for TMS for people with bipolar disorder?

Moderate quality evidence finds improved clinical response, particularly for depression following high frequency (10 Hz) repetitive TMS over the left dorsolateral prefrontal cortex. There was no benefit for mania and little risk of switching to mania in people with bipolar depression.

Moderate to low quality evidence finds improved cognition post-treatment with high-frequency repetitive TMS over the left dorsolateral prefrontal cortex, although the findings were not significantly different to the improvements reported in sham conditions.

November 2021

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