Hett Danielle, Marwaha Steven
Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, UK.
Ther Adv Psychopharmacol. 2020 Nov 18;10:2045125320973790. doi: 10.1177/2045125320973790. eCollection 2020.
Bipolar disorder (BD) is a debilitating mood disorder marked by manic, hypomanic and/or mixed or depressive episodes. It affects approximately 1-2% of the population and is linked to high rates of suicide, functional impairment and poorer quality of life. Presently, treatment options for BD are limited. There is a strong evidence base for pharmacological (e.g., lithium) and psychological (e.g., psychoeducation) treatments; however, both of these pose challenges for treatment outcomes (e.g., non-response, side-effects, limited access). Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, is a recommended treatment for unipolar depression, but it is unclear whether rTMS is an effective, safe and well tolerated treatment in people with BD. This article reviews the extant literature on the use of rTMS to treat BD across different mood states. We found 34 studies in total ( = 611 patients), with most assessing bipolar depression ( = 26), bipolar mania ( = 5), mixed state bipolar ( = 2) or those not in a current affective episode ( = 1). Across all studies, there appears to be a detectable signal of efficacy for rTMS treatment, as most studies report that rTMS treatment reduced bipolar symptoms. Importantly, within the randomised controlled trial (RCT) study designs, most reported that rTMS was not superior to sham in the treatment of bipolar depression. However, these RCTs are based on small samples (BD ⩽ 52). Reported side effects of rTMS in BD include headache, dizziness and sleep problems. Ten studies ( = 14 patients) reported cases of affective switching; however, no clear pattern of potential risk factors for affective switching emerged. Future adequately powered, sham-controlled trials are needed to establish the ideal rTMS treatment parameters to help better determine the efficacy of rTMS for the treatment of BD.
双相情感障碍（BD）是一种使人衰弱的情绪障碍，其特征为躁狂、轻躁狂和/或混合或抑郁发作。它影响着约1%-2%的人口，并与高自杀率、功能损害和较差的生活质量相关。目前，双相情感障碍的治疗选择有限。药物治疗（如锂盐）和心理治疗（如心理教育）有强有力的证据基础；然而，这两种治疗方法在治疗效果方面都存在挑战（如无反应、副作用、可及性有限）。重复经颅磁刺激（rTMS）是一种非侵入性脑刺激技术，是单相抑郁症的推荐治疗方法，但rTMS在双相情感障碍患者中是否为有效、安全且耐受性良好的治疗方法尚不清楚。本文综述了关于使用rTMS治疗双相情感障碍不同情绪状态的现有文献。我们总共发现了34项研究（n = 611例患者），其中大多数评估双相抑郁（n = 26）、双相躁狂（n = 5）、混合状态双相情感障碍（n = 2）或当前未处于情感发作期的患者（n = 1）。在所有研究中，rTMS治疗似乎存在可检测到的疗效信号，因为大多数研究报告rTMS治疗减轻了双相情感障碍症状。重要的是，在随机对照试验（RCT）研究设计中，大多数报告称rTMS在双相抑郁治疗中并不优于假刺激。然而，这些RCT基于小样本（双相情感障碍≤52例）。rTMS在双相情感障碍中报告的副作用包括头痛、头晕和睡眠问题。十项研究（n = 14例患者）报告了情感转换病例；然而，未出现情感转换潜在风险因素的明确模式。未来需要进行充分有力的、有假刺激对照的试验，以确定理想的rTMS治疗参数，从而更好地确定rTMS治疗双相情感障碍的疗效。
