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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by KaraS on March 18, 2005, at 14:13:11
Since I've read some good things about it lately, I was wondering why there isn't much discussion about it here. Is it the view of most that rTMS is a dead end or that this is really promising? Are there safety concerns? There seems to be a lot more interest in DBS and VNS both of which involve invasive surgery so I'm thinking that safety isn't the issue. Any light you can shed on this would be appreciated.
Thanks,
Kara
Posted by Pfinstegg on March 18, 2005, at 15:34:30
In reply to rTMS promising treatment or not?, posted by KaraS on March 18, 2005, at 14:13:11
I have posted before about TMS, but will just mention again that it has been tremendously helpful for me. I had an initial three-week course in January, 2003, and have returned seven times for 3 days of twice-daily "boosters". Each time, I have become completely free of depression after about three treatments. It's not permanent: after about two months the depression very slowly begins to recur. But going back for re-treatment, as needed, taking extremely low doses of Lexapro and Wellbutrin, and continuing therapy to address the root cause (csa) have all together worked extremely well. I know it doesn't work for everyone, of course, but there are quite a few of us who feel it's just a blessing.
Posted by Pfinstegg on March 18, 2005, at 15:55:31
In reply to Re: rTMS promising treatment or not? » KaraS, posted by Pfinstegg on March 18, 2005, at 15:34:30
I realized that I didn't answer your question about side effects! The treatment hurts me enough that I take codeine 45 minutes beforehand; with that, I'm pretty comfortable. The pulses sound like a loud hammer, so you do need to be sure to use earplugs to protect your hearing. Some people get a headache; I never have. After the treatment is over, I feel completely normal, and just walk out and drive back to where I'm staying- no confusion or memory loss whatsoever.
As to any possible long-term, more serious side-effects, I try to watch carefully for any hint of those in the medical reports, as does the psychiatrist who gives it to me. I haven't seen anything to concern me; still, it is not yet an FDA-approved treatment.
Posted by KaraS on March 18, 2005, at 20:22:18
In reply to Re: rTMS promising treatment or not? » Pfinstegg, posted by Pfinstegg on March 18, 2005, at 15:55:31
> I realized that I didn't answer your question about side effects! The treatment hurts me enough that I take codeine 45 minutes beforehand; with that, I'm pretty comfortable. The pulses sound like a loud hammer, so you do need to be sure to use earplugs to protect your hearing. Some people get a headache; I never have. After the treatment is over, I feel completely normal, and just walk out and drive back to where I'm staying- no confusion or memory loss whatsoever.
>
> As to any possible long-term, more serious side-effects, I try to watch carefully for any hint of those in the medical reports, as does the psychiatrist who gives it to me. I haven't seen anything to concern me; still, it is not yet an FDA-approved treatment.
Thanks so much for your response! It sounds very encouraging. How are you able to get this treatment if it is not yet FDA-approved? Are you part of a study? I wonder how long before it is approved. I also wonder how it compares to CES (cranial electrical stimulation). There have been some posts about CES lately so I've been curious. CES is probably much milder but it has the advantage of buying a device and giving yourself the treatments.I'm still baffled as to why rTMS gets so little attention here at Babble. Why would people be looking to Deep Brain Stimulation that involves brain surgery if something like this could work as well and be much easier and probably safer? Maybe because with the DBS you don't have to keep going back for treatments?
At any rate, thanks again for taking the time to answer me. I should probably do some searches to find out what else has been said about it here in the archives.
Take care,
Kara
Posted by Pfinstegg on March 20, 2005, at 16:13:51
In reply to Re: rTMS promising treatment or not? » Pfinstegg, posted by KaraS on March 18, 2005, at 20:22:18
As far as I know, three babblers have tried TMS- me privately- "off-label", and two others as part of studies. I think I'm the only one who thought it was helpful; I don't know, with the others, where the electromagnet was placed, or what the frequency of the pulses were.All those things make a huge difference, and because it's still being studied, different reseqarchers are trying all different ways.There are a lot of TMS studies going on- about 20 are being sponsored by Neuronetics, a company that makes the device. It looks to me like a good study, and it's being done at major medical and psychiatric centers. I never qualify for any of those because I'm left-handed! I thought it was so encouraging that Columbia is doing one, too. They are real leaders in psychiatry, and are certain to be doing a careful, well-designed study.
I have posted a lot about TMS, where I get it, what the parameters are, etc. I think you'll find it all in the archives if you look under something like "Pfinstegg- TMS". If you can't find all the information you want, let me know.
Posted by KaraS on March 20, 2005, at 18:10:17
In reply to Re: rTMS promising treatment or not? » KaraS, posted by Pfinstegg on March 20, 2005, at 16:13:51
> As far as I know, three babblers have tried TMS- me privately- "off-label", and two others as part of studies. I think I'm the only one who thought it was helpful; I don't know, with the others, where the electromagnet was placed, or what the frequency of the pulses were.All those things make a huge difference, and because it's still being studied, different reseqarchers are trying all different ways.There are a lot of TMS studies going on- about 20 are being sponsored by Neuronetics, a company that makes the device. It looks to me like a good study, and it's being done at major medical and psychiatric centers. I never qualify for any of those because I'm left-handed! I thought it was so encouraging that Columbia is doing one, too. They are real leaders in psychiatry, and are certain to be doing a careful, well-designed study.
>
> I have posted a lot about TMS, where I get it, what the parameters are, etc. I think you'll find it all in the archives if you look under something like "Pfinstegg- TMS". If you can't find all the information you want, let me know.
Thank you so much! I have since my last post done more research here at PB and found many of your posts. I think TMS sounds very encouraging. Hopefully they will study it enough to fine tune the dosage and placement of the magnetic pulses and this will become a major treatment option for depression. I never knew that being left-handed would preclude a person from these studies. Does that pertain to all studies of antidepressant medications as well? I am left-handed too so this interests me a great deal. I can write well enough with my right hand so that they would never have to know but I don't think I would be able to lie like that. Anyway, thanks again for all of the info. TMS is definitely on my list of things to look into.Take care,
Kara
Posted by Sarah T. on March 21, 2005, at 2:37:29
In reply to Re: rTMS promising treatment or not? » KaraS, posted by Pfinstegg on March 20, 2005, at 16:13:51
Hi Pfinstegg. I'm sorry to post off-topic on this thread, but I wanted to get your attention. If you have a moment, could you go over to the Alternative Medicine board and reply to my question about the use of acupuncture for lowering cortisol levels? Do you know whether it would help? I did a VERY quick, inadequate search, and it looks as if acupuncture might actually elevate cortisol somewhat. If that's the case, then that's not for me. I have highly elevated cortisol levels. I do not appear Cushingoid AT ALL, and I had a negative DST (i.e., I did suppress cortisol). Nevertheless, my 24-hr. urinary free cortisol is always high (I feel my hippocampus disintegrating as we speak!).
Posted by Cecilia on March 21, 2005, at 3:48:23
In reply to Re: rTMS promising treatment or not? » Pfinstegg, posted by KaraS on March 20, 2005, at 18:10:17
I had rTMS (20 treatments-twice a day for two weeks) at the Mindcare Centre in Vancouver last year. (They now have a clinic in Toronto as well). It is still experimental in the U.S. but approved in Canada, and I think several babblers have described their treatment there. It is expensive (US $200 per treatment, so about $5000 when you add the cost of a hotel for 2 weeks.) And for me it was EXTREMELY painful, though supposedly for most people it is not. It did nothing for my depression, but apparently it does help a lot of people, so it`s worth trying if you can afford it. Cecilia
Posted by Pfinstegg on March 21, 2005, at 11:09:57
In reply to Re: rTMS promising treatment or not? » Pfinstegg, posted by KaraS on March 20, 2005, at 18:10:17
As to being left-handed, I don't think it applies to any ADs. But in TMS, they most often treat your left lateral pre-frontal cortex, although in some studies they are treating the right lateral prefrontal- the areas for recognizing emotions in facial expressions, processing emotions, and learning to self-calm. I have seen two studies where this has been helpful with PTSD, so there are lots of different, promising ways to use TMS which are being explored. The best known one, so far, is the left frontal, rapid frequency treatment, which is what I have been having. Almost everyone, including left-handers, have their language and problem-solving areas in the left frontal cortex, but an occasional, maybe rare, left-hander, has a complete reversal of the hemispheres, with language and problem-solving on the right side. They exclude all left-handed people in their studies so as to eliminate this possible, though rare, situation of treating a completely different part of the brain.
I guess, to help the researchers do their work as well as possible, and find good treatments for us in the future, you do have to own up to being left-handed, even though you sound quite ambidextrous!
Posted by KaraS on March 21, 2005, at 12:11:32
In reply to Re: rTMS promising treatment or not? » KaraS, posted by Pfinstegg on March 21, 2005, at 11:09:57
Posted by KaraS on March 21, 2005, at 12:13:25
In reply to Re: rTMS promising treatment or not?, posted by Cecilia on March 21, 2005, at 3:48:23
> I had rTMS (20 treatments-twice a day for two weeks) at the Mindcare Centre in Vancouver last year. (They now have a clinic in Toronto as well). It is still experimental in the U.S. but approved in Canada, and I think several babblers have described their treatment there. It is expensive (US $200 per treatment, so about $5000 when you add the cost of a hotel for 2 weeks.) And for me it was EXTREMELY painful, though supposedly for most people it is not. It did nothing for my depression, but apparently it does help a lot of people, so it`s worth trying if you can afford it. Cecilia
Thanks for your response. I'm sorry it didn't work for you, especially with that kind of expense. I don't have that kind of money now. Also, I'm left-handed so I think this is a treatment that will have to wait in my case.K
Posted by Cecilia on March 22, 2005, at 2:06:05
In reply to Re: rTMS promising treatment or not? » Cecilia, posted by KaraS on March 21, 2005, at 12:13:25
It doesn`t matter whether you`re left handed for the regular treatment-only for experiments (clinical trials) where they want to control as many variables as possible. I`m right handed but I don`t think they even asked about that, only stuff like whether you have any metal in your head! Clinical trials are very rigid in their requirements, in my case the university in my city refused to let me in their trial because there was no time period in the last 5 years when I hadn`t been depressed. Truthfully, there`s no time period in my whole life when I can say I wasn`t depressed. There`s "more depressed" and "less depressed" but the concept of "not depressed" is something I can`t even comprehend. Clinical trials don`t want people like that-they want good results. Cecilia
Posted by KaraS on March 22, 2005, at 13:16:48
In reply to Re: rTMS promising treatment or not?, posted by Cecilia on March 22, 2005, at 2:06:05
> It doesn`t matter whether you`re left handed for the regular treatment-only for experiments (clinical trials) where they want to control as many variables as possible. I`m right handed but I don`t think they even asked about that, only stuff like whether you have any metal in your head! Clinical trials are very rigid in their requirements, in my case the university in my city refused to let me in their trial because there was no time period in the last 5 years when I hadn`t been depressed. Truthfully, there`s no time period in my whole life when I can say I wasn`t depressed. There`s "more depressed" and "less depressed" but the concept of "not depressed" is something I can`t even comprehend. Clinical trials don`t want people like that-they want good results. Cecilia
Celia,Thanks for letting me know about that distinction.
Take care,
Kara
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