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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by floatingbridge on September 17, 2010, at 16:44:37
Has anyone here undergone rTMS? Please post or babblemail if you would.
If you've undergone treatment, and had a successful outcome, even partial or temporary, I'd love to hear about it, especially if any physical symptoms diminished.
Thanks.
Posted by linkadge on September 17, 2010, at 17:36:52
In reply to rTMS experience or knowledge please, posted by floatingbridge on September 17, 2010, at 16:44:37
I've done rTMS, but theres a catch! It was done with my own homemade rTMS machiene.
Linkadge
Posted by Phillipa on September 17, 2010, at 21:01:54
In reply to Re: rTMS experience or knowledge please, posted by linkadge on September 17, 2010, at 17:36:52
Link I remember that. Wasn't it before official rtms? You invented it. Phillipa
Posted by Conundrum on September 17, 2010, at 23:12:24
In reply to Re: rTMS experience or knowledge please » linkadge, posted by Phillipa on September 17, 2010, at 21:01:54
What you Macgyvered a rTMS gizmo?
Posted by Phillipa on September 18, 2010, at 0:48:48
In reply to Re: ROFLCOPTER WTF LINK? » Phillipa, posted by Conundrum on September 17, 2010, at 23:12:24
Ask Link seriously he did I think it was a hat type devise not sure though. Phillipa
Posted by twinleaf on September 18, 2010, at 8:33:50
In reply to rTMS experience or knowledge please, posted by floatingbridge on September 17, 2010, at 16:44:37
I received TMS both before and after it was approved by the FDA. When I first began having it, my depression was moderate to severe. The TMS brought me out of the severe depression each time, so that I was either depression-free or only mildly depressed. Symptoms such as insomnia improved a lot. However, each time, the improvement lasted only about six weeks, and by several months I was back where I started. It is a very safe treatment with just two drawbacks: it hurts, especially at the beginning of the treatment, and it's expensive! (insurance does not pay for it yet) With the new machines, they are achieving about a 60% remission rate, roughly comparable to that for ECT.
Now, my depression is somewhere between mild and in remission, so I don't feel the need for TMS. Because I have also been having psychotherapy, and have been taking low-dose lithium and tianeptine, I'm not sure whether the TMS has had a beneficial long-term effect or not. It certainly could have.
In addition to being so safe, TMS has several neuroprotective functions, which increased my interest in trying it, For example, it tends to decrease levels of cerebral cortisol.
Posted by linkadge on September 18, 2010, at 9:40:53
In reply to Re: rTMS experience or knowledge please » linkadge, posted by Phillipa on September 17, 2010, at 21:01:54
No, I certainly didn't invent rTMS. It was being used, I just don't know if it was approved in Canada at the time.
Posted by twinleaf on September 18, 2010, at 10:00:13
In reply to my experience with rTMS, posted by twinleaf on September 18, 2010, at 8:33:50
If I'm going to post abut TMS, I should emphasis its complete safety in terms of cognition and brain function. There are no reports of memory loss or any other cognitive impairments. One study from Harvard actually showed patients performing better on memory tests just after a TMS treatment. Because TMS treatments are now comparable in effectiveness to ECT, the difference in safety between the two becomes extremely important.
I would love to know more about the new, safer type of ECT being done in Australia- the effectiveness rate and the degree of safety. Some of the earliest work on TMS was also done in Australia.
Posted by Phillipa on September 18, 2010, at 10:55:37
In reply to Re: rTMS experience or knowledge please » Phillipa, posted by linkadge on September 18, 2010, at 9:40:53
Link didn't know that but you did have some sort of one you build didn't you. Could be mistaking you for another if so sorry. Phillipa
Posted by linkadge on September 18, 2010, at 13:52:03
In reply to TMS safety, posted by twinleaf on September 18, 2010, at 10:00:13
>I should emphasis its complete safety in terms >of cognition and brain function.
Well, I don't know about that. rTMS can cause seizures and sometimes the effects can be unexpected. There are case reports of rTMS worsening psychosis.
Also, there could well be long term effects that we are unaware of. Perhaps it causes chromisomal damage or something like power lines. I know theres no evidence to suggest this (at this point), but who knows, the research is still early.
Linkadge
Posted by twinleaf on September 18, 2010, at 14:51:38
In reply to Re: TMS safety » twinleaf, posted by linkadge on September 18, 2010, at 13:52:03
If you give ENOUGH electromagnetic current, you can certainly cause a seizure. From what I have read, and from the physicians I've talked to, there have not been any instances of seizures with the amounts used for treatment. Patients with a history of seizures are never accepted for treatment.
Could you give a reference for TMS causing a worsening of psychosis? I haven't come across any reference to that. If it's true, it's extremely serious and should be mentioned in all these discussions. Babble has been in the vanguard of giving accurate information about the negative effects of SSRIs, and it would be great if we could do that for all major psychiatric treatments.
Doctors like Mark George at the University of South Carolina, who have worked with TMS for 25 years say that they have always kept the possibility of tumor causation in mind, but that they feel reassured on this point after so much time without any evidence of it..
Posted by ed_uk2010 on September 18, 2010, at 15:13:02
In reply to Re: rTMS experience or knowledge please, posted by linkadge on September 17, 2010, at 17:36:52
>I've done rTMS, but there's a catch! It was done with my own homemade rTMS machine.
I guess it's safer that do-it-yourself ECT.
Posted by SLS on September 18, 2010, at 15:30:30
In reply to Re: TMS safety » linkadge, posted by twinleaf on September 18, 2010, at 14:51:38
> Could you give a reference for TMS causing a worsening of psychosis?
Applying slow 1 Hz pulse train to the right temporaral region can produce mania. Interestingly, applying 1 Hz to the left side can produce depression.
- Scott
Posted by floatingbridge on September 18, 2010, at 15:31:15
In reply to TMS safety, posted by twinleaf on September 18, 2010, at 10:00:13
Twinleaf, nice to see you :)
Something I read about vgf stimulation and ect and rTMS interested me. Thanks for posting. I'm so glad you are doing well.
Posted by floatingbridge on September 18, 2010, at 15:34:55
In reply to Re: TMS safety » twinleaf, posted by SLS on September 18, 2010, at 15:30:30
To anyone in theory?
Posted by floatingbridge on September 18, 2010, at 15:35:56
In reply to Re: rTMS experience or knowledge please » linkadge, posted by ed_uk2010 on September 18, 2010, at 15:13:02
Posted by twinleaf on September 18, 2010, at 16:29:14
In reply to Re: TMS safety » twinleaf, posted by floatingbridge on September 18, 2010, at 15:31:15
Hi floating bridge! Nice to see you, too.
TMS treatments have been standardized as part of the FDA approval process. All treatments are given to the left frontal area, at between 10 and 20 Hz. (they start with 10 Hz and go up slowly). Stimuli in this range are excitatory; stimuli at 1 Hz are depressive, and are not used in treatment. They don't stimulate the right side at all.
I looked back in my file to see if there was any information about psychosis. There actually was. They said that a patient showing signs of psychosis should not be given TMS, because TMS is relatively slow-acting, and the psychosis could worsen dangerously before any benefit might occur. I don;t think they feel that TMS can help psychosis, anyway, but because of the importance of giving the best treatment for psychosis promptly, it is contraindicated to use TMS. I didn't see anything about TMS causing a worsening of psychosis. The focus seems to be on not treating psychosis with TMS at all.
fb, when TMS eventually gets approved for insurance, I think it is a great treatment to consider. The way it is now, having to get re-treated regularly just mounts up in expense. Maybe the new safer type of ECT will do the same thing, but better.
Posted by Roslynn on September 18, 2010, at 18:30:55
In reply to rTMS experience or knowledge please, posted by floatingbridge on September 17, 2010, at 16:44:37
The thing I don't understand, and sorry if this is very basic, but why in rTMS are they trying to avoid a seizure when in ECT their goal is to produce one?
Confused,
Roslynn
Posted by twinleaf on September 18, 2010, at 19:55:39
In reply to Re: rTMS experience or knowledge please, posted by Roslynn on September 18, 2010, at 18:30:55
The idea behind TMS is that you can stimulate a small part of the brain directly (about one and a half cm.), and because those parts in turn stimulate other deeper parts, achieve the same thing with a treatment where you remain awake as you can with traditional
ECT, which stimulates the whole brain all at once. Because the seizure ECT causes would be dangerous if patients were awake, they are anesthetized very briefly.
Posted by floatingbridge on September 18, 2010, at 20:51:15
In reply to Re: rTMS experience or knowledge please, posted by twinleaf on September 18, 2010, at 19:55:39
Twinleaf,
I was told I'd need periodic *tuneups* and maintenance meds.
I'm wondering if it would help with physical symptoms such as fatigue. And maybe excessive ruminations. Maybe positive stimulation for my poor, beat-up brain. Anxiety?
Your information is so helpful--thank
you.
Posted by twinleaf on September 18, 2010, at 21:25:51
In reply to Re: rTMS experience or knowledge please » twinleaf, posted by floatingbridge on September 18, 2010, at 20:51:15
I'd say yes to anxiety, rumination and fatigue. I don't mean that it would improve everything completely, but it should help - if you are in the right 60%! You should know if you are starting to feel better after a week or so. Because your left hemisphere is stimulated, you tend to feel more alert and energized, and less in the grip of negative thoughts. And because cortisol is decreased, you tend to feel calmer
They felly expect that you will continue on some medication, and they are right in saying that you will need to return for maintenance treatments. Everyone is different in how often they need these- for me it was about four every four months; for some people, it's as often as once a week.
Posted by SLS on September 19, 2010, at 5:04:55
In reply to Re: rTMS experience or knowledge please, posted by twinleaf on September 18, 2010, at 19:55:39
> The idea behind TMS is that you can stimulate a small part of the brain directly (about one and a half cm.), and because those parts in turn stimulate other deeper parts, achieve the same thing with a treatment where you remain awake as you can with traditional
> ECT, which stimulates the whole brain all at once. Because the seizure ECT causes would be dangerous if patients were awake, they are anesthetized very briefly.
Another magnetic treatment is known as magnetic seizure therapy (MST), and involves purposely producing a seizure with magnetic stimulation.
- Scott
Posted by linkadge on September 19, 2010, at 6:23:33
In reply to Re: TMS safety » twinleaf, posted by SLS on September 18, 2010, at 15:30:30
I don't know if the whole left side / right side issue has been fully sorted out. There have been conflicting study results.
Linkadge
Posted by linkadge on September 19, 2010, at 6:32:14
In reply to Re: rTMS experience or knowledge please, posted by SLS on September 19, 2010, at 5:04:55
I think this is one of the studies I was thinking of:
http://www.biologicalpsychiatryjournal.com/article/S0006-3223(01)01369-5/abstract
After further reading, it appears that the risk of seizure is comparitively low, but still existent, even in healthy volunteers
http://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation
Also, keep in mind that the approval of rTMS has apparently not been that straightforward. Many studies have failed to demonstrate superiority over sham (see wikipedia article above)
Posted by twinleaf on September 19, 2010, at 10:04:00
In reply to Re: Here, posted by linkadge on September 19, 2010, at 6:32:14
Thanks! That's important to know.
In the pre-approval trials, there were no seizures reported, but in earlier trials, the incidence was 1 in 30,000.
You are right: they failed to show a clear effect the first time, and although they did the second time, it was not robust.
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