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

Table 1 Characteristics of the studies included in the systematic review

Ref.	Population (No total, No male, No subgroups, age ± SD of the subgroups)	Type of treatment	Protocol (type, Hz, No pulses/session, RMT, coil type, target area, treatment duration)	Mood Disorder Sub-type	Reported adverse events (yes, no, NS)	HMS (No tot)	Drop out due to HMS
Trevizol et al[53], 2019-A	Active TMS, No = 20, age = 66.8 ± 5.8 (M = 13). Sham = 12, age = 64.1 ± 3.7 (M = 3)	Only TMS	rTMS, 1 Hz, 465 impulse/session, 120% RMT, B-65 figure-8 coil, RDLPFC, 15 session AND rTMS, 10 Hz, 750 impulse/session, 120% RMT, B-65figure-8 coil, LDLPFC, 15 session	Late-life TRD	No (light and not worth mentioning)	0	no
Trevizol et al[53], 2019-B	Active TMS, No = 11, age = 66.1 ± 8.5 (M = 4). Sham = 12, age = 64.1 ± 3.7 (M = 3)	Only TMS	rTMS, 10 Hz, 1450 impulse/session, 120% RMT, B-65 figure-8 coil, LDLPFC, 15 session	Late-life TRD	Yes (TMS, No = 2; SHAM, No = 0)	1	no
Rao et al[65], 2019	Active TMS, No = 13, age = 39.8 ± 14.2 (M = 5). Sham = 17, age = 40.2 ± 14.6 (M = 11)	Only TMS	rTMS, 1 Hz, 12000 impulse/session, 110% RMT, B-65 figure-8 coil, RDLPFC, 20 session	MDE after traumatic Brain Injury	No (light and not worth mentioning)	0	no
Matsuda et al[64], 2020	Active TMS, No = 20, age = 43.4 ± 5.5 (M = 18). Sham = 20, age = 45.2 ± 7 (M = 19)	Only TMS	dTMS, 18 Hz, 1980 impulse/session, 120% RMT, H1 coil, LDLPFC, 30 session	Depression NS	No (light and not worth mentioning)	0	no
Li et al[59], 2020-A	Active TMS, No = 35, age = 47.1 ± 13.8 (M = 11). Sham = 35, age = 47.1 ± 12.4 (M = 11)	Only TMS	rTMS, 10 Hz, 1600 impulse/session, 100% RMT, figure-8 coil, LDLPFC, 10 session	Recurrent major depression	Yes (TMS, No = 12; SHAM, No = 8)	0	no
Li et al[59], 2020-B	Active TMS, No = 35, age = 47.1 ± 14.2 (M = 12). Sham = 35, age = 47.1 ± 12.4 (M = 11)	Only TMS	piTMS, 50 Hz, 1800 impulse/session, 80% RMT, figure-8 coil, LDLPFC, 10 session	Recurrent major depression	Yes (TMS, No = 9; SHAM, No = 8)	0	no
Bulteau et al[56], 2019	Active TMS, No = 12, age = 52.7 (M = 5). Sham = 14, age = 53.1 (M = 10)	Only TMS	iTBS, 50 Hz, 990 impulse/session, 80% RMT, figure-8 coil, LDLPFC, 15 session	BD	No	0	no
Siddiqi et al[63], 2019	Active TMS, No = 9, age = 43 ± 13 (M = 7). Sham = 6, age = 50 ± 18 (M = 4)	Only TMS	Bilateral rTMS, 10 Hz, 4000 impulse/session, 120% RMT, B-65 figure-8 coil., LDLPFC, 25 session AND Bilateral rTMS, 1 Hz, 1000 impulse/session, 120% RMT, B-65figure-8 coil, RDLPFC, 25 session	MDE after traumatic Brain Injury	Yes (TMS, No = 9; SHAM, No = 0)	0	no
Kaster et al[52], 2018	Active TMS, No = 25, age = 65.0 ± 5.5 (M = 17). Sham=27, age = 65.4 ± 5.5 (M = 15)	Only TMS	rTMS, 18 Hz, 6012 impulse/session, 120% RMT, H1 coil, LDLPFC, 20 session	Late-life MDE	No (light and not worth mentioning)	1	no
Xie et al[57], 2015	Active TMS, No = 35, age=65.3 ± 5.1 (M = 12). Sham = 26, age = 64.7 ± 4.2 (M = 8)	rTMS + shuganjieyu	rTMS, 10 Hz, NS impulse/session, 30% RMT, B-65NS coil, LDLPFC, 5 session	MDD	Yes (TMS, No = 14; SHAM, No = 13)	0	no
Levkovitz et al[58], 2015	Active TMS, No = 101, age = 45.1 ± 11.7 (M = 53). Sham = 111, age = 47.6 ± 11.6 (M = 58)	Only TMS	dTMS, 18 Hz, 1980 impulse/session, 120% RMT, H1 coil, LDLPFC, 20 session	MDD	No (light and not worth mentioning)	0	no
Kreuzer et al[42], 2015-A	Active TMS, No = 13, age = 43.5 ± 10.3 (M = 8). Sham = 12, age = 43.8 ± 10.5 (M = 4)	Only TMS	rTMS, 10 Hz, 2000 impulse/session, 110% RMT, B-65 double cone coil, Anterior Cingulate, 15 session	MDE	Yes (TMS, No = 7; SHAM, No = 8)	0	no
Kreuzer et al[42], 2015-B	Active TMS, No = 15, age = 46.1 ± 9.5 (M = 7). Sham = 12, age = 43.8 ± 10.5 (M = 4)	Only TMS	rTMS, 10 Hz, 2000 impulse/session, 110% RMT, B-65 figure-8 coil., LDLPFC, 15 session	MDE	Yes (TMS, No = 4; SHAM, No = 8)	0	no
George et al[62], 2014	Active TMS, No = 20, age=38.7 ± 15 (M = 18). Sham = 21, age = 46.1 ± 15.9 (M = 17)	Only TMS	rTMS, 10 Hz, 6000 impulse/session, 120% RMT, B-65 figure-8 coil., LDLPFC, 9 session	MDE	Yes (TMS, No = 7; SHAM, No = 6)	0	no
Lingeswaran[51], 2011	Active TMS, No = 9, age = 34 ± 10.5 (M = 3). Sham = 14, age = 37.26 ± 11.8 NS (M = 6)	Only TMS	rTMS, 10 Hz, 500 impulse/session, 100% RMT, B-65 figure-8 coil, LDLPFC, 10 session	MDE	No	0	no
Pallanti et al[54], 2010-A	Active TMS, No = 20, age=47.6 ± 12.33, (M = 9). Sham = 20, age = 47.85 ± 9.12 (M = 8)	Only TMS	Bilateral rTMS, 1 Hz, 420 impulse/session, 110% RMT, B-65 figure-8 coil., RDLPFC, 15 session AND rTMS, 10 Hz, 1000 impulse/session, 100% RMT, B-65 figure-8 coil., LDLPFC, 15 session	TRD	No (light and not worth mentioning)	0	no
Pallanti et al[54], 2010-B	Active TMS, No = 20, age = 51.2 ± 12.33, (M = 8). Sham = 20, age = 47.85 ± 9.12 (M = 8)	TMS + placebo	rTMS, 1 Hz, 420 impulse/session, 110% RMT, B-65 figure-8 coil., RDLPFC, 15 session	TRD	No (light and not worth mentioning)	0	no
Fitzgerald[55], 2008	Active TMS, No = 30, age = 45.7 ± 10.8 (M = 10). Sham = 28, age = 44.8 ± 11.4 (M = 15)	Only TMS	LF rTMS, 1 Hz, 900 impulse/session, 110% RMT, B-65 figure-8 coil., rDLPFC, 10 session	Depression NS	No (light and not worth mentioning)	0	no
Fitzgerald et al[44], 2007	Active TMS, No = 25, age = 46.8 ± 10.7 (M = 10). Sham = 25, age = 43.7 ± 10.2 (M = 9)	Only TMS	Bilateral rTMS, 10 Hz, 750 impulse/session, 100% RMT, B-65 figure-8 coil., LDLPFC, 30 session AND Bilateral rTMS, 1 Hz, 420 impulse/session, 110% RMT, B-65 figure-8 coil., RDLPFC, 30 session	TRD	No (light and not worth mentioning)	0	no
O’Reardon et al[50], 2007	Active TMS, No = 155, age = 47.9 ± 11 (M = 69). Sham = 146, age = 48.7 ± 10.6 (M = 72)	Only TMS	rTMS, 10 Hz, 3000 impulse/session, 120% NS coil, LDLPFC, 25 session	MDE	No (light and not worth mentioning)	0	no
Fitzgerald et al[43], 2006	Active TMS, No = 25, age = 46.8 ± 10.7 (M = 10). Sham = 25, age = 43.7 ± 10.2 (M = 9)	Only TMS	Bilateral rTMS, 10 Hz, 750 impulse/session, 100% RMT, B-65 figure-8 coil., LDLPFC, 30 session AND Bilateral rTMS, 1 Hz, 420 impulse/session, 110% RMT, B-65figure-8 coil., RDLPFC, 30 session	TRD	No (light and not worth mentioning)	0	no
Rumi et al[48], 2005	Active TMS, No = 22, age = 39.3 ± 12.8 (M = 3). Sham = 24, age = 38.9 ± 8.8 (M = 4)	TMS + Amitriptyline	rTMS, 5 Hz, 1250 impulse/session, 120% RMT, B-65 figure-8 coil, LDLPFC, 20 session	MDE	No (light and not worth mentioning)	0	no
Boggio et al[49], 2005	Active TMS, No = NS, age = NS (M = NS). Sham = NS, age = NS, (M = NS)	TMS + fluoxetine+ placebo	rTMS, 15 Hz, 3000 impulse/session, 110% RMT, B-65figure-8 coil, LDLPFC, 10 session	MDE in Parkinson’s disease	No	0	0
Poulet et al[46], 2004	Active TMS, No = NS, age=NS (M = NS). Sham = NS, age = NS (M = NS)	TMS + paroxetine	rTMS, 10 Hz, 400 impulse/session, 80% RMT, B-65 figure-8 coil, LDLPFC, 10 session	MDE	No	0	no
Mosimann et al[47], 2004	Active TMS, No = 15, age = 60 ± 13.4 (M = 10). Sham = 9, age = 64.4 ± 13 (M = 5)	Only TMS	rTMS, 20 Hz, 1600 impulse/session, 100% RMT, B-65 figure-8 coil, LDLPFC, 10 session	MDE	Yes (TMS, No = 7; SHAM, No = 5)	1	no
Hansen et al[45], 2004	Active TMS, No = 6, age = 42.5 (M = 4). Sham = 7, age = 46, (M = 5)	TMS + antidepressant	rTMS, 10 Hz, 2000 impulse/session, 90% RMT, B-65 figure-8 coil, LDLPFC, 10 session	MDE	No	0	no
Nahas et al[41], 2003	Active TMS, No = 11, age = 42.4 ± 7.3 (M = 4). Sham = 12, age = 43.4 ± 9.3 (M = 5)	Only TMS	rTMS, 5 Hz, 1600 impulse/session, 110% RMT, B-65 figure-8 coil, LDLPFC, 10 session	BD	No (light and not worth mentioning)		no
Fitzgerald et al[66], 2003-A	Active TMS, No = 20, age = 42.4 ± 9.8 (M = 12). Sham = 20, age = 49C.15 ± 14.243 (M = 9)	Only TMS	rTMS, 1 Hz, 300 impulse/session, 100% RMT, B-65 figure-8 coil, RDLPFC, 10 session	BD,MDE, TRD	No (light and not worth mentioning)	0	no
Fitzgerald et al[66], 2003-B	Active TMS, No = 20, age = 45.55 ± 11.49 (M = 13). Sham = 20, age = 49.15 ± 14.243 (M = 9)	Only TMS	rTMS, 10 Hz, 1000 impulse/session, 100% RMT, B-65 figure-8 coil., LDLPFC, 10 session	BD,MDE, TRD	No (light and not worth mentioning)	1	no
Pascual-Leone et al[60], 1996	Active TMS, No = 17, age = 48.6 ± NS (M = 6). Sham = 17, age = 48.6 ± NS (M = 6)	Only TMS	rTMS, 10 Hz, 2000 impulse/session, 90% RMT, B-65 figure-8 coil, LDLPFC, 5 session	Psychotic depression	Yes (TMS, No = 7; SHAM, No = 7)	0	no

SD: Standard deviation; RMT: Resting motor thresholds; HMS: Hypomanic/manic switch; TMS: Transcranial magnetic stimulation; rTMS: Repetitive TMS; RDLPFC: Right dorsolateral prefrontal cortex; LDLPFC: Left dorsolateral prefrontal cortex; TRD: Treatment resistant depression; MDE: Major depressive episode; dTMS: Deep TMS; piTBS: Prolonged intermittent theta burst stimulation; iTBS: Intermittent theta-burst stimulation; BD: Bipolar depression; MDD: Major depressive disorder.