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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by SLS on June 26, 2015, at 6:50:14
From:
Synchronised Transcranial Magnetic Stimulation Effective for Major Depressive Disorder
June 24, 2015NEW YORK -- June 24, 2015 -- Synchronised transcranial magnetic stimulation (sTMS) therapy with the NEST device is effective for adult patients with major depressive disorder (MDD), according to a study published in the journal Brain Stimulation.
In the study, over 200 subjects were analysed across 17 leading academic and private psychiatric institutions in the United States. Enrolment included both treatment-naïve and treatment-resistant patients, as prior exposure to antidepressant medication was not a requirement for inclusion into the trial.
The study found sTMS therapy to be significantly more effective than sham when administered as intended, supporting the hypothesis that low-field magnetic stimulation improves depressive symptoms, said Andrew Leuchter, MD, University of California Los Angeles, Los Angeles, California. Additional analyses found subjects who failed to benefit from or tolerate prior antidepressant treatment in the current episode were most likely to demonstrate significant benefit from sTMS therapy compared with sham.
When delivered accurately and consistently, antidepressant resistant/intolerant subjects treated with active sTMS therapy achieved clinical response at a rate of 34.2% compared with a rate of 8.3% among those treated with an inactive device.
There were no significant differences between active and sham treatment in the rate or severity of adverse events. There were no device-related serious adverse events.
These promising results indicate that sTMS is a promising novel technology for the treatment of depression, said co-author Mark S. George, MD, University of South Carolina, Columbia, South Carolina. This technology is revolutionary in 2 ways over the current FDA [US Food and Drug Administration]-approved forms of TMS. First, this device tunes the stimulation to the patients own brain rhythms. By stimulating at each patients individual resonant frequency, sTMS may be able to achieve therapeutic success using lower energy. Second, this device is safe, easy to use, and portable, which would allow use in a wide variety of treatment settings. sTMS may expand the options we have for treating serious depression.
- Scott
Posted by Lamdage22 on June 26, 2015, at 7:47:06
In reply to Synchronised Transcranial Magnetic Stimulation, posted by SLS on June 26, 2015, at 6:50:14
Scientists stay scientists.
Hm. Im just very critical because all of the treatments i tried had "very good science" behind them and scientists saying how good they are.
Didnt do squat.
Doctors need to make publications
So why should this be a success now?
I probably will try Rapastinel when it comes out. But until then, if the treatments where so successful, we would have heard about it.
They are not. Anything is helpful against depression if people tell you it is and you believe it.
Posted by Lamdage22 on June 26, 2015, at 12:05:04
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Lamdage22 on June 26, 2015, at 7:47:06
Im sorry for being a downer, im just frustrated with it all.
Posted by Lamdage22 on June 26, 2015, at 12:14:26
In reply to Synchronised Transcranial Magnetic Stimulation, posted by SLS on June 26, 2015, at 6:50:14
How would stms be different that rtms?
Posted by SLS on June 26, 2015, at 12:41:58
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Lamdage22 on June 26, 2015, at 12:05:04
> Im sorry for being a downer, im just frustrated with it all.
Me, too.
:-(
From reading your posts, I think that you are still more resilient than you probably give yourself credit for.
- Scott
Posted by SLS on June 26, 2015, at 13:26:25
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Lamdage22 on June 26, 2015, at 12:14:26
> How would stms be different that rtms?
From what I gather, brain waves are monitored during treatment, and the frequency and / or power of the magnet are changed instantaneously to synchronize with the brain waves. It has to do with resonant frequencies. It operates under the same principle of a singer being able to shatter a glass with their voice. When the voice frequency matches (synchronizes with) the resonant vibration frequency of the glass, the glass breaks. If a glass with a different resonant frequency (another shape or thickness) were used instead, the voice would not have broken it. The sTMS might cause a wider or deeper spread of brain tissue stimulation compared to the original rTMS. I don't know.
- Scott
Posted by Lamdage22 on June 26, 2015, at 14:37:56
In reply to Re: Synchronised Transcranial Magnetic Stimulation » Lamdage22, posted by SLS on June 26, 2015, at 13:26:25
Hmm. I am just pretty disillusioned.
I only get frustrated with my hobbies if i dont make any progress.
Validation is what i miss the most!
Posted by SLS on June 26, 2015, at 16:10:35
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Lamdage22 on June 26, 2015, at 14:37:56
> Hmm. I am just pretty disillusioned.
You are doing much better than I did.
I was disillusioned after only nine months of unsuccessful treatment at Columbia Presbyterian in 1983. I thought doctors knew everything about my illness. It was then that I first set foot into a medical school library. After a few weeks of research, I came to the conclusion that I was deficient in dopamine. I asked my doctors for Wellbutrin (which was investigational at the time) or bromocriptine. At the time, they believed depression was due to a deficiency in norepinephrine. So, they refused my request and literally laughed in my face. I left.
> I only get frustrated with my hobbies if i dont make any progress.
Are you a perfectionist by any chance? I used to be very bad that way until a doctor impressed upon me that my perfectionism would make me more resistant to treatment.
> Validation is what i miss the most!
I understand. After years of struggling and seeing doctors who had only words of encouragement, I finally met one at NYU who described my condition as being "horrendous". I cried because I felt vindicated and validated. For some reason, I had not reacted so emotionally ten years earlier when the NIH doctors told me that I was "very sick".
MI really sucks.
- Scott
Posted by SLS on June 26, 2015, at 16:30:17
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Lamdage22 on June 26, 2015, at 14:37:56
> -------------------------------
Schizo-Affective, type depressive
Seroquel 800mg
Zyprexa 15mg
Lithium orotate 360mg
Metformin 2000mg
Effexor 37.5mg> -------------------------------
Why is the dosage of Effexor so low? I needed 300 mg/day before feeling an improvement in bipolar depression.
What is your current lithium blood level?
Although I have not researched lithium orotate closely, I am not a big believer in its usage for several reasons:
1. I have not seen a chart or calculation formula that shows the biological equivalency of orotate to carbonate.
2. I have not seen any clinical studies of lithium orotate demonstrating comparable efficacy to lithium carbonate.
3. I have not seen any research demonstrating an advantage in toxicity or side effects when lithium orotate produces clinically relevant blood levels.
Of course, just because I have not seen any of these things doesn't mean that they don't exist. If you can point me in the right direction, that would be great. Thanks. :-)
- Scott
Posted by Lamdage22 on June 26, 2015, at 16:55:03
In reply to Re: Synchronised Transcranial Magnetic Stimulation » Lamdage22, posted by SLS on June 26, 2015, at 16:30:17
There is no tweaking my meds. There is nothing i can do.
Accepting the fact can be helpful.
LO is against suicidal thoughts. For this purpose very little of whatever lithium can be helpful.
Effexor: I have taken it in higher dosages but i have not been better than at 37.5... More and i get anorgasmia.
So theres no tweaking, no trying.
I am sick of this.
Posted by SLS on June 26, 2015, at 22:32:31
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Lamdage22 on June 26, 2015, at 16:55:03
> There is no tweaking my meds. There is nothing i can do.
>
> Accepting the fact can be helpful.
>
> LO is against suicidal thoughts. For this purpose very little of whatever lithium can be helpful.
>
> Effexor: I have taken it in higher dosages but i have not been better than at 37.5... More and i get anorgasmia.
>
> So theres no tweaking, no trying.
>
> I am sick of this.
Depression is a dark beast.Please don't get too mad at me:
* For the sake of factual accuracy:
1. How much time did you give Effexor 300 mg/day to work?
2. Do any of the SSRIs you've tried produce anorgasmia?I can't blame you for wanting to stop taking full therapeutic dosages of Effexor. In the past, I have had a difficult time staying on drugs long enough to allow them to work when side effects appeared - especially while I continued to feel terrible. How many times am I expected to put myself through that?
For long-standing cases of severe depression, it can take several months for a drug to really kick in. So, how long are you supposed to suffer anorgasmia before 300 mg/day has had enough time to work - especially when there are no guarantees that it will? If you experience a partial response to Effexor at 37.5 mg/day, I would feel somewhat hopeful that full therapeutic dosages could make you feel much, much better. Are you willing to give up the capacity to have orgasms for a stable full remission? I already made this decision for myself, but I would not presume to suggest what is best for anyone else. It is a terrible compromise.
Options:1. Increase the dosage of Effexor gradually to at least 300 mg/day to first determine your responsivity to it. If it works, you could then see if the anorgasmia lessens over time. I doubt it will, though.
2. Increase the dosage of Effexor and look for remedial treatments for the anorgasmia. Ritalin, Buspar, Wellbutrin, and Periactin come to mind. I'm wondering if Viibryd would help.
3. Switch to Pristiq. This metabolite of Effexor has been reported to be less likely to produce anorgasmia. Perhaps this is because therapeutic dosages are much lower (50 - 100 mg/day).
4. Switch to Cymbalta.
5. Switch to nortriptyline.
6. Switch to Parnate or Marplan. Nardil is known to produce anorgasmia.
7. Abandon antidepressants.
a) Switch to lithium carbonate.
b) Add Lamictal 200 - 300 mg/day8. Evaluate Seroquel 800 mg/day as a contributor to anorgasmia.
a) Reduce the dosage to 400 mg/day
a) Switch to Saphris 20 mg/day
b) Add Trileptal* #8 would be tricky and perhaps ill-advised if you are apt to become manic / psychotic.
* I'm a layman - not a doctor.
* You might be frustrated and resistant to everything I wrote here. You may have tried many, if not all of these things. You might get really pissed off at me. I would understand this. Just don't question my motives, though.
* Don't give up yet.
- Scott
Posted by Lamdage22 on June 27, 2015, at 6:10:20
In reply to Re: Synchronised Transcranial Magnetic Stimulation » Lamdage22, posted by SLS on June 26, 2015, at 22:32:31
Hey Scott, its fine.
You hear someone is not doing well and you want to do something about it.
I have tried most of your suggestions.
Once i come off Seroquel and Zyprexa i may try Lithium. Not before though because of weight gain.
Posted by Hugh on June 27, 2015, at 13:16:45
In reply to Synchronised Transcranial Magnetic Stimulation, posted by SLS on June 26, 2015, at 6:50:14
It's encouraging to see that some TMS clinicians are refining their techniques. It makes a lot of sense to use EEG to look at the brain you're treating, instead of just using a one-size-fits-all approach. There's a TMS clinic in Los Angeles that uses fMRI to target dysfunctional areas of the brain. This video explains their approach. The discussion of TMS begins at 6:30.
Posted by europerep on June 27, 2015, at 13:44:59
In reply to Re: Synchronised Transcranial Magnetic Stimulation » Lamdage22, posted by SLS on June 26, 2015, at 22:32:31
> If it works, you could then see if the anorgasmia lessens over time. I doubt it will, though.
I know anecdotal evidence should be treated cautiously, but I just wanted to say that that is exactly what happened to me. Anorgasmia disappeared completely after one or two months of treatment. And I went higher than the 375mg/d dose that is generally considered the maximum.
Posted by SLS on June 27, 2015, at 13:56:41
In reply to Re: Synchronised Transcranial Magnetic Stimulation » SLS, posted by europerep on June 27, 2015, at 13:44:59
> > If it works, you could then see if the anorgasmia lessens over time. I doubt it will, though.
>
> I know anecdotal evidence should be treated cautiously, but I just wanted to say that that is exactly what happened to me. Anorgasmia disappeared completely after one or two months of treatment. And I went higher than the 375mg/d dose that is generally considered the maximum.That's very encouraging. I didn't have a hint of anorgasmia with Effexor at 300 mg/day. However, I don't remember having had it to begin with. I may have.
How did Effexor work out for you?
I experienced only a mild improvement with Effexor, but adding nortriptyline helped. I'm surprised other people don't try it.
- Scott
Posted by europerep on June 27, 2015, at 16:36:09
In reply to Re: Synchronised Transcranial Magnetic Stimulation » europerep, posted by SLS on June 27, 2015, at 13:56:41
> That's very encouraging. I didn't have a hint of anorgasmia with Effexor at 300 mg/day. However, I don't remember having had it to begin with. I may have.
Yeah, with me it did start right after I began taking it, so at a dose of 75mg I guess. I think I had read someone else's account where anorgasmia disappeared after a few weeks, so I wasn't too worried and eventually it went away. It was only later that I realized how much sexual side effects are a problem with venlafaxine for the people, and that I was rather lucky with my experience.
> How did Effexor work out for you?It worked somewhat. I was basically functional, but still very depressed. So my strategy back then was to find something to add on to it. I tried mirtazapine, lithium, aripiprazole and methylphenidate as adjunctives (all separately of course). I have all of them a full trial except aripiprazole, which I stopped after two doses because of what I experiences as serious side effects. My theory is that it was mild serotonin syndrome due to its partial agonism at 5HT-1A, but it may also have been something else.
Anyway, eventually I realized venlafaxine would not get me any further than I had gotten so far, and so I decided to go off of it. Oh but to achieve functionality and get maximum benefit from it, I was at 600mg/d for about a year. I think at that point venlafaxine does also have some dopanine reuptake inhibition. But I experienced basically no side effects even at that dose.
ER
Posted by Hugh on June 29, 2015, at 13:59:30
In reply to Synchronised Transcranial Magnetic Stimulation, posted by SLS on June 26, 2015, at 6:50:14
This was written by someone who has been treated with both sTMS and rTMS:
http://depression-time.com/stms-therapy/
This is a comment posted by a reader:
I was also in the stms study (neosync) at Duke. It was miraculous!!! I too had to get back on meds after about 2 months post-study. Meds have never, ever helped even close compared to the overall sence of clarity of thought, well-being, energy, ability to sleep deeply, mood, as the neosync. Does anyone know what the fda hold-up is??
Posted by Lamdage22 on June 29, 2015, at 15:07:03
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Hugh on June 29, 2015, at 13:59:30
Hmm this may or may not have been a reader.
As always i am sorry to be a downer!
Posted by SLS on June 29, 2015, at 16:49:10
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Hugh on June 29, 2015, at 13:59:30
> This was written by someone who has been treated with both sTMS and rTMS:
>
> http://depression-time.com/stms-therapy/Thank you for this, Hugh.
> Does anyone know what the fda hold-up is??
I have no idea where sTMS is in the approval process.
- Scott
Posted by powerboss on July 8, 2015, at 0:59:23
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Lamdage22 on June 26, 2015, at 7:47:06
Here is the scoop:
I tried this treatment in 2006 at the MindCare Centres in Canada. The treatment was not available in the U.S. back then.
They called it Repeated Transcranial Magnetic Stimulation, (rTMS).
I was feeling moderately depressed and was taking Doxepin at the time and was supposed to get 10 treatments.
I figured rather than dealing with the side-effects of increasing the dosage of my medication, (Doxepin), I would take the easy way out.
Wow, depression-free with no medication side-effects!
I had 2 treatments done in one day and it made my depression worse.
During the first treatment session, I felt myself feeling more sad.
I thought maybe I was just tired.
Then I went for a second treatment and I was starting to feel more miserable during the treatment. Afterwards my depression went from moderate to major.
This happened in 1 day!
They told me at the Clinic that I was just feeling more relaxed.
I wasn't more relaxed but I certainly was more depressed!
The staff at the clinic told me that it was impossible to feel either better or worse after only 2 treatments.
I felt worse after 1 treatment.
They want to try a different type of stimulation but I decided to cut my losses because they were not sure if it would help.
My stopping wasn't about money.
I stopped it because this treatment was making me worse.
Please feel free to ask me any questions.
Posted by powerboss on July 8, 2015, at 1:04:50
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by Lamdage22 on June 26, 2015, at 7:47:06
Here is the scoop:
I tried this treatment in 2006 at the MindCare Centres in Canada. The treatment was not available in the U.S. back then.
They called it Repeated Transcranial Magnetic Stimulation, (rTMS).
I was feeling moderately depressed and was taking Doxepin at the time and was supposed to get 10 treatments.
I figured rather than dealing with the side-effects of increasing the dosage of my medication, (Doxepin), I would take the easy way out.
Wow, depression-free with no medication side-effects!
I had 2 treatments done in one day and it made my depression worse.
During the first treatment session, I felt myself feeling more sad.
I thought maybe I was just tired.
Then I went for a second treatment and I was starting to feel more miserable during the treatment. Afterwards my depression went from moderate to major.
This happened in 1 day!
They told me at the Clinic that I was just feeling more relaxed.
I wasn't more relaxed but I certainly was more depressed!
The staff at the clinic told me that it was impossible to feel either better or worse after only 2 treatments.
I felt worse after 1 treatment.
They want to try a different type of stimulation but I decided to cut my losses because they were not sure if it would help.
My stopping wasn't about money.
I stopped it because this treatment was making me worse.
Please feel free to ask me any questions.
Posted by powerboss on July 8, 2015, at 1:25:43
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by powerboss on July 8, 2015, at 0:59:23
My point on my posting is whether sTMS is going to be better than rTMS.
With all the hype back then, the rTMS made me feel a lot worse.
Nobody expected that to happen.
I have trouble getting excited about sTMS.
Posted by SLS on July 8, 2015, at 5:33:43
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by powerboss on July 8, 2015, at 1:25:43
> My point on my posting is whether sTMS is going to be better than rTMS.
>
> With all the hype back then, the rTMS made me feel a lot worse.
>
> Nobody expected that to happen.
>
> I have trouble getting excited about sTMS.
Do you recall on what side of the forehead the magnet was placed and what frequency was used? Some people are now using 1 Hz on the RIGHT side to treat depression with good effect. If the frequency is too low on the left or too high on the right, a worsening of depression is likely.How much money did it cost you to have the treatments?
- Scott
Posted by powerboss on July 8, 2015, at 15:38:44
In reply to Re: Synchronised Transcranial Magnetic Stimulation » powerboss, posted by SLS on July 8, 2015, at 5:33:43
> > My point on my posting is whether sTMS is going to be better than rTMS.
> >
> > With all the hype back then, the rTMS made me feel a lot worse.
> >
> > Nobody expected that to happen.
> >
> > I have trouble getting excited about sTMS.
>
>
> Do you recall on what side of the forehead the magnet was placed and what frequency was used? Some people are now using 1 Hz on the RIGHT side to treat depression with good effect. If the frequency is too low on the left or too high on the right, a worsening of depression is likely.
>
> How much money did it cost you to have the treatments?
>
>
> - Scott
>
Hi Scott,Thanks for the excellent information.
I don't have all the answers to your questions but I will get the information.
The cost was $500.00 per treatment. The treatment lasted for 40 minutes. My actual contact with the device was 20 minutes. There was always a pause during the treatment.
They got a $5,000 authorization on my Visa Card.
The first thing that the technician did was test me for my seizure threshold.
Then he gave me earplugs because the device was loud.
The goal was to speed up serotonin producing part of the brain.
(The only thing sped up was my misery).
I'm thinking left side but I'm not 100 percent certain.
I will get back to you with more details.
Larry
Posted by powerboss on July 8, 2015, at 16:42:03
In reply to Re: Synchronised Transcranial Magnetic Stimulation, posted by powerboss on July 8, 2015, at 15:38:44
To describe their method:
An insulated coil is placed near the scalp above the brain's prefrontal cortex, where an electrical current gives off about 3,000 pulses in a single sitting to target specific nerve cells.
The idea is depressed people display abnormally low activity in the prefrontal cortex.
I know that they used a high frequency.
It was at least 10 hz but may have been as high as 20 hz.
So, I guess that he tried to speed mine up and it led to speeding up negative thoughts.
As I mentioned, the cost was $500.00 per 40 minute session.
It could have easily gone to 20 sessions.
They initially billed me for 10 session to avoid sticker shock.
How does this compare to what you think?
Would this method have worsened depression?
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