Rachid Fady
RACHID: Private Practice, Geneva, Switzerland.
J Psychiatr Pract. 2017 Mar;23(2):150-159. doi: 10.1097/PRA.0000000000000219.
This review focuses on treatment-emergent mania/hypomania (TEM) associated with repetitive transcranial magnetic stimulation (rTMS).
English-language studies involving possible rTMS-induced mania/hypomania published between 1966 and 2015 were retrieved through a Medline search using the search terms mania, hypomania, mixed affective state, treatment-emergent, repetitive transcranial magnetic stimulation, and rTMS. Fifteen case series and controlled studies describing TEM associated with rTMS treatment have been published involving 24 individuals, most of whom were diagnosed with either bipolar I or II disorder or major depressive disorder.
rTMS has been shown to possibly induce manic or hypomanic episodes in patients with depression, who are sometimes also taking antidepressants. Both high-frequency and low-frequency rTMS with different stimulus parameters may be associated with TEM in both males and females.
Given these findings, it is highly recommended that patients with bipolar disorder who are experiencing a depressive episode be prescribed a mood stabilizer and that patients diagnosed with major depressive disorder be reevaluated to consider the possibility that they might have bipolar disorder, before rTMS treatment is initiated. If TEM occurs, discontinuation of rTMS should be considered, while continuing mood-stabilizing medications. Further research is needed concerning the underlying neurobiological mechanisms and epidemiologic characteristics of TEM associated with rTMS.
本综述聚焦于与重复经颅磁刺激（rTMS）相关的治疗中出现的躁狂/轻躁狂（TEM）。
通过使用搜索词“躁狂”“轻躁狂”“混合情感状态”“治疗中出现的”“重复经颅磁刺激”和“rTMS”在Medline数据库中进行检索，获取1966年至2015年间发表的涉及rTMS可能诱发躁狂/轻躁狂的英文研究。已发表了15个病例系列和对照研究，描述了与rTMS治疗相关的TEM，涉及24名个体，其中大多数被诊断为双相I型或II型障碍或重度抑郁症。
rTMS已被证明可能在抑郁症患者中诱发躁狂或轻躁狂发作，这些患者有时也在服用抗抑郁药。不同刺激参数的高频和低频rTMS在男性和女性中都可能与TEM相关。
鉴于这些发现，强烈建议在开始rTMS治疗前，为正在经历抑郁发作的双相情感障碍患者开具心境稳定剂，并对被诊断为重度抑郁症的患者进行重新评估，以考虑他们可能患有双相情感障碍的可能性。如果发生TEM，应考虑停用rTMS，同时继续使用心境稳定药物。关于与rTMS相关的TEM的潜在神经生物学机制和流行病学特征，还需要进一步研究。
