Published online Aug 19, 2021. doi: 10.5498/wjp.v11.i8.477
Peer-review started: February 16, 2021
First decision: March 16, 2021
Revised: March 24, 2021
Accepted: July 20, 2021
Article in press: July 20, 2021
Published online: August 19, 2021
Processing time: 176 Days and 13 Hours
Nowadays there is an increasing use of transcranial magnetic stimulation (TMS) both in neurological and psychiatric fields. After Food and Drug Administration approval of TMS for the therapy of treatment-resistant depression, TMS has been widely used in the context of mood disorders (MD). However, growing reports regarding the possibility of developing hypomanic/manic switch (HMS) have generated concern regarding its use in MDs.
To investigate the actual risk of developing HMS due to TMS in the treatment of MD.
We led our research on PubMed, Scopus and Web of Science on March 22, 2020, in accordance to the PRISMA guidelines for systematic review. Only double blind/single blind studies, written in English and focused on the TMS treatment of MD, were included. A meta-analysis of repetitive TMS protocol studies including HMS was conducted using RevMan 5.4 software. The assessment of Risk of Bias was done using Cochrane risk of bias tool. This protocol was regis
Twenty-five studies were included in our meta-analysis: Twenty-one double blind randomized controlled trials (RCT) and four single blind-RCT (no. of subjects involved in active stimulation = 576; no. of subjects involved in sham protocol = 487). The most frequently treated pathology was major depressive episode/major depressive disorder, followed by resistant depression, bipolar depression and other MD. The majority of the studies used a repetitive TMS protocol, and the left dorsolateral prefrontal cortex was the main target area. Side effects were reported in eight studies and HMS (described as greater energy, insomnia, irritability, anxiety, suicidal attempt) in four studies. When comparing active TMS vs sham treatment, the risk of developing HMS was not significantly different between conditions.
Applying the most usual protocols and the appropriate precautionary measures, TMS seems not to be related to HMS development.
Core Tip: Transcranial magnetic stimulation (TMS) has been widely used in the context of mood disorders. The purpose of this review/meta-analysis was to examine the risk of developing a hypomanic/manic switch (HMS) during active TMS treatment of mood disorders. Twenty-five double blind/single blind studies were included in the quantitative synthesis. When comparing active TMS vs sham treatment, we did not find any significant difference in the risk of developing HMS between conditions. So, we can conclude that, applying the appropriate precautionary measures, TMS seems not to be related to HMS development.