SOURCE: Journal of Clinical Medicine. 11(18) (no pagination), 2022. Article Number: 5434.
DATE OF PUBLICATION: September 2022.
AUTHORS: Koutsomitros T.; van der Zee K.T.; Evagorou O.; Schuhmann T.; Zamar A.C.; Sack A.T.
ABSTRACT: In this open-label naturalistic study, we assess the feasibility, tolerability, and effectiveness of a repetitive transcranial magnetic stimulation protocol with a reduced total pulse number for treating patients suffering from bipolar disorder type II. All patients received one rTMS treatment session of 1000 pulses for 20 consecutive working days, accumulating to 20.000 rTMS pulses applied over 4 weeks. We measured the patients' symptoms before the start, halfway through, directly after, and one month after treatment. We quantified the depression symptoms using both the Beck depression inventory scale and the symptom checklist-90 depression subscale. Patients showed a significant reduction in depression symptoms directly after treatment and an even further reduction one month after treatment. The remission rates were at 26% halfway through treatment (after the 10th session), 61% directly after treatment (after the 20th session), and increased to 78% at the 1-month follow-up. Importantly, the protocol proved to be feasible and highly tolerable in this patient population, with no adverse effects being reported. Considering these positive results, further research should focus on replicating these findings in larger clinical samples with control groups and longer follow-up periods, while potentially adding maintenance sessions to optimize the treatment effect and stability for bipolar disorder type II patients.
CONCLUSION: This open-label naturalistic study showed the potential efficacy of high-frequency rTMS with a reduced number of pulses applied over the left DLPFC in patients with bipolar depression type II. Given that the overall treatment effect was highly significant, with a remission rate of 61% after 20 sessions and 78% at one-month follow-up, and given that no side effects, especially no induced hypomanic episodes, were induced, these results are highly encouraging and motivate replication studies using a randomized control trial design.
FULL ARTICLE LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505040/