fMRI Guided Accelerated TMS for Bipolar Disorder...Maybe

Yet another Ode to Table One from Dr. Owen Muir.

As a newsletter author with bipolar disorder who happens to be a psychiatrist who deploys accelerated transcranial magnetic stimulation, it is a bit strange for me to be offering the following article taking issue with published research on the condition I have, with positive findings. Still, it's 2024, so I guess this is…just what's happening?

I've written about bipolar on numerous prior occasions and was treated with transcranial magnetic stimulation over a decade ago. I have a dog in this fight.

A paper was recently published in JAMA Psychiatry, demonstrating aiTBS (accelerated intermittent theta burst stimulation—a pattern of brain stimulation using transcranial magnetic stimulation (TMS) devices) in the treatment of “treatment-refractory bipolar depression.”

Readers are wondering: does the title accurately describe the paper? That title:

Accelerated Intermittent Theta-Burst Stimulation and Treatment-Refractory Bipolar Depression: A Randomized Clinical Trial

My argument? A careful reading of this clinical trial will demonstrate not all is as it seems…