Posted by Pfinstegg on March 31, 2003, at 20:10:09
In reply to Re: rTMS - Has anyone else had this successfully? » Pfinstegg, posted by Dave1 on March 31, 2003, at 18:55:08
Hi Dave.. I think the cortisol surges are the best studied abnormalities in depression/anxiety- and I'm assuming OCD comes under that general heading- but there are also supposed to be excessive surges in glutamate and mineralo-corticoids, which are also harmful to the neurotransmitters and receptors in the hippocampus. So far, these illnesses are being treated by trying to normalize the levels of serotonin, nor-epinephrine and dopamine in the intercellular spaces. This is helpful, often, but it only minimally addresses the basic problem of CRF-ACTH-cortisol overactivity, and the resultant hippocampal damage. I guess it will be several years at least before the first CRF antagonist is available, but that would certainly be a huge step towards treating the basic disorder in the depressive illnesses.
One of the things which is exciting about both ECT and TMS is that, in about half of the treated cases, the CRF-DST or DST suppression tests revert to normal, indicating that less CRF is produced in response to routine stress. To be completely fair, there are also reports in the literature of the same thing occurring with successful AD treatment, including SSRI's, mood stabilizers and MAOI inhibitors. One of the things which is frustrating is that this is not routinely studied or reported, so we don't know how often it occurs. I think we'll see more information about this as the primacy of HPA axis dysregulation and abnormal glucocorticoid and mineralocorticoid secretion becomes more firmly established.
I think ketaconozodole is used primarily in Cushing's disease. It is effective in reducing cortisol secretion, but there are enough risks to liver function that it isn't used as an AD.
As done in Atlanta, TMS and ECT have almost identical improvement rates of about 63%. The TMS is always given to the left dorsolateral prefrontal cortex at high frequency. (There are studies going on at NIH and the University of Chicago using low-frequency pulses and right frontal application.) Although there is moderate spread of the electro-magnetic pulse to the left hippocampus, amygdala and basal ganglia, there is much less spread than there is with ECT- enough spread to be effective, but not enough to cause short-term memory loss. I think everyone working in this area fully expects that TMS will get FDA approval within a few years- it's now routinely used in Europe and Canada.
If anything I have said doesn't correspond to what you have learned, I hope you will let me know!
Pfinstegg
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URL: http://www.dr-bob.org/babble/20030329/msgs/214876.html