A negative double-blind controlled trial of sequential bilateral rTMS in the treatment of bipolar depression

•Sequential bilateral rTMS did not prove superior to sham stimulation in the treatment of patients with bipolar depression.•Treatment was well tolerated with no major adverse events.•Further research is required to test unilateral rTMS paradigms in bipolar depression.

Background/ObjectiveTo explore the therapeutic benefit of sequential bilateral repetitive transcranial magnetic stimulation (rTMS) in the treatment of bipolar depression.MethodA 2 arm randomized controlled parallel design trial comparing the use of active sequential bilateral rTMS to a sham form of stimulation in 49 patients with bipolar disorder and treatment resistant depression.ResultsThere was no significant difference in mean reduction in depression rating scale scores or response rates between active and sham stimulation.LimitationsThe study was of limited sample size and the use of bilateral rTMS limited generalizability to other forms of rTMS.ConclusionsThis study provides no support to the use of active sequential bilateral rTMS in the treatment of the depressive phase of bipolar affective disorder. Although this result is not definitive, we suggest that future research may be better focused on trials evaluating the use of unilateral types of rTMS.