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Re: Off TMS 2 Week Update! SLS

Posted by PCB on June 24, 2020, at 12:26:59

In reply to Re: Off TMS 2 Week Update! PCB, posted by SLS on June 24, 2020, at 9:59:36

> Hi, PCB.
> Thanks for taking the time to answer my questions. I never heard of bilateral TMS. Wow.
> Quick thought: Many people who took Nardil and responded to it discontinued it prematurely. When they relapsed, the choice was an obvious one - just restart Nardil. The problem is, it didn't work for them ever again.

The pdoc said bilateral was to help my anxiety. But I was not anxious (even though that is my main mood problem with some depression and a family history of bipolar). The literature reports some pt have increased anxiety with the beginning of left frontal rTMS similar to antidepressant initiation. I think the pdoc would have cycled me next to right sided rTMS only which as you probably know is good or better for both unipolar and bipolar disease, but I think an off label indication. I think because it is not FDA approved/cleared for bipolar, pdoc dont start right away with right sided. Now clear bipolar patientS will often say, Amazing, it only took two sessions and the depression was gone. And now I come in for one dose every few months if Im starting to slide into depression. I talked to a patient who responded like this. Here is one if you want to see the video (its in the McMullen video series which some people love or dont care for) .....

I did have poop out with Nardil after going back and forth from 60 mg with weight gain, impotence and insomnia then back to 45 mg with severe depression returning but side effects gone several times over 2 years. I think my trace of bipolar was the cause of my poop out. From my readings, I thought the only solution was ECT and lucky it did get Nardil (the only med to work for me except imipramine/lithium) working again. With 450 of lithium, I have been able to lower Nardil to 50 and never have had poop out again (but I was scared this TMS 5 sessions was pseudopoop out .... but right sided TMS probably would have worked) which I think points again to my some trace bipolarity in me. Although I know many argue that low dose lithium is good for unipolars too.




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