{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T10:16:31Z","timestamp":1780913791837,"version":"3.54.1"},"reference-count":55,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Bipolar depression is disabling and often inadequately responsive to medication alone. The current efficacy evidence of transcranial magnetic stimulation (TMS) for bipolar depression is conflicting. Therefore, we synthesized randomized controlled trials (RCTs) that tested the efficacy, safety, and tolerability of TMS for bipolar depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched MEDLINE\/EMBASE\/Cochrane\/PsycINFO\/gray literature (01\/10\/2025) for RCTs comparing any TMS protocol with sham. Co-primary outcomes were depressive symptoms, all-cause discontinuation; secondary outcomes were response, remission. Risk of bias (RoB) was assessed with RoB-2. Random-effects models estimated standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (95%CI), alongside sensitivity, subgroup, and meta-regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nineteen comparisons from 17 RCTs (N\u2009=\u2009563; TMS\u2009=\u2009293, sham\u2009=\u2009270; mean N TMS\u2009=\u200915.4, sham\u2009=\u200915.9; mean duration\u2009=\u20092.40 weeks; RoB \u201clow\u201d =\u200935%, \u201csome concerns\u201d =\u200965%) were included. Among trials reporting subtypes (k\u2009=\u200913), 41.8% of participants had bipolar I disorder, and 58.2% had bipolar II disorder. The left dorsolateral prefrontal cortex was the most common target (k\u2009=\u200912). TMS reduced depressive symptoms versus sham (SMD\u2009=\u2009\u22120.34; 95%CI\u2009=\u2009\u22120.58 to \u22120.11), with no difference in all-cause discontinuation. TMS was favoured for response (RR\u2009=\u20091.41; 95%CI\u2009=\u20091.10 to 1.80) and remission (RR\u2009=\u20091.54; 95%CI\u2009=\u20091.06 to 2.23). However, these effects were not consistently confirmed in sensitivity or subgroup analyses by RoB, TMS type, stimulation site, or treatment resistance. Overall, 15 comparisons (88.2%) did not show superiority of TMS over sham for depressive symptoms at the individual trial level. No seizures or serious adverse events occurred; adverse events did not differ from sham. Meta-regression suggested a greater number of total pulses was associated with greater depressive symptom reduction (\u03b2\u2009=\u2009\u22120.018;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.00017).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TMS shows a small meta-analytic antidepressant effect and acceptable tolerability in bipolar depression despite most individual trials being negative. However, subgroups and sensitivity findings did not support TMS as an efficacious treatment at current doses. Further testing via larger RCTs with higher-dose protocols is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/07067437261457224","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T04:18:09Z","timestamp":1780633089000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transcranial Magnetic Stimulation for Bipolar Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Stimulation magn\u00e9tique transcr\u00e2nienne dans les cas de d\u00e9pression bipolaire : une revue syst\u00e9matique et une m\u00e9ta-analyse d\u2019essais contr\u00f4l\u00e9s \u00e0 r\u00e9partition al\u00e9atoire"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1642-8349","authenticated-orcid":false,"given":"Carl","family":"Zhou","sequence":"first","affiliation":[{"name":"University of Ottawa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Fabiano","sequence":"additional","affiliation":[{"name":"University of Ottawa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7316-5370","authenticated-orcid":false,"given":"Stanley","family":"Wong","sequence":"additional","affiliation":[{"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5786-5203","authenticated-orcid":false,"given":"Mikkel","family":"H\u00f8jlund","sequence":"additional","affiliation":[{"name":"Mental Health Services in the Region of Southern Denmark"},{"name":"Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Shorr","sequence":"additional","affiliation":[{"name":"The Ottawa Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Sab\u00e9","sequence":"additional","affiliation":[{"name":"Geneva University Hospital"},{"name":"Department of Medicine, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Campana","sequence":"additional","affiliation":[{"name":"University of Ottawa"},{"name":"Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada"},{"name":"Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Hyde","sequence":"additional","affiliation":[{"name":"School of Psychology, University of Southampton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Brandt","sequence":"additional","affiliation":[{"name":"School of Psychology, University of Southampton"},{"name":"Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuele","family":"Cortese","sequence":"additional","affiliation":[{"name":"University of Southampton"},{"name":"Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK"},{"name":"Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, UK"},{"name":"Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA"},{"name":"DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari \u201cAldo Moro\u201d, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Tremblay","sequence":"additional","affiliation":[{"name":"University of Ottawa Institute of Mental Health Research at The Royal"},{"name":"Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada"},{"name":"Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"School of Psychology, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"D\u00e9partement de psycho\u00e9ducation et psychologie, Universit\u00e9 du Qu\u00e9bec en Outaouais, Gatineau, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram","family":"Brender","sequence":"additional","affiliation":[{"name":"University of Ottawa"},{"name":"Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayatri","family":"Saraf","sequence":"additional","affiliation":[{"name":"University of Ottawa"},{"name":"Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshmi N.","family":"Yatham","sequence":"additional","affiliation":[{"name":"University of British 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