Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder

A meta-analysis comparing the effectiveness and safety of repetitive transcranial magnetic stimulation versus theta burst stimulation for treatment-resistant depression

Objective

This study compares the safety and effectiveness of theta-burst stimulation (TBS) and repetitive transcranial magnetic stimulation (rTMS) for treating treatment-resistant depression (TRD).

Methods

We reviewed randomized controlled trials (RCTs) that evaluated rTMS and TBS in managing TRD. Searches were conducted in PubMed, Embase, the Cochrane Library, and Web of Science for studies published up to July 31, 2024. Data from these studies were analyzed using statistical software.

Results

Five RCTs involving 1,196 patients were included, with 553 receiving rTMS and 663 receiving TBS. The analysis found no significant differences between rTMS and TBS in reducing depression [SMD = -0.07, 95% CI (-0.19, 0.04)] or anxiety [SMD = -0.02, 95% CI (-0.15, 0.11)], nor in side effects like headaches [OR = 1.00, 95% CI (0.72, 1.40)], nausea [OR = 1.42, 95% CI (0.79, 2.54)], or fatigue [OR = 0.87, 95% CI (0.46, 1.64)].

Conclusions

Both rTMS and TBS are similarly effective in reducing depression and anxiety symptoms, with comparable side effect profiles. However, TBS is more time-efficient, with sessions lasting only 192 seconds, making it a cost-effective option for patients. These findings support TBS as a practical treatment choice for TRD.

Current practices of psychoeducation interventions with persons with bipolar disorders: a literature review

This review sought to summarize the literature on current practices and forms of psychoeducation in the management of patients with bipolar disorder (BD), including only randomized controlled trials to ensure the best level of evidence. An extensive review of the available literature was conducted using PubMed/MEDLINE, Embase, and PsychInfo databases from inception to April 28th, 2022. The search yielded 381 studies. Seventy articles were included after removing duplicates and applying the inclusion/exclusion criteria. A best-evidence synthesis was used to identify the key results of each study and summarize the outcomes. Eleven descriptive categories were made. They encompass different forms of psychoeducation compared or combined with other psychosocial interventions, varying in setting (individual or group), with or without family members, structured or unstructured, mediated or not by digital tools (smartphone, internet). Globally, these studies show that psychoeducation is important in the treatment of BD, as it leads to a decrease in relapses, mood episodes, hospitalizations, and improved functioning or quality of life. Some studies also showed the benefits of psychoeducation on the patient's level of knowledge of pharmacological treatment and the disorder or compliance with medication, as well as reduced self-stigma. The limitations of this review are linked to the selection of only RCTs and the reliance on their post-hoc analyses. This review confirms the benefit of psychoeducation and psychosocial interventions on the evolution of BD (in different outcomes, including quality of life, relapse, and rehospitalization rates, for example). More recent interventions, such as mindfulness or online psychoeducation, represent an interesting option but more evidence is needed.