A review of mechanisms and optimization strategies for clinical improvement after repetitive transcranial magnetic stimulation in bipolar disorder

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Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for drug-resistant depression, with less clear efficacy in bipolar disorder (BD).
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Clinical response to rTMS in BD may be linked to lower left frontal cortex volume, slower EEG activity, and reduced default mode network activity.
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rTMS induces neurochemical changes and alters blood flow, primarily in the stimulated area, but studies on its effects in BD are limited.
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Navigated rTMS may enhance therapeutic outcomes by targeting brain areas based on their connectivity with other regions, particularly for cognitive performance.
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Anatomical and neurophysiological factors are associated with rTMS response in BD, indicating the need for further research in this area.

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