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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by ravenstorm on July 26, 2005, at 20:59:07
I know of one person who was treated by Mark Hutto in Atlanta. Has anyone been treated in Canada? If so where? Was it helpful?
Also, if anyone else has had this done by someone else in the U.S. or in clinical trials I'd love to hear about it. Thanks!
Posted by bipolarspectrum on July 26, 2005, at 22:23:47
In reply to rTMS, has anyone been to mindcare centers in Canad, posted by ravenstorm on July 26, 2005, at 20:59:07
Hi,
I've been to the mindcare centre in Vancouver. No, you didnt help at all. I went through 2 weeks of sessions.
bps
Posted by ravenstorm on July 26, 2005, at 23:14:14
In reply to Re: rTMS, has anyone been to mindcare centers in Canad, posted by bipolarspectrum on July 26, 2005, at 22:23:47
Hey, thanks for replying. I notice your name contains bp. Did you know you were bp when you got the rTMS? I have heard that rTMS does not work for bipolar, unlike ECT.
When I contacted mindcare they indicated an 80% success rate which instantly sent up BIG red flags. They are not getting success anywhere close to that in the trials in the U.S.
Dr. Hutto from Atlanta indicated a 40% success rate.
Thanks again. Anyone else?
Posted by Cecilia on July 27, 2005, at 3:12:14
In reply to Re: rTMS, has anyone been to mindcare centers in Canad, posted by ravenstorm on July 26, 2005, at 23:14:14
I also had rTMS (20 sessions over 2 weeks) at the Mindcare Centre. It didn`t help me at all. I also find that 80% statistic hard to believe, considering the treatment resistant population they`re dealing with. ECT is nowhere near that effective on patients who have failed multiple meds. And the brochure describes the treatment as "painless". IT HURTS!!!!!! Cecilia
Posted by Cecilia on July 27, 2005, at 3:34:09
In reply to Re: rTMS, has anyone been to mindcare centers in Canad, posted by Cecilia on July 27, 2005, at 3:12:14
P.S. I think if you search the archives there are quite a few babblers who`ve had rTMS, and the only one I remember it helping was Pfinstegg. Of course, we`re not exactly a typical population. Perhaps if you took 100 newly depressed never treated people and gave then rTMS 80 would respond. But in real life who`s going to pay that kind of money until they`ve tried a few meds? Cecilia
Posted by ravenstorm on July 27, 2005, at 8:29:57
In reply to Re: rTMS, posted by Cecilia on July 27, 2005, at 3:34:09
Hi Cecilia--
I don't think they are being honest with the 80% success rate. The problem is, they are a business, so I think they are making untrue claims to get more business. I don't know.
Did you meet anyone at the clinics that this worked for?
Yes Pfinstegg went to Dr. Hutto in Atlanta with great results. I was just hoping to find more than one person! Thanks for replying!
Posted by denise1966 on July 27, 2005, at 14:15:43
In reply to rTMS, has anyone been to mindcare centers in Canad, posted by ravenstorm on July 26, 2005, at 20:59:07
Hi Ravenstorm,
Yes I travelled from the UK to Vancouver to try it out last year. It didn't help me at all, although the guy who was giving me the treatments was lovely and I know he was really willing it to work for me. Unfortunately his will wasn't enough.
I didn't find it hurt that much after a while you just get used to it. Although it did hurt my wallet big time!
Denise
Posted by Pfinstegg on July 27, 2005, at 16:21:31
In reply to Re: I tried it, posted by denise1966 on July 27, 2005, at 14:15:43
I noticed that my name, and this topic, has come up once again, and I wanted to let you know what I have learned about it recently. The FDA is expected to approved rTMS in the summer of 2006. I have to agree with you that an 80% improvement rate, as claimed in Vancouver, is far too high an estimate; Dr. Hutto cites 40% (he deals with an extremely ill group of patients, many of whom have had multiple hospitalizations and courses of ECT). All the other studies which I have read range around 35-60% improvement, with around 45-50% being the average. (Improvement means an improvement of 50% or more on one of the depression rating scales).
rTMS is a physiologically good treatment, in that it temporarily reverses some of the physical abnormalities present in major depression. It brings HPA axis overactivity down to normal, increases blood flow to the left cerebral hemisphere, normalizes serotonin and dopamine levels, and increases BDNF and new cell growth in the hippocampus. This is real- at least in animal models of depression in rats and tree shrews studied at the German Primate Center. There was no evidence of neuronal damage, or any increase in inflammatory markers, in the studies done there. At Harvard, cognitive function before and after rTMS was studied intensively; there were no adverse effects, and memory acquisition actually improved for several hours after each treatment.
There are some limitations. The effects don't last very long (two weeks to several months), it's very painful (I need Tylenol #3 to tolerate it), and, if you don't protect your ears carefully, you could get some hearing loss. Also, until it's approved and begins to be covered by insurance, it's awfully expensive!
I think it's a wonderful treatment for about half of us who have TRD. I still take a tricyclic, and Cytomel, but they work really well combined with the rTMS, although they're not very effective by themselves.
Recently, I went to see my pdoc in my home town, armed with a sheaf of reprints about rTMS from Medscape. Even before reading them, he said, "I've just been waiting for a patient to show an interest! I really want to do it." (He does medications and a lot of ECT at present). He then asked ME (!) where he should get trained to do it. I suggested Dr. Mark George at the University of South Carolina, as he has been among the first to take an interest in rTMS, and has published the most about it. Also, Dr. Hutto trained with him, and he is very skilled at it. It turned out that Dr. George is now giving week-long courses for physicians in rTMS several times a year! My pdoc is there now. Because this is an electromagnetic treatment which only goes one or two centimeters into the brain, I think it's very important that the doctor who is giving it knows exactly where and how to place the magnetic coil, and also knows what intensities and frequencies are the most effective. As it gradually becomes a more available treatment, I think it would be important for anyone interested to make sure their doctor is trained by Dr. George, rather than by someone from the Neonetics company, who manufacture the rTMS machines. (they may do a good job of training, but I do know from personal experience that Dr. George is really excellent.)
Posted by ravenstorm on July 27, 2005, at 19:58:44
In reply to Re: rTMS, posted by Pfinstegg on July 27, 2005, at 16:21:31
Thanks Pfinstegg.
I believe Dr. George is on the board of directors of the clinics in Canada, so I'm surprised he lets them make such claims! I wonder if he has trained the clinicians there? I'll have to ask.
I was under the mistaken impression that you did boosters of rTMS rather than taking meds. Were you off meds after rTMS and doing boosters for awhile? or have you always been on meds with rTMS. I don't seem to be able to tolerate any meds anymore so I was hoping I could do the rTMS instead.
Thanks as always for jumping in.
Posted by ravenstorm on July 27, 2005, at 19:59:49
In reply to Re: rTMS, posted by Pfinstegg on July 27, 2005, at 16:21:31
Thanks for the input Denise. So far the odds aren't looking real good! Only one person who did well with rTMS and that wasn't at any of the mindcare centers!
Posted by Pfinstegg on July 27, 2005, at 21:25:24
In reply to Re: rTMS, posted by ravenstorm on July 27, 2005, at 19:58:44
I would prefer to just have the rTMS, plus Cytomel, vitamin B's and fish oil. But, this works for only about a month, and then I find that i do need some kind of AD. I am hopeful that when my pdoc starts offering rTMS, that I'll be able to have regular maintenance treatments with him-probably just one or two treatments would be all I would need. I know I'll feel a lot better having them regularly (once every one or two months). Neither one of us knows, but it might help me eventually not need them so often, or I might just go on needing them! The hard part for me is trying to get off work and fly down to Atlanta every month or two. I did it when I really felt that I had to, but when things started to get better, i began to feel like I had more options- if I can get it at home. it will be wonderful.
Just wondering- since rTMS can do such good things for one's brain, wouldn't it be worth considering, along with AD's, even if you didn't have a robust clinical response? It might be helping in the long run.
Posted by ravenstorm on July 28, 2005, at 8:56:16
In reply to Re: rTMS » ravenstorm, posted by Pfinstegg on July 27, 2005, at 21:25:24
My problem is not being able to take things because of my severe stomach problems or because of horrendous side effects. The meds make me feel sick all the time (those that I can even take). Oh, that is so disappointing to me. Would doctor Hutto let someone come every one or two if they needed to?
What TCA do you take?
Sigh. I don't feel like this is ever going to end.
Posted by Pfinstegg on July 28, 2005, at 9:58:20
In reply to Re: rTMS, posted by ravenstorm on July 28, 2005, at 8:56:16
Because this is such a new area, Dr. Hutto has always been extremely flexible, and has worked closely with me to find out what works best. I had an initial treatment of daily TMS for three weeks; since then, I have gone down six more times, and have had twice-daily treatments for three days. He has people on all different kinds of maintenance schedules; for example, one man comes every two weeks for one treatment- he lives in Atlanta. It's a two-hour flight for me, plus an hour and a half drive to north Atlanta from the airport, so I always have six, to make sure! I usually feel fine after two, though, and I think that's what i will do when my pdoc can give them here.
As to the tricyclic, I'm unusual here, also. I take tianeptine, which is not FDA-approved, but is used widely in Europe. I chose it, with my pdoc's approval, because the studies at the German Primate Center and Rockefeller University (Bruce McEwen) show that it is the most neuroprotective of all the AD's. It's not a strong AD, for me, but it has no sexual side-effects, weight gain problems, or emotional blunting effects. I had a terrible time with all of those on all of the SSRI's. I also tend to have suicidal ideation on the SSRI's, but not off of them. Are the side effects you are talking about similiar?
Posted by ravenstorm on July 28, 2005, at 11:15:00
In reply to Re: rTMS » ravenstorm, posted by Pfinstegg on July 28, 2005, at 9:58:20
I dealt with sexual side effects for years on paxil. No, I'm talking about side effects which are worse than the cure! If I could take something that would work and just have sexual side effects I'd deal with it.
I got severely suicidal during paxil withdrawal and it has never completely left.
Celexa I got askathesia from. I think that is what happened. It was hell on Earth whatever it was. Had to stop it in less than a week
Lexapro made me literally vomit.
Zoloft: severe nausea and cotton headed feeling like my head was separated from my body. Felt very ill all the time. This was the first AD I was tried on. After four weeks I was switched to Paxil and I was great.
Remeron: only partial response and made me have severe blood sugar problems, worse anxiety and incredible rage. Despite its longer half life took me forever to get off of it. Further destroyed my stomach with severe heartburn. Ate oatmeal and rice for months.
Wellbutrin added to remeron: at first made me tired, then sent me over the edge with crazy levels of anxiety. Took two months for the shaking to stop after I discontinued.
Nortriptyline: never made it up to theraputic levels due to severe heart pounding. Also, lost six pounds of water weight in the first two days on extremely low doses. Pdoc took me off that one due to the severe heart racing, pounding. Made my anxiety worse and disturbed my sleep.
Posted by ravenstorm on July 28, 2005, at 13:45:31
In reply to Re: rTMS, posted by ravenstorm on July 28, 2005, at 11:15:00
Oh I forgot Prozac.
Severe heart burn and stomach problems never went away after six to eight weeks.
I am so envious you got a pdoc to go get trained in this! Is he going to invest in a machine and everything? I would think that would be expensive.
You indicated Dr. George is now training different pdocs. Do you know how you could find out where these docs are? Maybe they would be closer than Atlanta to me.
Thanks again.
Posted by Pfinstegg on July 28, 2005, at 14:50:30
In reply to Re: rTMS, posted by ravenstorm on July 28, 2005, at 13:45:31
Your side effects from the AD's sound really awful! The only thought that I have would be to contact Dr. George. Others from Babble have talked to him on the phone, or by e-mail. Just guessing- but I think he would be glad to refer you to someone he trained who is near you. I don't have his number, but you can probably google it.
At present, obtaining a machine is very difficult.. You can't buy a new one from Neonetics (the only manufacturer) until after the FDA approval date. My pdoc is looking everywhere for a secondhand one, but no luck so far. I'm expecting to wait a year before I can receive it locally, and will probably make two more trips to Atlanta.
Posted by linkadge on July 28, 2005, at 18:28:11
In reply to Re: rTMS » ravenstorm, posted by Pfinstegg on July 28, 2005, at 14:50:30
As some people know, I had built my own rTMS machiene a few years back. I havn't used it in a good 6 months.
I know this one is home made and as such is not subject to the same safety standards, but I am not so sure that rTMS is all that safe.
I will admit that it has had a positive effect on my depression when I use it, but the effect lasts only about a week.
When I stopped using it, I crashed into a extremely dark an intollerable depression, deeper than I have ever known. My vision went black on the side that I was doing the rTMS !!
And that side of my face has gone periodically numb since.
I know I bash meds, but I have to be honest when I say that I think I have done some real dammage to myself with rTMS. rTMS does increase BDNF
but its effects on neurogenesis are not as clear-cut.-------------------------------------------
Chronic psychosocial stress and concomitant repetitive transcranial magnetic stimulation: effects on stress hormone levels and adult hippocampal neurogenesis.
Czeh B, Welt T, Fischer AK, Erhardt A, Schmitt W, Muller MB, Toschi N, Fuchs E, Keck ME.
The German Primate Center, Division of Neurobiology, Gottingen, Germany.
BACKGROUND: Repetitive transcranial magnetic stimulation is increasingly used as a therapeutic tool in psychiatry and has been demonstrated to attenuate the activity of the stress hormone system. Stress-induced structural remodeling in the adult hippocampus may provide a cellular basis for understanding the impairment of neural plasticity in depressive illness. Accordingly, reversal of structural remodeling might be a desirable goal for antidepressant therapy. The present study investigated the effect of chronic psychosocial stress and concomitant repetitive transcranial magnetic stimulation treatment on stress hormone regulation and hippocampal neurogenesis. METHODS: Adult male rats were submitted to daily psychosocial stress and repetitive transcranial magnetic stimulation (20 Hz) for 18 days. Cell proliferation in the dentate gyrus was quantified by using BrdU immunohistochemistry, and both the proliferation rate of progenitors and the survival rate of BrdU-labeled cells were evaluated. To characterize the activity of the hypothalamic-pituitary-adrenocortical system, plasma corticotropin and corticosterone concentrations were measured. RESULTS: Chronic psychosocial stress resulted in a significant increase of stress hormone levels and potently suppressed the proliferation rate and survival of the newly generated hippocampal granule cells. Concomitant repetitive transcranial magnetic stimulation treatment normalized the stress-induced elevation of stress hormones; however, despite the normalized activity of the hypothalamic-pituitary-adrenocortical system, the decrement of hippocampal cell proliferation was only mildly attenuated by repetitive transcranial magnetic stimulation, while the survival rate of BrdU-labeled cells was further suppressed by the treatment. CONCLUSIONS: These results support the notion that attenuation of the hypothalamic-pituitary-adrenocortical system is an important mechanism underlying the clinically observed antidepressant effect of repetitive transcranial magnetic stimulation, whereas this experimental design did not reveal beneficial effects of repetitive transcranial magnetic stimulation on adult hippocampal neurogenesis.----------------------------------------------
I think that it can be usefull I certainly had a very robust responce to it, but I am not positive that its effects on the brain are all that benign.
When I stop using it, I have NO exectutive function at all.
Linkadge
Posted by ravenstorm on July 28, 2005, at 20:24:22
In reply to Re: rTMS » ravenstorm, posted by Pfinstegg on July 28, 2005, at 9:58:20
Pfinstegg,
You must have the best pdoc ever. He goes to trainings for you, your taking a non fda approved drug. My pdoc is just horrible. I've got to start fighting with my HMO to get a new one.
What kind of side effects do you have from the tianeptine? Do you know why its not approved in the U.S.? I've emailed Dr. George as you have suggested.
Do you happen to live anywhere in the midwest? Just curious, as I'd ride your rTMS coattails with your pdoc if that was the case!
Thanks!
Posted by Pfinstegg on July 28, 2005, at 23:06:27
In reply to Re: rTMS, posted by ravenstorm on July 28, 2005, at 20:24:22
tianeptine:none, except for a slight mood lift for about three hours (it's got a very short half-life). I do have liver function tests taken twice a year, as, rarely, it can cause a kind of liver problem which is reversible when you stop the drug. I don't think there's any money to be made from tianeptine- it's not a very strong AD, and there wouldn't be any patent here.
I live on the east coast. If you live anywhere near Chicago, there is another excellent doctor giving TMS just west of the city. I think his name is Dr. Steven Best. He and Dr. Hutto are the only two doctors giving TMS "off-label", and who are known to be well-trained and very reliable, so that university professors recommend them.
Posted by ravenstorm on July 29, 2005, at 16:19:44
In reply to Re: rTMS » ravenstorm, posted by Pfinstegg on July 28, 2005, at 23:06:27
Well, I'm about 2.5 hours drive from Chicago, so maybe that would be the place to start. I wonder if he is as good as Dr. Hutto?
I also emailed Dr. George about him training physicians etc this was his reply:
"Dr. Ziad Nahas here has handled training. There is no one here this week learning. I am not aware of anyone in Wisconsin. You could contact
www.neuronetics.com
They are conducting a nationwide trial and would know of local resources.
The response rate in Canada is more like 40%, which is still good considering that people who go there have not responded to other treatments"Are you sure your pdoc is training this week?
Posted by Pfinstegg on July 29, 2005, at 18:54:51
In reply to Re: rTMS, posted by ravenstorm on July 29, 2005, at 16:19:44
I guess not, but it was sometime in July. Dr Best might be a good choice for you, as he's about an hour west of Chicago, and has done it for quite a few years. He and Dr. Hutto were the two who were recomended to me by the psychiatry department of Emory University.
I think 40% is good, too, especially when you realize that this is a TRD gtoup. I should clear up about why my pdoc went for the training: he had been reading and thinking about TMS, and apparently one patient (me) coming in saying she wanted it was enough to get everything going. He even has an additional room rented to give it in- but no machine!
Posted by kered on September 4, 2007, at 22:39:41
In reply to Re: rTMS, posted by ravenstorm on July 29, 2005, at 16:19:44
Found this old post. New on this board since finding this today. Not sure if I should be trying a new post? Wondering if anyone had any more info on TMS. I was considering Dr Best in Deerfield, IL or Dr Hutto in Atlanta, GA.
Any info would be greatly appreciated.
kered
Posted by BGB on November 30, 2007, at 12:27:58
In reply to Re: rTMS, posted by Pfinstegg on July 27, 2005, at 16:21:31
I know it's been awhile since this thread's been active, but I was wondering how you liked Dr. Hutto. My psychologist has referred me to him and I was just wondering what your opinion was.
Thanks! =)
Posted by twinleaf on November 30, 2007, at 22:17:10
In reply to Re: rTMS + Dr. Hutto » Pfinstegg, posted by BGB on November 30, 2007, at 12:27:58
I have had ten treatment series with Dr. Hutto. The first was 15 treatments, while the subsequents ones were either four or six maintenance treatments, at a rate of two a day. I have been going about every six months. Although it only lasted a few months, each time i have gotten into remission. For me, it has been the best treatment for depression, by far. I think highly of Dr. Hutto. There are no side effects, but i did find the magnetic pulses quite painful. It helped a lot to take codeine beforehand. Good luck to you! I hope it is as successful for you as it has been for me.
Pfinstegg- now twinleaf
Posted by BGB on November 30, 2007, at 22:50:39
In reply to Re: rTMS + Dr. Hutto » BGB, posted by twinleaf on November 30, 2007, at 22:17:10
Thanks SO much for your post!
My psychologist recommended him since I need a new psychiatrist, and I had no idea that he used rTMS until I read it on this site! How lucky I am!
I am going to try to change my meds first, but it's nice to know that rTMS is actually available to me now. If my depressive cycle doesn't respond to meds soon, I will do rTMS, ECT, or anything else that he recommends.
I have some kind of stupid bipolar disorder and my current regimen of Remeron, Wellbutrin SR, Lamictal, Depakote ER, and Provigil has stopped working. I don't think I've ever been this depressed, but reading all these good things about Dr. Hutto is very promising and is a "light at the end of the tunnel".
Thanks again for your helpful post. =)
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