Hypomanic/manic switch after transcranial magnetic stimulation in mood disorders: A systematic review and meta-analysis

doi:10.5498/wjp.v11.i8.477

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World Journal of Psychiatry

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Meta-Analysis

World J Psychiatr. Aug 19, 2021; 11(8): 477-490
Published online Aug 19, 2021. doi: 10.5498/wjp.v11.i8.477

Hypomanic/manic switch after transcranial magnetic stimulation in mood disorders: A systematic review and meta-analysis

Andrea Miuli, Gianna Sepede, Gianfranco Stigliano, Alessio Mosca, Francesco Di Carlo, Giacomo d’Andrea, Aliseo Lalli, Maria Chiara Spano, Mauro Pettorruso, Giovanni Martinotti, Massimo di Giannantonio

Andrea Miuli, Gianna Sepede, Gianfranco Stigliano, Alessio Mosca, Francesco Di Carlo, Giacomo d’Andrea, Aliseo Lalli, Mauro Pettorruso, Giovanni Martinotti, Massimo di Giannantonio, Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti, Chieti 66100, Italy

Maria Chiara Spano, Department of Psychiatry Affective Neuropsychiatry, Sahlgrenska University Hospital, Göteborg 40530, Sweden

Giovanni Martinotti, Department of Pharmacy, Clinical Science, University of Hertfordshire, Herts AL10 9AB, Italy

Author contributions: Miuli A, Sepede G, Pettorruso M, Martinotti G and di Giannantonio M designed the research study; Miuli A, Stigliano G, Mosca A, Di Carlo F, d’Andrea G, Lalli A and Spano MC performed the research; Miuli A and Sepede G analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.

Conflict-of-interest statement: The authors declare no conflicts of interest.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Francesco Di Carlo, MD, Doctor, Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti, ITAB-Via dei Vestini 33, Chieti 66100, Italy. francesco.dic@hotmail.it

Received: February 16, 2021
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

ARTICLE HIGHLIGHTS

Research background

One of the most innovative and most investigated non-invasive brain stimulation techniques is Transcranial Magnetic Stimulation (TMS). This device has received Food and Drug Administration approval for the treatment of various neurological (headache) and psychiatric (treatment resistant depression) disorders. Several studies have been conducted to find new applications of TMS in conditions that do not respond or partially respond to standard psychopharmacological therapies.

Research motivation

TMS is an increasingly used technique in the neurological and psychiatric fields. One of the greatest concerns about its use is the possibility of developing severe side effects such as hypomanic/manic switches (HMS).

Research objectives

The aim of this meta-analysis is to quantify the risk of developing HMS after treatment with TMS in mood disorders and to evaluate the drop-out rate due to that adverse event.

Research methods

The search was conducted using PubMed, Scopus and Web of Science databases on March 22, 2020. All procedures were registered on PROSPERO and performed according to the PRISMA guidelines. Only double blind/single blind articles, written in English were included. RevMan 5.4 Software for Windows was used to perform the meta-analysis.

Research results

Of the 25 eligible studies, only four HMSs were described. No dropouts were reported due to symptoms severity.

Research conclusions

Our data confirm that, by applying appropriate psychopharmacological and anamnestic precautions, TMS is a safe technique for treating mood disorders.

Research perspectives

Greater uniformity of protocols, their online registration and the timely reporting of side effects on scientific papers could guarantee a more accurate analysis of the health risks induced by TMS in future meta-analyses.