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Re: meds and belief systems Bob

Posted by SLS on August 13, 2008, at 13:26:16

In reply to Re: meds and belief systems SLS, posted by Bob on August 13, 2008, at 11:46:40

>
> Is someone TRD if, after trying 10 individual drugs sequentially, goes on to respond to the 11th? What about combination drug treatments? The number of possible psychotropic combinations is in the thousands. If this is not reason enough to instill hope, one might consider that there are several novel drugs close to being submitted for FDA approval:
> >
> > http://www.neurotransmitter.net/newdrugs.html
> >
> > One must be aggressive, persistent, and creative to treat the most stubborn of cases. Such a proposition is much more likely to end in success rather than failure.
> >
> > It takes more courage to maintain hope than it does to lose it.
> >


> Scott,
>
> What are your thoughts on the somatic treatments like TMS, DBS, and ECT?


I think rTMS is becoming a more viable treatment, now that more is known about how to apply it. It has been shown that antidepressant response is produced by applying a magnetic flux on the left side of the forehead at a frequency of 20Hz. Interestingly, applying the same parameters to the right side of the head actually produces depression. If, however, a low frequency of 1Hz is applied on the left side, one sees an antidepressant effect. This has encouraged some practitioners to combine 20Hz left with 1Hz right. Results are superior to what was seen early in the development of the treatment.

ECT can work. I think it is obvious that as practiced now, too many people are hurt by ECT as well. I think it still has a place. People whose psychotic mania is resistant to pharmacotherapy might have no better choice than to go with ECT, so long as lithium is not being used. I had a series of 6 unilateral left followed by 8 bilateral as a treatment for depression. It didn't work. I experienced cognitive and memory disturbances for about a month afterwards.

DBS is a fascinating procedure. The idea is to disrupt the circuits in Brodmann's Area 25 of the anterior cingulate cortex. Blocking neurotransmission in this region produces an immediate change of state. Depression can clear up within seconds. In fact, the way they determine the precise location to place the electrodes depends on the patient being awake to report the effects of differential application of current.

Generally speaking, rTMS is rather benign; the most troublesome side effect being headache. I would recommend trying it before considering ECT. I would be scared to go with DBS without knowing more about it.


- Scott

 

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