Bipolar Disorder

The depression symptoms of Bipolar Disorder are similar to Unipolar Depression (also called Major Depressive Disorder or MDD) and may include an individual being withdrawn from family and friends, showing noticeably little interest in usually pleasurable activities, and perhaps a significant change in weight or sleep. Persons with Bipolar Disorder also tend to have low energy levels during their depressive periods, and may have a hard time concentrating. In its most serious forms, these periods may result in thoughts of death or suicide.

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Importance of treating mania in Bipolar Disorder

Often just as problematic to an individual with Bipolar Disorder are manic episodes. These may include racing thoughts, an inability to focus for an extended period of time, reduced need for sleep, and engaging in high risk activities such as gambling, excessive spending, or indescriminate sexual activity. In addition to these symptoms, someone in a manic episode will often be noticeably more talkative and feel an inflated sense of self.

Many people with Bipolar Disorder will present during periods of depression, and fail to report prior manic episodes.  A detailed history is important to establish a diagnosis of Bipolar Disorder. Collateral information from family, friends, emergency room visits, or other sources may be needed to make an accurate diagnosis.

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Options for treatment of Bipolar Disorder

There are a number of options that someone with Bipolar Disorder can take when it comes to treatment. The most common is medication, which can be very effective. However, there may be side effects such as headache, stomach upset, weight gain, tremor, thyroid and kidney problems, or sexual issues.

Transcranial Magnetic Stimulation (TMS) is an FDA-approved treatment for Major Depressive Disorder that uses a MRI-strength magnetic field to stimulate very specific parts of the brain. One of its main benefits is its low tendency to produce negative side effects. Current studies have shown TMS may also have a role in the depressed phase of Bipolar Disorder.

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Selected References

  • Harel EV, Zangen A, Roth Y, Reti I, Braw Y, Levkovitz Y. H-coil repetitive transcranial magnetic stimulation for the treatment of bipolar depression: an add-on, safety and feasibility study. World J Biol Psychiatry. 2011 Mar;12(2):119-26.
  • Dell’Osso B, Mundo E, D’Urso N, Pozzoli S, Buoli M, Ciabatti M, Rosanova M, Massimini M, Bellina V, Mariotti M, Altamura AC. (2009). Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression. Bipolar Disord. 2009 Feb;11(1):76-81.
  • Michael N, Erfurth A. (2004) Treatment of bipolar mania with right prefrontal rapid transcranial magnetic stimulation. J Affect Disord. 2004 Mar;78(3):253-7.
  • Kaptsan A, Yaroslavsky Y, Applebaum J, Belmaker RH, Grisaru N. (2003) Right prefrontal TMS versus sham treatment of mania: a controlled study. Bipolar Disord. 2003 Feb;5(1):36-9.
  • Nahas Z, Molloy MA, Hughes PL, Oliver NC, Arana GW, Risch SC, George MS. (1999) Repetitive transcranial magnetic stimulation: perspectives for application in the treatment of bipolar and unipolar disorders. Bipolar Disord. 1999 Dec;1(2):73-80. Review.

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*At this time, TMS is not FDA-approved for the treatment of Bipolar Disorder, which would be considered an off-label application.