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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Phil on May 8, 2006, at 9:45:41
I've just upped Cymbalta to 90mg. Along w/ Lamictal, Clonazepam, and Zyprexa, I'm still depressed.
When this doesn't work I may try EMSAM. I've tried everything else-way too many drugs to list. I sleep through every weekend.
EMSAM may be the ticket but if it fails or has intolerable side effects, I don't know what else to try. I haven't seen enough info on VNS to feel comfortable taking that step. I'm not real hip on implanting anything unless it's like 80% effective.
25 years and hundreds of drug combo's. Depression just f*cking sucks.Happy Monday
Phil
Posted by RetiredYoung on May 8, 2006, at 10:39:11
In reply to Worn out, posted by Phil on May 8, 2006, at 9:45:41
I have nothing to add except I know *exactly* how you feel. My current regimen (Prozac, Zyprexa, and Strattera) is just marginally effective for me, and my psychiatrist said the next steps would be EMSAM or VNS. I cannot imagine being able to get completely off all anti-depressants to even give EMSAM a try, nor do I have a desire for surgery for something that seems to have a laughable success rate.
I agree with your last sentence 100%.
Jim
Posted by Phil on May 8, 2006, at 10:53:17
In reply to Re: Worn out » Phil, posted by RetiredYoung on May 8, 2006, at 10:39:11
Sounds like we have the same doctor. I already told mine I didn't want to do VNS but he brought it up again last week. I wanted to kick his ^ss.
Posted by zenhussy on May 8, 2006, at 11:02:37
In reply to Worn out, posted by Phil on May 8, 2006, at 9:45:41
>>>I've just upped Cymbalta to 90mg. Along w/ Lamictal, Clonazepam, and Zyprexa, I'm still depressed.
When this doesn't work I may try EMSAM. I've tried everything else-way too many drugs to list. I sleep through every weekend.
EMSAM may be the ticket but if it fails or has intolerable side effects, I don't know what else to try. I haven't seen enough info on VNS to feel comfortable taking that step. I'm not real hip on implanting anything unless it's like 80% effective.
25 years and hundreds of drug combo's. Depression just f*cking sucks.
Happy Monday
Phil<<<Melancholy Monday back atcha.
Hang in there toots. Your ability to stick with treatment where mere mortals would have given up years back shows your dedication to wellness.
Sorry there isn't a magic phrase to utter to lift this dreadful bleh you exist in.
Toadstools and fairy dust wishes for any perceptible changes in a positive-for-you-direction.
c.o.g.,
--zhp.s. Waiting for more results with better odds for the VNS implant doesn't sound like a bad idea. It is relatively new considering and it sounds as if the rx combos haven't been fully exhausted YET so no rush to install the VNS.
You're one of the originals who keeps the rest of us going with your tales of battle through mental disease/disorder. Long war but focus on each battle so that you're not overwhelmed by the larger picture. You have our best wishes backing you.
Posted by RetiredYoung on May 8, 2006, at 15:13:45
In reply to Re: Worn out » RetiredYoung, posted by Phil on May 8, 2006, at 10:53:17
That is weird; my doctor has brought up VNS twice now, as well. If you don't mind my asking, what state do you live in? I'm in Ohio.
Jim
Posted by Phil on May 8, 2006, at 15:23:55
In reply to Re: Worn out » Phil, posted by RetiredYoung on May 8, 2006, at 15:13:45
I'm in Austin. Our docs must be pen pals.
That's really strange.
Posted by Phillipa on May 8, 2006, at 17:49:50
In reply to Re: Worn out » RetiredYoung, posted by Phil on May 8, 2006, at 15:23:55
I've been getting babblemails and E-mails from a lot of the people on ENSAM. There is good and bad in everything. But a lot of people are having a lot of problems with this . I was going to try it Now I'm not so sure. Love Phillipa
Posted by Larry Hoover on May 12, 2006, at 7:20:53
In reply to Worn out, posted by Phil on May 8, 2006, at 9:45:41
> I haven't seen enough info on VNS to feel comfortable taking that step. I'm not real hip on implanting anything unless it's like 80% effective.
> 25 years and hundreds of drug combo's. Depression just f*cking sucks.
>
> Happy Monday
>
> PhilSorry life has served you this unappetizing food (for thought), mate. I hope you left the bad taste with Monday. It will never notice.
I am currently absolutely underwhelmed by the data emerging about the VNS. It's about 80% ineffective, and I'm being generous. For those who benefit from it, there seems to be a dramatic effect. It can be a miracle, I guess. But it's surgery, and even stopping using it is more surgery.
Have you tried rTMS? Apart from having to have your head positioned in their machine (i.e. there is a travel/inconvenience cost), it's non-invasive, at least. If you booked some sort of holiday excursion around your treatments, you might even get away with having a good time.
Take care of you.
Lar
Posted by honeybee on May 12, 2006, at 10:13:22
In reply to Re: Worn out » Phil, posted by Larry Hoover on May 12, 2006, at 7:20:53
Larry,
So you have a pretty positive view of rTMS? I'm curious, b/c I highly respect your opinion. Since I'm in NYC, I've looked into getting into the study underway at Columbia. The rub is that a) I work 9-5, b) they're only open 9-5, and c) I am skeptical that I can get that far uptown for that long each day for three weeks.
To be honest, I've only been on a very few meds (effexor, cymbalta, lexapro, and SAM-e, if you consider that one). For a long time, I was doing fine, tolerating some annoying side effects with effexor (horrific night sweats). Now I'm in med limbo and terrified of taking drugs over the long haul.
For anyone interested, the people who I've corresponded with haven't been able to share any of their preliminary data with me (and are in the process of developing a "compassionate rTMS" study, which differs from the current I don't know how). They did say that they're delivering their data to the FDA in the next couple of months, though. Don't know what the ETA on hearing about approval would be, but it's nice to hear that another prospect is in the pipeline.
b
Posted by SLS on May 13, 2006, at 7:18:36
In reply to Re: Worn out: rTMS, posted by honeybee on May 12, 2006, at 10:13:22
> To be honest, I've only been on a very few meds (effexor, cymbalta, lexapro, and SAM-e, if you consider that one). For a long time, I was doing fine, tolerating some annoying side effects with effexor (horrific night sweats). Now I'm in med limbo and terrified of taking drugs over the long haul.
You might be an ideal candidate to be treated with rTMS. People who have had many unsuccessful drug trials tend to do poorly with rTMS. I believe they have focused their attention on high-frequency (20 Hz) left prefrontal cortical stimulation.
- Scott
Posted by Larry Hoover on May 13, 2006, at 8:37:24
In reply to Re: Worn out: rTMS, posted by SLS on May 13, 2006, at 7:18:36
> > To be honest, I've only been on a very few meds (effexor, cymbalta, lexapro, and SAM-e, if you consider that one). For a long time, I was doing fine, tolerating some annoying side effects with effexor (horrific night sweats). Now I'm in med limbo and terrified of taking drugs over the long haul.
>
> You might be an ideal candidate to be treated with rTMS. People who have had many unsuccessful drug trials tend to do poorly with rTMS. I believe they have focused their attention on high-frequency (20 Hz) left prefrontal cortical stimulation.
>
>
> - ScottTreatment-resistance extends there, too, does it? Pity. Perhaps that's also why VNS works to poorly, in practise. The only subjects yet approved were the most seriously treatment-resistant. I haven't yet seen any outcome data from more liberal use of this modality.
Lar
Posted by Larry Hoover on May 13, 2006, at 8:44:21
In reply to Re: Worn out: rTMS, posted by honeybee on May 12, 2006, at 10:13:22
> Larry,
>
> So you have a pretty positive view of rTMS? I'm curious, b/c I highly respect your opinion. Since I'm in NYC, I've looked into getting into the study underway at Columbia. The rub is that a) I work 9-5, b) they're only open 9-5, and c) I am skeptical that I can get that far uptown for that long each day for three weeks.I've seen some encouraging results puplished. Similar efficacies to other antidepressant treatments. I can't imagine it does harm. It has no withdrawal effects. Like I said, if you could work it into your life (most people would have to travel to a treatment center, and thus my idea of working it into a vacation-like excursion), and you can afford it, I think it's one of the more benign treatments to consider.
If I could handle the logistics, I'd do it.
> To be honest, I've only been on a very few meds (effexor, cymbalta, lexapro, and SAM-e, if you consider that one). For a long time, I was doing fine, tolerating some annoying side effects with effexor (horrific night sweats). Now I'm in med limbo and terrified of taking drugs over the long haul.
I try to avoid meds. Maybe I'm no more than an older version of you.
> For anyone interested, the people who I've corresponded with haven't been able to share any of their preliminary data with me (and are in the process of developing a "compassionate rTMS" study, which differs from the current I don't know how).
What that suggests to me is that they are trying to provide more open access. People might not meet the selection criteria for clinical studies. Trying to get people in the side door, rather than the front.
> They did say that they're delivering their data to the FDA in the next couple of months, though. Don't know what the ETA on hearing about approval would be, but it's nice to hear that another prospect is in the pipeline.
>
> bIt's available at a couple of centers in Canada, too. Cash is all you need, as far as I know. But that's the main logistical element that precludes my visiting with them.
Lar
Posted by ttee on May 13, 2006, at 18:41:18
In reply to Re: Worn out: rTMS » honeybee, posted by Larry Hoover on May 13, 2006, at 8:44:21
Just got a cool holograph post card in the mail today from Neuronetics. They show a picture of the new and improved NeuroStar rTMS machine with the "Rx Pad" touch panel the doc uses to administer the rTMS. Really cool and impressive pictures, but does it work? At least they should be able to sell a few of the NeuroStar's on ebay. :-)
The post card is advertising the Neuronetics booth at the APA meeting in Toronto. They offer those that stop by the chance to test drive this new model and get a chance to see how it works with a hands on demonstration. Any volunteers?
Posted by honeybee on May 14, 2006, at 17:04:06
In reply to Re: Worn out: rTMS, posted by ttee on May 13, 2006, at 18:41:18
Me!
Er, if I could make it there. Could someone add teleporting and magical payment into the TMS machine so that more of us could a) get there to do it and b) afford it?
Even though my brother (a therapist), has cautioned me to "wait until the FDA approves it," I really would sign on if I could figure out a way to get out of my job. Silly having to make a living...
Have other working depressed folks figured out ways to talk to their employers about getting treatment? I feel like I would have to invent a kidney disorder or something so that I could miss the three weeks necessary to participate (and keep my fingers crossed, majorly, that I actually get the real treatment instead of the placebo treatment...
Posted by ttee on May 15, 2006, at 14:18:08
In reply to Re: Worn out: rTMS, posted by honeybee on May 14, 2006, at 17:04:06
NEW POST: From what understand about rTMS, it is not a very time consuming process. 20 min a day, 5 days a week. However, when you get to the rTMS vs. ECT deal, you are not working anyway. Keep in mind that the FDA approval process is much easier for a device vs. drugs. If the data is very strong and there were no significant adverse (read dangerous) events in the trials, I wouldn't be surprised that rTMS gets fast tracked with a FDA this year. Since rTMS will cost a fraction of the cost of ECT or VNS, the insurance companies should have no problem with reimbursement. Compared to some of the newer meds, rTMS that can be administered by an RN instead of a doctor might be cheaper. Insurance companies are all about things that work fast and are cheaper. Given the choice of paying $700 a month for an insured’s meds for life vs. a couple grand for rTMS and they get well and take less meds; that will be the cost vs. benefit analysis. It all comes down to the data and if there was a significant response vs. the placebo (sham) arms. They are supposed to publish the trial results this month. Since the company has invested so much in the pre approval pre-launch, I would be very surprised if the data is not very strong for a speedy FDA approval. Nothing ever works for everyone, but the more new and different things there are, the better everyone’s chances become. TTEE
> Me!
>
> Er, if I could make it there. Could someone add teleporting and magical payment into the TMS machine so that more of us could a) get there to do it and b) afford it?
>
> Even though my brother (a therapist), has cautioned me to "wait until the FDA approves it," I really would sign on if I could figure out a way to get out of my job. Silly having to make a living...
>
> Have other working depressed folks figured out ways to talk to their employers about getting treatment? I feel like I would have to invent a kidney disorder or something so that I could miss the three weeks necessary to participate (and keep my fingers crossed, majorly, that I actually get the real treatment instead of the placebo treatment...
>
>
>
Posted by Larry Hoover on May 15, 2006, at 15:00:39
In reply to Re: Worn out: rTMS, posted by honeybee on May 14, 2006, at 17:04:06
> Me!
>
> Er, if I could make it there. Could someone add teleporting and magical payment into the TMS machine so that more of us could a) get there to do it and b) afford it?
>
> Even though my brother (a therapist), has cautioned me to "wait until the FDA approves it," I really would sign on if I could figure out a way to get out of my job. Silly having to make a living...
>
> Have other working depressed folks figured out ways to talk to their employers about getting treatment? I feel like I would have to invent a kidney disorder or something so that I could miss the three weeks necessary to participate (and keep my fingers crossed, majorly, that I actually get the real treatment instead of the placebo treatment...If you could get into one of the compassionate programs (somebody mentioned their existence, right?), then you wouldn't even have to worry about sham treatment.
Link built an electromagnet, and self-treated. I recall he had good outcomes. Linkage, you did this, did you not? You determined the magnetic flux, and how many windings and the current required to produce the flux, etc., did you not?
Home-made TMS, as r as you require.
Lar
Posted by Pfinstegg on May 15, 2006, at 16:56:12
In reply to Re: Worn out: rTMS, posted by honeybee on May 12, 2006, at 10:13:22
I've got a pdoc in my hometown who is very enthusiastic about TMS. He has taken a one-week course with Dr, Mark George at the Univ. of South Carolina- he has studied it for 20 years and probably knows as much about it as anyone in the world. My pdoc is just waiting for the new machine (it's impossible to purchase an old one). He telephoned me about two weeks ago, saying that the approval application has been sent to the FDA (on March 30), and that the results of the Neuronetics trial are good enough that approval is expected before the end of 2006.
I'm planning on being his first patient, when he is able to get a machine!.Each treatment takes 20 minutes, and costs about $150. You feel fine right afterwards. If you can find "compassionate use" in NYC, you could start soon. For me, and about 50% of the people who have tried it, it's a great treatment. It's possible to take twice-daily treatments (a total of 20) for two weeks, and then take maintenance ones. Depending on you, it might be one every six months, two a week, or something in between. I think it's a wonderful, side-effect free treatment; it would definitely be worth a try to see if it helps you.
This is the end of the thread.
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