4.4 Review

Brain stimulation treatment for bipolar disorder

Journal

BIPOLAR DISORDERS
Volume 25, Issue 1, Pages 9-24

Publisher

WILEY
DOI: 10.1111/bdi.13283

Keywords

bipolar and related disorders; bipolar depression; bipolar disorder; deep brain stimulation; electroconvulsive therapy; magnetic seizure therapy; mania; transcranial direct current stimulation; transcranial magnetic stimulation; vagus nerve stimulation

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The evidence base for brain stimulation treatments in bipolar disorders is limited but expanding, offering potential as an adjunct or alternative to pharmacological and psychological treatments, with the ability to target all states of bipolar disorders, including cognitive dysfunction during euthymic periods.
AimsBipolar disorders are clinically complex, chronic and recurrent disorders. Few treatment options are effective across hypomanic, manic, depressive and mixed states and as continuation or maintenance treatment after initial symptom remission. The aim of this review was to provide an up-to-date overview of research on the efficacy, tolerability and cognitive effects of electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), magnetic seizure therapy (MST), deep brain stimulation (DBS) and vagus nerve stimulation (VNS). MethodsReferences included in this review were identified through multiple searches of the Embase, PubMed/MEDLINE and APA PsycINFO electronic databases for articles published from inception until February 2022. Published reviews, meta-analyses, randomised controlled trials and recent studies were prioritised to provide a comprehensive and up-to-date overview of research on brain stimulation in patients with bipolar disorders. ResultsThe evidence base for brain stimulation as an add-on or alternative to pharmacological and psychological treatments in patients with bipolar disorders is limited but rapidly expanding. Brain stimulation treatments represent an opportunity to treat all bipolar disorder states, including cognitive dysfunction during euthymic periods. ConclusionWhilst findings to date have been encouraging, larger randomised controlled trials with long-term follow-up are needed to clarify important questions regarding treatment efficacy and tolerability, the frequency of treatment-emergent affective switches and effects on cognitive function.

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