Magnetic brain zap reveals clues to bipolar mood swings

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: 1. All participants * 18-35 years of age * Scoring less than or equal to 8 on the Hamilton Rating Scale for Depression (HRSD) at screen visit 2. Participants with Bipolar Disorder (BD) * Diagnosis of Bipolar Disorder I/II (BDI/II) (DSM-5 criteria) in remission (euthymic for \>2 months) or with mild-moderate hypomania * \<15 on the Young Mania Rating Scale * Not psychotic * \<3 on delusions, hallucinations, unusual thought content, and conceptual disorganization items of the Positive and Negative Syndrome Scale (PANSS) * Unmedicated or on any combination (except antidepressant monotherapy) of anxiolytics (benzodiazepines, buspirone, pregabalin, hydroxyzine) as needed, and/or atypical antipsychotics, and/or lithium, and/or other mood stabilizers, and/or non-SNRI antidepressants and/or non benzodiazepine hypnotics, as these are commonly-prescribed medications for BD 3. Participants without Bipolar Disorder * No present or lifetime history of BD or psychiatric disorder other than anxiety or non BD mood disorders * Not in a current depressive episode * No family history of BD Exclusion Criteria: 1. All participants * History of head injury, neurological, pervasive developmental disorder (e.g. autism), systemic medical disease and treatment (medical records, participant report) * Family history of epilepsy (TBS exclusion criterion) * Use of substances with seizure risk (e.g., stimulants) in the past month, assessed as at screening, baseline, and before each fMRI-cTBS-fMRI session * Mini-Mental State Examination score (cognitive state) \<24 * Premorbid National Adult Reading Test Intelligent Quotient estimate\<85 * Visual disturbance: \<20/40 Snellen visual acuity * Left/mixed handedness * History of alcohol/substance use disorder (SUD; all substances, including nicotine), and/or illicit substance use (except cannabis) over the last 6 months (SCID-5). Note: lifetime/present cannabis use (at non-abuse (\<3 times in the past month) and non SUD levels) will be allowed, given its common usage in BD and young adults. Cannabis SUD over the last 6 months will not be allowed. Urine tests on scan days will exclude current illicit substance use (except cannabis). Salivary alcohol tests on scan days will exclude intoxicated individuals * Binge drinking in the week before, and/or \>3 units/day for the 3 days before, and/or alcohol in the last 12 hrs before, any cTBS scan day, confirmed at screening and scan days (to avoid TBS during alcohol withdrawal). Alcohol/nicotine/ caffeine/cannabis use (below SCID-5 SUD, binge levels) will be allowed, and used as covariates * MRI exclusion criteria: metallic objects, e.g., surgical implants; claustrophobia; proneness; positive pregnancy test for females (performed at the MRRC) or self-report pregnancy * Inability to understand English * \<18 years of age or \>35 year of age * SNRI antidepressants and bupropion will not be allowed, as they can elevate seizure risk, a contraindication for TBS * Scoring greater than or equal to 8 on HRSD and in depressive episode is confirmed on SCID-5 at screen visit * Scoring greater than or equal to 18 on HRSD at any visit * In current depressive episode 2. Participants with Bipolar Disorder * BD diagnosis other than BDI/II * More severe hypo/mania (YMRS\>15) * Psychosis * Using psychotropic medications other than those allowed in inclusion criteria 3. Participants without Bipolar Disorder * Present/ lifetime history of any psychiatric disorder other than anxiety and non BD mood disorders * Family history of of BD