Sustained Remission of Psychotic Bipolar Disorder After Long-Term Transcranial Magnetic Stimulation: A Case Report

Bipolar disorder with psychotic features remains one of the most treatment- resistant psychiatric conditions, frequently requiring hospitalization and multiple medications trials. Transcranial magnetic stimulation (TMS), though primarily approved for unipolar depression, has shown great results in complex bipolar presentations. Case presentation: We present the case of a 56-year-old woman with bipolar I disorder with psychotic features, resistant to many pharmacologic interventions, and hospitalized more than 30 times over a span of 30 years. She had experienced auditory and visual hallucinations, suicide attempts, homicidal behavior, and severe depressive episodes. Her condition was refractory to treatment until initiating maintenance TMS four years ago. Since then, she has experienced no further psychiatric hospitalizations, no psychotic episodes, and marked functional improvement, including being able to make internationally, social reintegration, and adherence to treatment for her other comorbid medical conditions. Conclusion: This case illustrates the potential of long-term maintenance TMS as a life-changing intervention in refractory bipolar disorder with psychosis. It also raises the need to revisit current guidelines excluding such patients from standard TMS protocols.