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Re: TMS, Ketamine, ECT ... last chance! SLS

Posted by PCB on June 10, 2020, at 20:02:28

In reply to Re: TMS, Ketamine, ECT ... last chance! PCB, posted by SLS on June 10, 2020, at 19:07:11

Hey SLS,

Thanks for the reply. I really appreciate it!

> > Insomnia for which ambien barely helps
> One of the problems with Ambien is that it has such a short half-life. It is used to initiate sleep, but doesn't do a very good job of keeping people asleep (sleep maintenance). Years ago, when nothing else worked to treat my insomnia while taking Parnate + desipramine, my doctor combined Halcion (the most potent benzodiazepine that has a very short half-life) to initiate sleep and Ativan to maintain it.

So anything with a longer half life leaves me a little sedated in the morning. So I take 5 mg at bedtime and wake up at 2 AM and take the other half.

> > Worry that so few people take Nardil, there will be a shortage one day
> Yes and if you stop taking it now, my future is less secure. :-)

Hahaha. Maybe the one good thing about going to TMS is the technician said alot of patients there take Nardil. So I take that back, you are safe ;)

> > I think we talked about this before, but Dr Fredrick Quitken The Godfather of Nardil told me that Nardil works 90% of the time but only 10% can tolerate it.
> Wow. I didnt know that.
> I was a patient of Dr. Quitkin. He and Michael Liebowitz were big proponents of Nardil for atypical depression and social anxiety.

Yes, Nardil really works! Quitkin said right after the "90% work, 10% tolerate comment" that he didn't even prescribe nardil anymore. He said "I just give Prozac." (the only ssri out when I saw him). He did say I could lower the dose and add ritalin to nardil. Wow! Nardil and Ritalin made me so high ... I suspect that how it feels to do narcotics. I hated the feeling

> > So TMS is making me worse, I all I have to choose between is Nardil and being fat, forever single, high blood pressure and diabetes or maintenance ECT with the inability to work at my high level job and this possibly of long term cognitive loss.
> Linkadge made a rather important comment regarding dominant handedness. It reminded me how critical frequency and laterality are in TMS treatment outcome. Are there any left-handed people in your family? Giving TMS on the wrong side of the brain (for that individual) can make someone feel worse instead of better. There are several different types of TMS that have emerged. You might want to look into deep TMS (dTMS).

So the really reason I don't want to continue TMS is I am back together with my on and off girlfriend of 2 years. I really can't afford to be depressed for 6 weeks without her breaking it off. I broke things off before, so she is giving me a test period where I have to be really good before she will say we are officially dating again. Otherwise I wouldn't worry about doing 6 weeks of TMS and being bedridden and nonfunctional. This sounds corny, but I really love her and she is my *main* antidepressant. She inspires me, walk in the parks are amazing, just my life is so much better with her. So if things go well, maybe TMS in 3 to 6 months. Also no lefties. But great thought!

> > And also, I have been on over 25 medication and the only ones I could not tolerate were despramine and Wellbutrin but to worsen of my panic attack. Of the other TCA, parnate, SSRI, lithium, SNRIs, depakote I had side effects but they were tolerable and I never complained. Nardil was really the first and only medication that I have had difficulties with and have tried to replace.
> Have you responded well to a drug that later became ineffective?

Nope. But I do have a strong family of Bipolar and Unipolar disorder. I have always been concerned I am Bipolar II or III (technically according to Hagop Akiskals bipolar subtypes, I might be type IV? after failing 3 or more antidepressants. I have tried lithium and depakote monotherapy and really felt worse trying to see if I was Bipolar I or maybe II. So all my docs have said no Bipolar, but I probably am unipolar or some form of mild bipolar spectrum. Actually my mother is unipolar and father was Bipolar I. I started wonder if I am some strange of combination disorder being both unipolar and bipolar making so I can't respond to any medications (It a strange thought, but maybe I got some strange gene combination that antidepressants put me into agitated bipolar depression and mood stabilizer send me into deep depression

> I imagine you have tried Effexor already. What about Trintellix? Intrestingly, Trintellix can enhance cognitive function, even when there is no improvement in depression. Its worth trying.

Really interesting you said that. So I switched my pdoc this year and he had me do all sorts of consults ... ECT, TMS, pharmacogenetic testing. My pharamcogentic test did list Trintellix and I thought I would switch to that off nardil and then start TMS. But the TMS doc said no, to start TMS and try tapering off nardil after 2 weeks.

P.S. what really got me to try TMS was this article ....

I actually talked to this kind gentleman and asked him what maintenance ECT was like. He said he stopped ECT several year ago because he now does TMS! Later I found out he takes nardil too, but I didn't get the dose. I hope it wasn't a high dose, but a low dose with TMS.




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