Repetitive Transcranial Magnetic Stimulation Bilateral as Adjuvant Therapy for Improvement of Cognitive Function in Patients with Bipolar Disorder

Sahid Dahtin; Rohmaningtyas Rohmaningtyas; Adriesti  Herdaetha

doi:10.46799/adv.v4i10.707

Authors

Sahid Dahtin Universitas Sebelas Maret
Rohmaningtyas Rohmaningtyas Universitas Sebelas Maret
Adriesti Herdaetha Universitas Sebelas Maret

DOI:

https://doi.org/10.46799/adv.v4i10.707

Keywords:

bilateral rTMS, cognitive function, bipolar disorder, COBRA, adjunctive therapy

Abstract

Cognitive impairment in bipolar disorder can persist despite mood stabilization, highlighting the need for adjunctive interventions targeting cognitive difficulties. This study evaluated the effectiveness of bilateral repetitive transcranial magnetic stimulation (rTMS) as an adjunctive treatment for reducing subjective cognitive complaints in patients with bipolar disorder. This quasi-experimental study with repeated assessments included 28 hospitalized patients at Dr. Arif Zainudin Hospital, Surakarta, between January and March 2026. Participants were recruited using purposive sampling and allocated alternately to the intervention and control groups, with 14 patients in each group. The intervention group received standard therapy plus 10 sessions of sequential bilateral rTMS targeting the dorsolateral prefrontal cortex (DLPFC), whereas the control group received standard therapy alone. Subjective cognitive complaints were assessed using the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) at baseline, midpoint, and treatment completion; depressive and manic symptoms were also assessed. Repeated-measures analyses, between-group comparisons, and regression analyses were performed. Mean COBRA scores decreased from 22.64 to 12.50 in the rTMS group and from 22.57 to 19.07 in the control group. The between-group difference in improvement was 6.64 points (p < 0.001; Cohen’s d = 3.027). Changes in depressive and manic symptoms were not significantly associated with improvements in cognitive complaints. One participant reported a headache. These findings suggest that bilateral rTMS may reduce subjective cognitive complaints in patients with bipolar disorder. However, baseline differences in depressive symptoms, nonrandom allocation, reliance on subjective cognitive assessment, and the short follow-up period warrant larger randomized controlled trials incorporating objective neurocognitive assessments before definitive clinical recommendations can be made.

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