Bipolar disorder is a mental health condition characterized by extreme mood swings, including emotional highs (mania or hypomania) and severe lows (bipolar depression). The depressive phase is often the most debilitating and the hardest to treat, partly because traditional antidepressants can sometimes trigger manic episodes.
Current FDA Status
TMS is not yet FDA-cleared specifically for bipolar disorder, but the FDA granted Breakthrough Device Designation for TMS in bipolar depression in 2020, recognizing the clinical need and the strength of early evidence. Many clinics now offer TMS off-label for the depressive phase of bipolar disorder, typically alongside mood-stabilizing medication.
What the Research Shows
A 2025 systematic review and meta-analysis published in Biological Psychiatry: Global Open Science analyzed 56 studies involving 1,709 patients with bipolar depression. The authors found that TMS was efficacious and safe, with response and remission rates similar to those seen in unipolar depression. Critically, rates of treatment-emergent mania or hypomania were low and equivalent to those found with sham treatment, addressing the primary safety concern.
A 2024 pilot study published in the Journal of Clinical Psychiatry recruited 31 adults with bipolar I or II depression at Sheppard Pratt and Mayo Clinic. All patients were treated concurrently with a mood stabilizer and received six weeks of high-frequency rTMS to the left dorsolateral prefrontal cortex. The results were notable: 87.1% of patients achieved response and 74.2% achieved remission, rates that exceed what's typically seen in unipolar depression.
These response rates come from a small open-label pilot, not a large randomized trial, so they should be interpreted with appropriate caution. Larger sham-controlled trials are underway.
Safety Considerations
The primary concern when treating bipolar depression with any modality is the risk of inducing mania. Current evidence indicates that when TMS is administered alongside mood stabilizers, it appears safe and well-tolerated, with mania rates no higher than placebo. This is why TMS for bipolar depression should always be managed by a psychiatric professional with experience in bipolar disorder.
Find a TMS Clinic for Bipolar Depression
Not every TMS clinic treats bipolar depression. Search our directory and ask each provider about their experience with bipolar patients and their protocol for coordinating with your prescribing psychiatrist.
Sources
- Cotovio G, et al. Efficacy, Effectiveness, and Safety of Transcranial Magnetic Stimulation for Bipolar Depression: A Systematic Review and Meta-Analysis. Biological Psychiatry: Global Open Science, 2025. Link
- Aaronson ST, et al. A Pilot Study of High-Frequency Transcranial Magnetic Stimulation for Bipolar Depression. Journal of Clinical Psychiatry, 2024. PubMed