title: Brain stimulation treatments in bipolar disorder: A review of the current literature.
abstract: OBJECTIVE
  Brain stimulation techniques are non-pharmacologic strategies which offer additional therapeutic options for treatment-resistant depression (TRD). The purpose of this paper is to review the current literature regarding the use of brain stimulation in resistant bipolar disorder (BD), with particular reference to hypomanic/manic symptoms.
  
  
  METHODS
  Keywords pertaining to the brain simulation techniques used in the treatment of depression (either unipolar or bipolar) along with their role in regard to hypomanic/manic symptoms were used to conduct an electronic search of the literature. Pertinent findings were identiﬁed by the authors and reviewed.
  
  
  RESULTS
  Brain stimulation techniques represent a valid therapeutic option in TRD. They have been extensively studied in unipolar depression and, to a minor extent, in the depressive phase of BD, showing encouraging but often limited results. With exception of electroconvulsive therapy, the efficacy of brain stimulation in the treatment of manic symptoms of bipolar patients is still uncertain and needs to be fully evaluated.
  
  
  CONCLUSIONS
  Brain stimulation in BD is derived from its use in unipolar depression. However, there are many important differences between these two disorders and more studies with a systematic approach need to be conducted on larger samples of bipolar patients with treatment-resistant characteristics.
authors.affiliation: a Department of Psychiatry , University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Oldani
authors.affiliation: a Department of Psychiatry , University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy.
authors.forename: A Carlo
authors.initials: AC
authors.lastname: Altamura
authors.affiliation: b Complex Depression, Anxiety and Trauma Service (CDAT) and Neurodevelopmental Service (Adult ADHD and Adult ASD), Camden and Islington NHS Foundation Trust, St Pancras Hospital , London , UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelghani
authors.affiliation: c Centre for Affective Disorders, Institute of Psychiatry, King's College London , Denmark Hill, London , UK.
authors.forename: Allan H
authors.initials: AH
authors.lastname: Young
mesh_terms: D001714:Bipolar Disorder / Q000628:therapy*; D046690:Deep Brain Stimulation; D061218:Depressive Disorder, Treatment-Resistant / Q000628:therapy*; D004565:Electroconvulsive Therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation
keywords: bipolar affective disorder; electroconvulsive therapy; neurostimulation; transcranial magnetic stimulation; treatment-resistant depression