Bipolar Disorder

TMS for Bipolar: Everything You Need to Know

November 4, 2020

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Bipolar disorder is a mental illness that affects approximately 2.3 million Americans a year. And over 4 percent of adults in the US experience some form of bipolar disorder at some point in their lives. Bi-polar disorder, also known as manic depression, can manifest itself in a variety of different ways. But 83% of people with bipolar disorder suffer some form of serious impairment to their lives. Serious impairment includes tangible difficulties in maintaining their professional, personal, and romantic responsibilities. This is the highest percentage of serious impairment among all of the different mood disorders. As such those who suffer from bipolar disorder undergo periods of enormous flux. 

Bipolar is primarily characterized by a person's activity levels, their mood, or their level of energy undergoing dramatic shifts.This can lead to periods of hyperactivity and impulsive behavior like spontaneous life decisions or irresponsible/extravagant purchases. It can also cause a person to become unusually irritable and confrontational with the people in their lives. Including their friends and family. Those who they would normally seek comfort in. Bipolar can even cause periods of extreme depression and total loss of enjoyment in life. 

The periods of being hyperactive are referred to as mania and a person undergoing a period of mania is known to be in a manic state. A manic, or hypomanic episode, includes at least three of the following symptoms.

  1. They appear abnormally upbeat or jumpy
  2. They have an Increased level of activity, energy, or agitation
  3. They have an overly exaggerated sense of well-being and self-confidence 
  4. They exhibit a decreased need for sleep
  5. They are unusually talkative or conversational
  6. They exhibit racing or disconnected thoughts
  7. They are easily distracted
  8. They display poor decision-making skills. For example they may impulsively spend large sums of money, or behave in sexually risky ways.

The very worst of these manic states may even trigger a total break from reality which is referred to as psychosis. Which is very serious and could require hospitalization.

However, when a person leaves one of these manic states they crash. Imagine a rollercoaster. The very top of the hill is the person's energy and activity level when they are manic. But when the mania subsides, and the coaster falls over the hill, the energy levels drop to an unusual low and this causes the period of depression in between manic states. These are called major depressive episodes. These episodes involve a level of depression and lethargy that actively affect important parts of the individuals life. Such as their job, their schooling, their romantic relationships, friendships, and social obligations. A major depressive episode includes at least five of the following symptoms.

  1. If the person displays a depressed mood. This includes the well feelings like sadness, emptiness, loneliness
  2. If they display a loss of enjoyment in their favorite hobbies, activities, or pastimes
  3. If they have wild fluctuations in their weight
  4. If they display symptoms of insomnia or hypersomnia (oversleeping)
  5. They are fatigued, lethargic, or show an overall loss of energy
  6. They suffer from feelings of a lack of self worth. This could include feelings of excessive or inappropriate guilt
  7. They are overly indecisive or show a lack of ability to focus and concentrate

People with bipolar disorder deal with the disorder for life. Their mood swings may occur frequently, multiple times a year, or only occasionally during periods with traumatic life events or serious disruption to their sleep.

Bipolar disorder can manifest at any age. However, it is typically diagnosed in a person’s late teens or their early twenties. There are a few different levels of bipolar that an individual may be diagnosed with. These include bipolar I disorder and bipolar II disorder. 

Bipolar I disorder means they’ve had at least one manic episode. This episode is usually preceded by major depressive episodes, or alternatively followed up by one. In some cases of Bipolar I the individual may suffer mania severe enough to trigger a psychosis break from reality. 

A person who suffers from Bipolar II disorder is a little different. The difference is that a person who suffers from Bipolar II has had at least one major depressive episode and at least one hypomanic episode. But unlike in Bipolar I disorder they have never had a full blown manic episode. It is important to note that Bipolar II disorder is not just a weaker or milder form of bipolar I disorder. Bipolar II is an entirely separate diagnosis. The manic episodes of Bipolar I are traded off for longer periods of depressive episodes.

sad and happy face masks
Bipolar disorder comes coupled with symptoms of both mania and major depressive episodes.

Where Does Bipolar Disorder Come From And What Causes It?

Neurotransmitters like Norepinephrine Evaluate and Negotiate Neural Equilibrium. 

The general consensus is that bipolar disorder originates in chemical imbalances in the brain. The human brain is separated into distinct areas and structures that are responsible for different things. In order for these different sections and structures to speak to each other they have to use electricity and neurotransmitters. The most common neurotransmitters the brain produces are Acetylcholine, Dopamine Glutamate, Serotonin, Norepinephrine (also called noradrenaline) and gamma-Aminobutyric acid (GABA). 

Although evidence shows that an imbalance of any neurotransmitter can cause bipolar symptoms, norepinephrine and serotonin appear to be particularly consequential. Norepinephrine functions as both a hormone and a neurotransmitter. Because of this norepinephrine has long reaching consequences when it is under or over produced. Episodes of mania may occur when norepinephrine production is higher than it should be and depressive episodes may occur when norepinephrine levels are too low. Evidence also suggests that serotonin plays a pivotal role in the pathophysiology of the disorder.

Because of this, doctors have found it difficult to treat bipolar disorder. Oftentimes the same antidepressants that are given to treat the depressive episodes of the disorder, have the potential to increase the manic swing that the patients experience. Antidepressants have been shown to be helpful in treating depression symptoms short term for the disorder but can increase the risk of manic switches in mood over the long term.

Because of this many patients feel that their treatment is not as effective for their disorder as they would like it to be. Standard treatment like medications and psychotherapy are not always effective. Because of this many individuals with bipolar disorder are interested in additional or alternative treatments to psychotherapy and pharmacology. With the modern advances in medical science, bipolar patients have a new option on the horizon called Transcranial Magnetic Stimulation (TMS)

man grabbing head in frustration
Bipolar individuals suffer from wild swings in mood and personality.

What Is Transcranial Magnetic Stimulation?

Magnetic Fields That Are Used to Manipulate Neuron’s Electrical Synapses.

Transcranial Magnetic Stimulation is a clever scientific treatment that is used as an addition to, or a replacement for, psychotherapy and medication when they have shown to be ineffective. Basically TMS is the use of magnetic waves to stimulate particular areas and structures in the brain. This is done in an interesting way. Scientists have long understood that there is an underlying physical connection between electricity and magnetism. Additionally scientists and clinicians know that the human nervous system, and by extension the human brain runs on electricity. As such scientists realized the mind could be influenced by the introduction of new electrical currents. In the 1980s P. A. Merton & H. B. Morton first successfully stimulated the motor cortex of the brain using transcranial electrical stimulation (TES). 

However, the use of electrical currents was quite uncomfortable for the patients. In 1985 Anthony Baker at the University of Sheffield relied upon the aforementioned underlying physical connection between electricity and magnetism to create the first functional and stable Transcranial Magnetic Stimulation device. By determining that the electricity could be influenced in the brain by the introduction of magnetic fields, Baker was able to analyze and influence the electrical impulses in the human mind without the painful application of electrical currents.

However, Transcranial Magnetic Stimulations devices potential for use in psychotherapy and treatment wasn’t readily apparent early on. The devices were primarily used only as diagnostic tools that would allow scientists to monitor the activity in different portions of the brain. In the early 1990s the journal Neurology published an article title Induction of Speech Arrest and Counting Errors With Rapid-Rate Transcranial Magnetic Stimulation by Alvaro Pascual-Leone.

This article excited the scientific community and led to two decades of research, clinical experiments, and conferences. The research continued to build over the years and after it was discovered that TMS could be “leveraged for therapeutic applications in neurology, psychiatry and rehabilitation” the United States Federal Government approved the devices for psychotherapy in 2008.  However, it wasn’t until March 18, 2020, that a TMS device was officially designated for the treatment of bipolar disorder.

woman in black and white crying
Bipolar disorder has the highest level of serious impairment of any mood disorder.

How Do Magnetic Fields Treat Bipolar Disorder?

Manipulated Magnetic Fields Manipulated Production of Neurotransmitters

Recent research has concluded that Transcranial magnetic stimulation shows promise as an approach to treating patients with bipolar disorder or manic depressive disorder. In particular the treatment shows promise for those who have failed to respond to the typical treatment of pharmacology or psychotherapy. However, there is some scientific hesitation. TMS has been shown to be an incredible treatment for depression. So while it seems that TMS may naturally be a great treatment for bipolar, it is a little bit more complex. 

Since bipolar is really functioning as two separate disorders at the same time (hence the name). Bipolar individuals suffer from both depression and mania. As such a treatment that is effective for depression is only effective for half of the disorder. In fact some doctors are concerned that the application of magnetic waves to parts of a depressed bipolar person's brain may actually overstimulate it and cause a switch into a manic state. This is not surprising as psychopharmacology has also shown a tendency to trigger a manic switch in the bipolar individual.

The use of TMS to treat the depressive aspect of bipolar is pretty conclusive. The treatment appears to be effective. However, the evidence around using TMS to treat the manic episodes of the disorder is less clear. A large part of this is caused by the fact that researchers are hesitant to use the treatment on bipolar individuals because they do not wish to induce a manic episode in their patient. However, the limited research available shows that TMS holds promise as a treatment for bipolar disorder. It has been shown to reduce feelings of mania after the application of the treatment and has shown less of an ability to cause a manic switch than some clinicians feared. 

But the research is far from complete. Almost every study available cites the need for additional research to determine which frequencies are best, which area of the brain needs to be targeted when, and how long and often the tms sessions need to be. In particular there needs to be studies that feature larger numbers of patients. And the sample size will need to be enough to differentiate between treatment in children and treatment in adults due to different metabolic rates in grown individuals. 

woman with arms out in front of sunset
It's important to always seek out professional help when suffering from mental health difficulties. Photo Courtesy of My Transformations.

Bipolar is a disorder that affects millions of people every year in the United States of America alone. If you or anyone you know suffers from bipolar or other mental disorders the best thing you can do is speak with a healthcare official at the first opportunity. However, if you’ve been struggling with bipolar disorder, or manic states, and haven’t found pharmacology and psychotherapy to be effective treatment you may want to look into TMS. It has shown promise for a variety of different neurological and behavioral disorders with limited side effects. It could be an elegant, non-invasive, solution to whatever underlying mood disorder you find disrupting your life.

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