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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
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.
Posted by twinleaf on September 19, 2010, at 12:56:39
In reply to risks of TMS » linkadge, posted by twinleaf on September 19, 2010, at 10:04:00
To me, it's still an extremely safe treatment for depression.Where else are you going to find such a side effect-free, neuro-protective treatment? It increases cerebral blood flow on the left, dampens the production of cortisol by the HPA axis, and makes favorable changes to BDNF and CA3 neurons in the hippocampus- all without running the risk of cognitive damage.
My only complaints are about it are that it is really only moderately effective, overall, and it becomes extremely expensive as a maintenance treatment. But when ir really works, as it did for me, it's wonderful.
Posted by chumbawumba on September 29, 2010, at 16:14:49
In reply to rTMS experience or knowledge please, posted by floatingbridge on September 17, 2010, at 16:44:37
I had twenty sessions. Cost $8000 out of pocket. Money well spent. VERY effective. Uncomfortable though. Not unbearable but the first time you get a real treatment level zap it's pretty startling. You get used to it quickly. It kind of feels like someone flicking you in the head with their finger. Or maybe snapping a rubber band on your skull...very rapidly.
My treating physician also combined it with two amino acid supplements, called Neuroreplete and CysReplete.
It was VERY, VERY effective for me. Of course your mileage may vary and the cost is prohibitive. But if you've exhausted your medication options I would say beg, borrow, or steal the money to do it.
Posted by floatingbridge on September 29, 2010, at 17:59:40
In reply to Re: rTMS experience or knowledge please, posted by chumbawumba on September 29, 2010, at 16:14:49
Glad your experience was positive. Have you had tune-ups?
Thanks for sharing the good news :)
Posted by Phillipa on September 29, 2010, at 20:13:54
In reply to Re: rTMS experience or knowledge please » chumbawumba, posted by floatingbridge on September 29, 2010, at 17:59:40
Very expensive for sure. Phillipa thinking of doing it?
Posted by floatingbridge on September 29, 2010, at 20:25:08
In reply to Re: rTMS experience or knowledge please » floatingbridge, posted by Phillipa on September 29, 2010, at 20:13:54
Yes, seriously. Have to check insurance. I am so sick of this dragging on, changing symptoms while my life gets smaller and smaller. Granted, I feel mentally healthier (less neurotic) and *happier* thanks to therapy and a good med cocktail. But I'm assessed at 50% capacity, I don't see how I can ever work again, and my husband believes flat out that I'll never be in the workplace again.
Besides, my son deserves my best.
Friday I have a phone interview to see if I qualify for non-invasive MRI and blood tests for Stanford research project. They'll share their findings with me....
That's where I'd go for rTMS.
Posted by Phillipa on September 30, 2010, at 18:52:34
In reply to Re: rTMS experience or knowledge please » Phillipa, posted by floatingbridge on September 29, 2010, at 20:25:08
FB that sounds positive working again with Stanford. Hope you get into the trial. Phillipa
Posted by floatingbridge on October 1, 2010, at 18:04:34
In reply to Re: rTMS experience or knowledge please » floatingbridge, posted by Phillipa on September 30, 2010, at 18:52:34
Had a preliminary interview for a Stanford study: non-invasive MRI and blood work including cortisol levels. I made round one. Monday is round two. Results of tests will be shared and explained.
The interviewer is forwarding the rTMS doctor my info and interest, and they, too, will get back to me. I'll drive 5× a
week for four+ weeks at this point. No problem. Even if it feels like my head is being struck with a rubber band :)The responses to this thread have helped immensely. Thank you.
I'll let anyone interested know.
Posted by twinleaf on October 1, 2010, at 19:37:45
In reply to rTMS information, posted by floatingbridge on October 1, 2010, at 18:04:34
Things seem to be falling into place quickly! Keep in mind that you don't have to be concerned about any frightening physical, emotional or cognitive side effects with TMS. The worst thing that can happen is that it won't be helpful. The treatments last about 45 minutes; for the first five minutes, it REALLY hurts, but by the end you are chatting and hardly noticing any discomfort.
It's very interesting that they are testing your serum cortisol. I had that test done, as well as the related dexamethasone suppression test TMS had the effect of lowering my cortisol and changing me from a non-suppressor to a suppressor. This showed that one of the effects of TMS, for me, was a dampening down of the HPA axis. I think beneficial effects on cortisol and having a good result from TMS are pretty closely correlated.Do keep us informed about that - there hasn't been much information about cortisol here.
Posted by Phillipa on October 1, 2010, at 20:13:01
In reply to rTMS information, posted by floatingbridge on October 1, 2010, at 18:04:34
Super and things sure are moving fast!!!! Phillipa
Posted by floatingbridge on October 1, 2010, at 21:18:52
In reply to rTMS information, posted by floatingbridge on October 1, 2010, at 18:04:34
Hi Phillipa and twinleaf, the procedures would be separate. Today was an interview for a study where they MRI the brain of mdd suffers, do a battery of blood tests and cortisol and...? I made it into the semifinals :)
One of her questions was if I'd be open to taking medication for depression. Silly, I thought, since earlier I gave my med list. Upon reflection, they may require me to switch meds. That's most likely a no-good from my end.
However, as part of my answer, I said yeah, that I'm even considering rTMS. She perked up at that and said that doctor was three doors down, and she'd take my information to him with my permission. She went on to say they had an excellent team.
So, things may fall into place easily. We'll see. As far as I know, the two procedures are separate.
Twinleaf, I'll post whatever I find out about cortisol. With ptsd yards yards, my hpa axis is wacked, and available info just confuses me.
Thanks you two! (And everyone else.)
Posted by chumbawumba on October 2, 2010, at 19:50:57
In reply to Re: rTMS experience or knowledge please » chumbawumba, posted by floatingbridge on September 29, 2010, at 17:59:40
I have not had a follow up yet. It's been about 6 months since my treatments and I am still doing well. I have been able to very slowly reduce the amount of Lamictal and Seroquel I take to 25 mg daily for each with the goal to be psych med free eventually.
I'll probably get another round of 10 treatments after I'm off all the psych meds just to cement all the gains in place and as a little "insurance" against relapse. The ten follow up treatments ONLY cost $3000 lol!
I really hope the cost of the treatments goes down so that everyone who needs it can get it. I would like to see this being the first line treatment for depression not just "treatment resistant" depression. And I think as time goes on and they refine the technology the success rates will only get better and better.
Here's a funny thing...after the treatments I lost my desire to drink alcohol. I still drink a little but nothing like before. I was self medicating with Vodka nightly before the treatments and now I can't stand the stuff. I mentioned this to my pdoc and she said it's happened with other patients. So who knows, there may be hope for this being a treatment for substance abuse as well.
In the end I think even if you pay $8000 out of pocket, think what a lifetime of psych meds costs. Plus the side effects. If it produces permanent remission, a BIG if I'll admit, the cost may balance out or at least be in the same ballpark as being on psych meds for life.
This is the end of the thread.
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