Mania has so far not been described as a side effect in trials of transcranial magnetic stimulation for unipolar depression (2) or for bipolar depression (3). This, in combination with the fact that mania is an uncommon symptom in PTSD, makes the occurrence of mania less likely to be the effect of chance and more likely to be an idiosyncratic side effect of right dorsolateral prefrontal transcranial magnetic stimulation in PTSD. To be able to further judge this, it would be relevant to know how severe these manic episodes were, how long they lasted, and how they were treated. It would also be important for the interpretation of the trial to know whether the treatment with transcranial magnetic stimulation was stopped as a consequence of the occurrence of mania. Finally, it would be relevant to know if these patients had any risk factors for mania, such as a personal or family history of bipolar disorder or other mental illness. I would like to submit that there is a risk that unexpected findings such as this do not receive enough attention amid the enthusiasm of reporting a successful new treatment (4). To avoid this, it would seem sensible from now on to carefully monitor symptoms of mania in subsequent trials, similar to advised practice in bipolar depression (5).