Efficacy of high frequency (rapid) suprathreshold repetitive transcranial magnetic stimulation of right prefrontal cortex in bipolar mania: A randomized sham controlled study

Objective: To examine the efficacy of adjunctive right prefrontal high-frequency suprathreshold rTMS treatment in bipolar affective disorder, mania patients as compared to sham stimulation. Method: 41 right handed bipolar mania patients were randomized to receive daily sessions of active or sham rTMS (20 Hz, 110% of MT, 20 trains, 10 s intertrain interval) over the right dorsolateral prefrontal cortex for 10 days. Mania was rated using Young Mania Rating Scale (YMRS) and Clinical Global Impression (CGI) at baseline, and after 5th and 10th rTMS. Result: For YMRS scores, repeated measures ANOVA showed a significant effect of treatment over time as shown by interaction effect (F = 12.95, df = 1.51/58.94, p < 0.001, Greenhouse-Geisser corrected). For CGI-S, repeated measures ANOVA showed a significant interaction effect of treatment over time (F = 5.34, df = 1.36/53.01, p = 0.016, Greenhouse-Geisser corrected). Conclusion: High-frequency supra-threshold right prefrontal rTMS in bipolar, mania patients was well tolerated and found to be effective as add-on to standard pharmacotherapy.