‘Manic Depression’


Bipolar Disorder, formerly known as manic depression, is a condition which is characterised by severe mood swings, which can last for weeks or even months. 

It is sometimes referred to as ‘bipolar affective disorder’.

Bipolar disorder affects about 1% of the adult population at some time in their life.  It usually starts after puberty, with the first episodes around the age of 15-19 and affects men and women equally.

The extreme states of bipolar disorder are:

  • High – or ‘manic’ – feeling extreme happiness, exuberant elation, overactivity. Untreated, this can last 3-6 months
  • Low – or ‘depressive’ – feeling intense depression, despair, lethargy. This phase tends to last longer than the ‘high’

Bipolar disorder is much more extreme than normal mood variation. The high or low episodes can be very distressing and overwhelming, which can have a big impact on the patient’s life.

Some patients may also experience some psychotic symptoms during manic or depressed episodes, which can be very frightening.

People can experience different types of bipolar disorder episodes:

  • Rapid cycling – swinging quickly from a high to low state without having a “normal” phase between the extremes
  • Mixed state – symptoms of depression and mania together e.g. depressed mood with the restlessness and overactivity of a manic episode.

Symptoms of Depression Episode

A ‘low’ or episode of depression may include:

  • Feeling sad, low, hopeless, pessimistic
  • Irritability
  • Lethargy, tiredness, lacking energy
  • Difficulty concentrating and remembering things
  • Loss of interest in everyday activities
  • Self-doubt, feeling empty or worthless
  • Feeling guilt and despair
  • Delusion, hallucinations, disturbed or illogical thinking
  • Loss of appetite, difficulty sleeping/waking early
  • Suicidal thoughts

Symptoms of Manic Episode

A ‘high’ episode may include:

  • Feeling very happy, elated, overjoyed
  • Talking very fast, saying things that are out of character
  • Feeling full of energy
  • Feeling overly confident, self-important
  • Feeling full of ideas and important plans
  • Easily distracted, irritated or agitated
  • Delusion, hallucinations, disturbed or illogical thinking
  • Loss of appetite, not wanting to sleep
  • Irrational behaviour e.g. spending binges
  • Risky or harmful decisions


While the exact cause of bipolar is not known, it is generally believed to be due to a combination of factors, including:

  • Chemicals in the brain – imbalance in chemical neurotransmitters (e.g. noradrenaline, serotonin, dopamine) is linked to bipolar episodes
  • Genetics – a tendency to developing bipolar disorder does appear to run in families, although no single gene has been found responsible
  • Triggers – stressful, life-altering events can cause episodes of depression and bipolar disorder.  Bipolar disorder can also be triggered by illness, disturbed sleep or overwhelming worries

Conventional Treatments

Conventional approaches to treating bipolar disorder include:

  • Medication to stabilise mood and treat high/low episodes
  • Psychological treatment – education, self-monitoring, coping skills
  • Self-help – exercise, relaxation
  • Cognitive behavioural therapy (CBT)

These can be very effective with the right group, but may not suit everyone. It can also take a long time to get the right balance of medication.

rTMS Treatment for Bipolar Disorder

Evidence shows that TMS may be a suitable alternative treatment for bipolar disorder. 

It is a safe, medication free treatment which works directly on the affected areas of the brain with a non-invasive therapy.

The rTMS treatment for depression stimulates the prefrontal cortex area of the brain.  This area controls mood, motivation, and social skills.  In particular, the left side of the prefrontal cortex is associated with positive feelings.  It is this area of the brain that is stimulated by rTMS. Stimulation of the prefrontal cortex by rTMS in depressed patients can lead to complete remission from depression with patients reporting that they feel much more positive; they are more sociable, motivated and talkative.

NICE Approved Treatment of Depression with rTMS

NICE approved rTMS as a safe and effective treatment for depression in December 2015 (NICE Guidelines, 2015).


Smart TMS Clinics

Transcranial Magnetic Stimulation therapy treatment for bipolar disorder is available at all Smart TMS clinics. See our clinic locations for more information.

Smart TMS was the first UK clinic to offer treatments for anything other than depression.

Treatment Protocol

At Smart TMS we provide a bespoke rTMS depression treatment, using our extensive experience of rTMS in the treatment of depression and our ongoing discussions with various researchers. Each treatment session takes 25 minutes.

The treatment protocol as outlined by NICE is typically 2-6 weeks.  We have developed treatment protocols which allow for multiple treatments per day, allowing for the full treatment to be delivered in between five days up to six weeks, at the patient’s discretion.  Patients will be assessed over the course of treatment to monitor the effect.  The actual length of the treatment will vary dependent on how quickly a reduction in the depression level is seen.