rTMS and Bipolar Depression: Predicting Clinical Response

A recent systematic review collected evidence on neuroimaging findings and biomarkers associated with responses to repetitive motion. Transcranial magnetic stimulation (rTMS) in patients with bipolar depression.¹

Studies have shown that alternative treatments, such as neurostimulation techniques such as rTMS, have shown positive results in treating unipolar depression. Therefore, neurostimulation has also been proposed as a therapeutic option for bipolar disorder.^2-5 Researchers have focused specifically on the neural correlates of responses to rTMS using a variety of methods. neuroimaging Techniques such as functional, structural and metabolic imaging.

“rTMS has become a promising and effective strategy for managing BD due to its improved safety profile, non-invasiveness, and locality, with response rates of approximately 40% to 50%,” Shamabadi et al. Stated.¹

A systematic review found five main neuroimaging correlates of rTMS response.

1. Right insular cortex activation

2. Changes in prefrontal cortex and subcortical circuit activity associated with deactivation of the ventromedial prefrontal cortex

3. Increased dmPFC-thalamic connectivity

4. Reduced connectivity of sgACC-caudate, dmPFC-insula cortex, sgACC-middle cingulate cortex, dmPFC and parahippocampal gyrus/amygdala

5. Poor SN Connectivity

The results of a systematic review showed that TMS-based neuroimaging has the ability to predict clinical response to treatment and may provide insight into the underlying biological mechanisms of BD. rice field. By observing brain activity and structural changes before and after TMS treatment, researchers may be able to determine which patients are more likely to respond positively to treatment. Clinicians can tailor treatment to individual patients based on efficacy assessments.

“This personalized treatment approach may lead to improved patient outcomes, reduced healthcare costs, and increased patient satisfaction,” reported Shammavadi et al.¹

How has TMS helped patients? Let us know what you think at [email protected].

References

1. Shamabadi A, Karimi H, Katarinussi G, et al. Neuroimaging correlates therapeutic response to transcranial magnetic stimulation in bipolar depression: a systematic review.brain science. 2023;13(5):801.

2. McGirr A, Karmani S, Arsappa R, et al. Clinical efficacy and safety of repetitive transcranial magnetic stimulation in acute bipolar depression.world psychiatry. 2016;15(1):85-86.

3. Lipsman N, McIntyre RS, Jacobbe P, et al. Neurosurgical treatment of bipolar depression: defining treatment resistance and identifying surgical targets.bipolar disorder. 2010;12(7):691-701.

4. Holtzheimer PE, Kelley ME, Gross RE, et al. Deep subcorpus callosum cingulate cortex stimulation for treatment-resistant unipolar and bipolar depression.archigene psychiatry. 2012;69(2):150-158.

5. Bahji A, Hawken E, Sepehry A, et al. ECT beyond unipolar major depression: A systematic review and meta-analysis of electroconvulsive therapy in bipolar depression.Acta Psychiatrist Scand. 2019;139(3):214-226.

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