ReviewFrontiers in psychiatry2026
A review of mechanisms and optimization strategies for clinical improvement after repetitive transcranial magnetic stimulation in bipolar disorder.
Review in Frontiers in psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
Introduction: Repetitive transcranial magnetic stimulation (rTMS) is an established therapeutic option in depression, especially in drug-resistant patients. While therapeutic efficacy in major depressive disorder (MDD) is confirmed in many meta-analyses, the results in patients with bipolar disorder (BD) are less unequivocal. This narrative review summarizes the current knowledge on possible mechanisms of action of rTMS in BD with focus on predictors of treatment response as well as on strategies that may improve therapeutic potential. Views: Available data suggest that a better clinical response may be associated with lower left frontal cortex volume, slower EEG activity, and lower default mode network activity. rTMS appears capable of inducing changes in transmitters and other neurochemical substances in BD but available studies are limited, compared with those in MDD. Furthermore, changes after rTMS include reduction in faster EEG bands and increase in blood flow, which were found mainly in the area of stimulation. Neuronavigation and connectivity guided targeting may improve therapeutic results of rTMS, which probably depend on connections of stimulated area with distant brain areas, especially regarding cognitive performance. Conclusions: Overall, several anatomical and neurophysiological factors were associated with therapeutic response. rTMS seems to induce significant neurochemical, connectivity, and EEG changes in BD but data in this area are still scarce. Navigated rTMS may improve clinical effects and provide better insights into therapeutic mechanisms, especially regarding cognitive performance of patients with BD.
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