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When your patient has severe bipolar depression, what would be your treatment options if all the usual stuff hasn’t worked? According to most guidelines, lamotrigine, quetiapine, and lithium can be your starting points, with newer guidelines including lurasidone. Cariprazine is too new yet, with half-life issues. Ketamine? Well, let’s back up a step. How about a tool that’s been around over 2 decades?
Hi! Jim Phelps here for the Psychopharmacology Institute. The tool is transcranial magnetic stimulation. Does it work for bipolar depression? Let’s look at the results of a new randomized trial by Alexander McGirr and colleagues. Previous trials of TMS in bipolar depression have used the protocol long studied for major depression—namely, stimulation of the left dorsolateral prefrontal cortex with 10 pulses per second for 30 minutes. In bipolar depression, evidence for efficacy has been mixed.
The main reason for this study is a new method of TMS,
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