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Dr. Bob is Robert Hsiung, MD,
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Posted by blueberry on May 19, 2006, at 17:49:12
In reply to Re: ECT sounding pretty good, posted by heaven help me on May 19, 2006, at 16:45:54
Thanks for your response. I appreciate it very much. This phenomenon of antidepressants making me worse is brand new to me. They've never done that before. You're right, a lot of pdocs probably would look at that and say bipolar. I tried lamictal and it made me very depressed and frightful. Depakote actually worked real well beginning on the first day and I was amazed, but after a week I couldn't feel it anymore. Higher doses just gave more side effects. But at the time I was also on lexapro...so you sparked a thought...mood stabilizer and antipsychotic (already on zyprexa) "without" an antidepressant. Hmmm.
I have been reading a lot about ECT and though it sounds scary on the outside, it apparently is usually very effective and fast.
Thanks again. You have given me hope and ideas. The most important being hope.
> I'm really new to this and to the board so maybe you've already been there on this idea, but when I was first diagnosed "depressed" I was given an anti-depressant. One after another they made things worse! Increased anxiety, horrid shakes and tremors, paranoia, sick, sick, sick. Finally they tried an antipsychotic and a mood stabilizer and they worked! (at least by far better than the AD alone). So my Dr. used that phenom to rediagnose me as Bipolar 2 and that's where I am at now.
> Just food for thought in case you haven't already
> :)
> Mary
Posted by blueberry on May 19, 2006, at 18:00:40
In reply to Re: ECT sounding pretty good, posted by linkadge on May 19, 2006, at 16:51:31
HI linkadge, you are kind and thoughtful as always. I appreciate your thoughts and response.
I understand what you are saying about consolidating, and that is actually what I recently did for 10 weeks. I kept deteriorating during that consolidating period. I am in too bad of shape now to not take action.
I agree with you about the TCAs. As sensitive as I am to meds, probably the only one I could remotely tolerate would be nortriptyline. But would it also send me to the pits of hell? Don't know. It seems like any reuptake inhibitor does.
The reason I take things for too short of a time is because they make me profoundly worse, more than words can describe. If I took something and it gave me side effects, fine, I can handle that. But on a 1 to 10 scale, with 10 being the worst, if I am at a 7 and something I take shoots me to a 10, forget it. I at least need to stay at a 7.
We'll see. You and the other responders here have given me enough hope to at least get through an evening. I thank you for that.
> I would not recomend ECT. Have you ever been on a TCA? TCA's are great for what we used to call "agitated depresson", before all this bipolar spectrum nonsence came into the picture.
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> I recomend clomipramine, or amitryptaline.
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> I think you really need to just consolodate for a while. I mean, what I think may be hurting you the most, is taking a little bit of everything, but for too short a period to really stabilize.
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> Changing medications and supplements too quickly can make pretty much anybody seem bipolar and out of it.
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> Are you able to take a little time off work to try and slow down and sort things out?
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> SSRI's didn't go over with me too well the second time around, but its not the end of the world. The TCA's helped, so did exercise.
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> Take Care.
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> Linkadge
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Posted by blueberry on May 19, 2006, at 18:35:28
In reply to Re: ECT sounding pretty good » bassman, posted by Pfinstegg on May 19, 2006, at 17:26:27
I had not thought of the bipolar thing. I mean, I've always had depression but never mania. My doctor thought I was bipolar when she first met me, but after observing me for months she said it didn't seem like I was. She said with all the meds and supplements she had tried me on that if I was bipolar I would have had a spark of hypomania somewhere along the way. But I wonder.
I have only sampled low dose lithium in the past for a couple days. All I really remember is that it made me feel wired, restless, and I had to go pee 4 times an hour. I liked depakote, though its goodness was short lived. Not sure where to go from here. You were nice to respond. I'll put lithium and bipolar on the radar screen. You weren't the only one that touched on the bipolar aspect, so maybe there is something there.
> They way you have responded to SSRI's makes me think of bipolar, too. What about a trial of low-dose lithium (you may have done that already). TMS will be out in about six months: Mark George, who's been working with it for many years, has gotten 8 bipolar patients into complete remission by giving one TMS per week for a year.
Posted by linkadge on May 19, 2006, at 19:07:23
In reply to Re: ECT sounding pretty good » Pfinstegg, posted by blueberry on May 19, 2006, at 18:35:28
Heres my take. The TCA's are vastly superior to the SSRIs for ameliorating f'd up HPA axis function.
The SSRI's are not that great for doing that. A few studies have shown that in the first few months of taking an SSRI, HPA axis responces are exasperated, ie increased levels of cortisol etc. Sometimes that tames down a little over time, somtimes not. When you come off an SSRI, you have to go through all of the horrible start up side effects again.
When I took an SSRI for the first time it was a totally different situation. It was in the summer, and I had just crashed from school exams. The SSRI's probably replaced the cortisol crash, and worked. The second time I took an SSRI right before midterm exams, my so called "bipolar reaction", was in my opinion was an antidepresant induced exasperation of already high levels of cortisol.
High levels of cortisol can make some people very suicidal, and psychotic, hence the use of drugs like RU-486 for psychotic depression/mania.
IF you were really bipolar, you would not have lasted so long on the drug combination that you had taken before.
In the end, if you can find a balance, then it doesn't matter what drug you are taking.
Linkadge
Posted by UgottaHaveHOPE on May 19, 2006, at 20:03:08
In reply to Re: ECT sounding pretty good » bassman, posted by Pfinstegg on May 19, 2006, at 17:26:27
I am sorry I am a newbie to medical terms. Please explain what that TMS is and anything about that study ... that is so exciting to hear. We need more good news like that on here.
Posted by Phillipa on May 19, 2006, at 22:37:10
In reply to Re: ECT sounding pretty good, posted by linkadge on May 19, 2006, at 16:51:31
Link are you on a TCA now? Love Phillipa
Posted by Phillipa on May 19, 2006, at 22:44:40
In reply to Re: ECT sounding pretty good, posted by linkadge on May 19, 2006, at 19:07:23
Link so you're saying that the TCA's are not sedating but the SSRI's start up effects are and that during the summer your anxiety was high from exams so you experienced all the high anxiety symptoms starting an SSRI? Love Phillipa
Posted by Jost on May 19, 2006, at 22:44:47
In reply to ECT sounding pretty good, posted by blueberry on May 19, 2006, at 16:24:55
I'd try a few more ADs before considering ECT. Maybe ECT will help--I'm sure you've done the research--but it is not a controlled treatment.
You say maois are the worst--but have you tried anything other than moclobemide? Often different chemicals in the same class have quite different effects, if the effects come from a different part of the molecule. Unless you're convinced it's the mao inhibition that's causing the depression, you could try another one.
Maois don't cause reuptake inhibition--they change the amount of the neurotransmitters, because they suppress production of an enzyme that breaks them (the neurotransmitters) down. That's a different process.
Jost
Posted by linkadge on May 20, 2006, at 1:21:52
In reply to Re: ECT sounding pretty good » linkadge, posted by Phillipa on May 19, 2006, at 22:44:40
I'm basically saying that if its a completely stress free time in your life, then the SSRI start up effects are easier to mannage. If you have stressfull things going on in your life then the SSRI start up effects can make things really horrible.
At least that was the case with me.
Linkadge
Posted by SLS on May 20, 2006, at 9:08:12
In reply to What is TMS?, posted by UgottaHaveHOPE on May 19, 2006, at 20:03:08
> I am sorry I am a newbie to medical terms. Please explain what that TMS is and anything about that study ... that is so exciting to hear. We need more good news like that on here.
TMS stands for transcranial magnetic stimulation. It is a treatment by which a powerful magnet applied to the head induces an electrical current to specific areas inside the brain. It is thought to work in a way similar to ECT, but without the cognitive and memory side effects.
At the moment, it is still unclear how effective TMS is relative to other treatment modalities. It probably won't get as many people as well as ECT, but it has shown significant efficacy in some. They are still experimenting with the treatment in order to establish the most effective settings for the magnet machine. At the moment, I believe that 20 Hz applied to the left side of the head is considered optimal.
- Scott
Posted by bassman on May 20, 2006, at 11:01:58
In reply to Re: ECT sounding pretty good » Phillipa, posted by linkadge on May 20, 2006, at 1:21:52
Very well said: if you are REALLY having a hard time, the last thing you need is side effects. If you become hypervigilant like I do when I'm very anxious/depressed, every side effect is also a clear symptom of a terminal disease ("headache and dizzy-my God; brain tumor! Fatigue-end-stage cancer! Etc.") :>}
Posted by linkadge on May 20, 2006, at 16:49:10
In reply to Re: What is TMS?, posted by SLS on May 20, 2006, at 9:08:12
"It probably won't get as many people as well as ECT"
An in the same light, it probably wont get as many people sick as ECT.
Linkadge
Posted by Phillipa on May 20, 2006, at 18:37:05
In reply to Re: ECT sounding pretty good » Phillipa, posted by linkadge on May 20, 2006, at 1:21:52
Maybe that's why I couldn't tolerate the cymbalta the second time? Love Phillipa too much stress new doc, new house, new neighbors, no jobs, everything different and my Daughter deciding to get a divorce. And then the inability to nevermind
Posted by Phillipa on May 20, 2006, at 18:39:10
In reply to Re: ECT sounding pretty good, posted by bassman on May 20, 2006, at 11:01:58
You sound like me. Love Phillipa
Posted by SLS on May 21, 2006, at 8:51:17
In reply to Re: What is TMS?, posted by linkadge on May 20, 2006, at 16:49:10
> > "It probably won't get as many people as well as ECT"
> An in the same light, it probably wont get as many people sick as ECT.ECT is no fun. Side effects are very variable, though.
Despite its lack of a good track record in treating TRD, I would still give rTMS a try.
Actually, ECT doesn't have such a good track record as a treatment for people whom have had multiple drug faiures. The problem is, what choices are there? There are people who won't live without it.
- Scott
Posted by chiron on May 21, 2006, at 10:48:06
In reply to ECT sounding pretty good, posted by blueberry on May 19, 2006, at 16:24:55
The fear/anxiety/insanity feeling is familiar to me-I hate it. Meds recently made me worse as well (I think). Mornings are the worse. Now I wake up and have anxiety about even doing my laundry. I get panicky about being alone, but I still feel intensely unstable/insane when I'm with my friends. I seriously thinking about starting ect later this week. I'll let you know if I do.
> Yeah, I've been reading about ECT and it is sounding pretty good to me about now.
>
> The problem is that no matter what antidepressant I try, they induce a much more severe form of depression than I had. If I'm not in total despair or crying before I start one, I will be in about 2 days after starting. Happened years ago with moclobemide. Recently it has happened with my old buddy prozac, lamictal, then milnacipran, then lexapro, and cymbalta. This phenomenon has never happened before, except on a maoi. I am accustomed to getting side effects early in treatment, but NEVER getting severely worse. This is new in my long journey with these meds.
>
> Odd though...I feel better right at the beginning of taking an antidepressant and I think I am on the right track...then it goes real bad the other direction...and then I feel better when I stop it. It's like the flow or the firing is all messed up, having nothing to do with neurotransmitter levels.
> It's like my brain needs stimulation, but not more neuros.
>
> My problem is two-fold...I need inhibitory action for the free-floating fear/insantity/anxiety stuff that grips me in the morning...and yet excitatory stuff for the melancholic depression. Maybe a benzo plus a stimulant...good luck finding a doctor who would do that.
>
> Yeah, ECT actually looks attractive at this point.
>
>
Posted by linkadge on May 21, 2006, at 15:41:33
In reply to Re: What is TMS?, posted by SLS on May 21, 2006, at 8:51:17
I believe you that it can make some people better. There are cases of people's disorders turning nasty after ECT. I suppose Hemmingway is a good example.
I know, I need to stop being so negitive. I just think that the decision to ECT should not be taken lightly.
Linkadge
Posted by bassman on May 21, 2006, at 16:41:26
In reply to Re: What is TMS?, posted by linkadge on May 21, 2006, at 15:41:33
I agree. As frustrating and depressing as taking every med in the world to try and feel better, at least the process is reversable in almost all cases-if the med does something bad to you, you stop taking it and the bad effect goes ways. With ECT, no guarantees of reversability...so it seems it should be exactly at the bottom of the list of alternatives. I wish you the best no matter what you do, of course.
Posted by linkadge on May 21, 2006, at 17:35:10
In reply to Re: What is TMS?, posted by bassman on May 21, 2006, at 16:41:26
The medical community insists that ECT is safe, and does no permanant dammage to the brain.
There are a whole host of other individuals who claim the contrary. Infact, I heard of a guy who claimed he could tell how many ECT treatments an animal has had, just by looking at the post mortem brain.
Linkadge
Posted by lost_and_delerious on May 21, 2006, at 18:14:56
In reply to ECT sounding pretty good, posted by blueberry on May 19, 2006, at 16:24:55
Please before anyone considers an ect really think about how well the long term effects are going to be.
My mother went through several series of ect's. Are you in canada or the us?
Usually any suppressed memory or depression that you have will go away for a short period of time but it does resurface and you will usually end up combining the tricyclic antidepressants with more rounds of ects throught your lifetime.
I spent a lot of time talking to my mom and other patients who went through their ects' and a lot of them said that they would never do it again or wished they had never started it, most people come out of the room crying or with a lot of short and long term memory loss.
Just my thoughts for now...I have written that no matter how bad I am that I am never to recieve ect's there are so many other options, and really I have seen what it is like to have gone through every medication and not have any of them work sometimes the newer ones aren't made for your body. but the older standbys like someone said amitryptaline is good try to take control of your medications and what you are doing with them learn everything you can about how you are feeling and what meds you think will work with how you are feeling and don't be afraid to suggest other meds to your doctor...and explain why...
Posted by Jost on May 21, 2006, at 19:35:20
In reply to Re: ECT's sounding scary at even worst of times, posted by lost_and_delerious on May 21, 2006, at 18:14:56
There was a program on NPR about ECT several weeks ago. Possibly on a program called the "Infinite Mind"--that's a guess.
The proponent of ECT stated clearly that it's probable, if not almost universal, to experience some memory loss for events right before each treatment. Memory loss can include greater periods of time, and could, in some instances, be quite extensive. Much of memory may be recoverable, but some is not--and it is impossible to predict.
However, she emphasized that most memory loss was miminal. For example, a patient who was introduced to her right before the first treatment, would not remember having met her, or other circumstances preceding the treatment.
She also agreed that you do need a course of treatments, and that there are often relapses after a period of months.
Now that was the pro case.
Anyone who considers this treatment should be sure they can accept this side effect.
Jost
Posted by ttee on May 24, 2006, at 9:32:44
In reply to Re: ECT's sounding scary at even worst of times, posted by Jost on May 21, 2006, at 19:35:20
FOR IMMEDIATE RELEASE
NEURONETICS ANNOUNCES POSITIVE MULTICENTER CLINICAL TRIAL RESULTS WITH TMS THERAPY™ FOR TREATING DEPRESSION
Drug-free, non-invasive treatment could benefit millions
TORONTO, CANADA – May 23, 2006 – Neuronetics, Inc., a privately held medical device company and developer of the NeuroStar TMS Therapy SystemTM for the treatment of major depression, today announced results of the first multicenter, controlled clinical trial for transcranial magnetic stimulation (TMS) therapy. The study demonstrated that TMS Therapy™ is an effective, safe, well tolerated antidepressant for patients who have not received adequate benefit from previous antidepressant medications. The trial results were presented at the American Psychiatric Association Meeting in Toronto, Canada.
NeuroStar TMS Therapy™, which is currently under review by the FDA and is pending market clearance for the treatment of major depression, is a non-invasive, outpatient treatment. It uses highly focused, pulsed magnetic fields to stimulate nerve cells in brain regions believed to be linked to depression. TMS Therapy does not require anesthesia or sedation, so patients can resume normal activities immediately after the 40-minute treatment.
The randomized, sham-controlled clinical trial was conducted at 23 leading clinical research institutions throughout the U.S., Canada and Australia to test the acute efficacy and safety of NeuroStar TMS Therapy. Extension studies provided open-label treatment for non-responders and a 6-month observation period for maintenance of response. All 301 patients who participated were suffering from major depression and had not benefited from previous antidepressant medication therapy.
“TMS Therapy offers patients with resistant depression a non-invasive, drug-free treatment alternative. In the randomized, controlled trial, TMS-treated patients had significantly higher response and remission rates than sham-treated patients,” said psychiatrist John O’Reardon, M.D., Director of the University of Pennsylvania’s
Treatment Resistant Depression Clinic and a principal investigator of the trial. “Additionally, TMS Therapy was remarkably well tolerated with less than 8% of patients leaving the study during the acute treatment trial. It clearly provides new hope for depressed patients.”
“Approximately 1 in 2 patients improved with TMS Therapy in the open-label study, despite being resistant to previous drug treatment,” said Alan Schatzberg, M.D, Chair of Stanford University’s Department of Psychiatry. “This is important because this study most closely mimics the real-world clinical practice setting. “
While not yet complete, the preliminary results from the 6-month observation study suggest that most of the patients maintained their response using simple single-medication treatment without the need for additional TMS Therapy.
"Depression afflicts approximately 14 million Americans annually” said Neuronetics President and CEO, Bruce Shook. “Unfortunately, drugs don’t help everyone and fail to achieve an adequate response in more than one-third of all depressed patients. Plus, they often cause side effects such as sedation, weight gain, sexual dysfunction, and gastrointestinal distress. If cleared by the FDA, NeuroStar TMS Therapy could help a significant number of patients without the burden of systemic side effects, opening new avenues for treating this widespread disease.”
The most common adverse event reported was headache. Slightly more than half of the patients receiving sham treatment or active treatment reported headaches. The incidence of headaches was generally mild to moderate and declined after the first week of treatment.
In addition to Stanford University and the University of Pennsylvania, research sites included Mayo Clinic, Columbia University, University of Washington, University of Texas, Baylor College of Medicine, Washington University, Rush Presbyterian, Northwestern University, University of Michigan, Wake Forest, Emory University, Duke University, University of Virginia, Medical University of South Carolina, Psycare, Inc., Sheppard Pratt Health System, Radiant Research, Centre for Addiction and Mental Health in Canada, and Black Dog Institute and Alfred Psychiatric Research Centre in Australia.
About Depression
Major depression is a serious medical illness affecting more than 14 million Americans annually. More than 4 million patients with major depression are resistant or intolerant to currently available treatments. Unlike normal temporary emotional states of sadness from external events like a loss or other negative events, major depression is persistent and can significantly interfere with an individual's thoughts, behavior, mood, and physical health. Mental illness is the leading cause of disability in the U.S. and depression is the most predominant illness within the mental health arena.
Women are almost twice as likely as men to suffer from depression. However, some experts feel that depression in men is significantly under-reported. Major depression can occur at any age, including childhood, the teenage years and adulthood. Major depression has no racial, ethnic, or socioeconomic boundaries. About two-thirds of those who experience an episode of depression will have at least one other episode in their lives. It is not unusual for depression sufferers to have more than one episode in any given year.
About Neuronetics, Inc.
Neuronetics, Inc. is a privately held medical device company focused on developing therapies for psychiatric and neurological disorders using the energy in magnetic fields. Based in Malvern, PA., Neuronetics is the leader in the development of TMS Therapy, a completely non-invasive form of neuromodulation. For more information, visit www.neuronetics.com.
NeuroStar TMS Therapy SystemTM is pending FDA clearance for the treatment of Major Depressive Disorder and is not commercially available. It is an investigational device and limited by federal law to investigational use.
NeuroStar TMS Therapy System, NeuroStar TMS Therapy, and TMS Therapy are trademarks of Neuronetics, Inc.
Posted by bassman on May 24, 2006, at 10:07:30
In reply to TMS, posted by ttee on May 24, 2006, at 9:32:44
You have to be careful not to take vitamin pills with iron in them or your head gets sucked into the magnet...
Posted by ttee on May 24, 2006, at 11:21:22
In reply to Re: TMS, posted by bassman on May 24, 2006, at 10:07:30
Bassman - I was in one of the rTMS trials and didn't have that problem with my vitamins with Iron. But, if I would move my arms in a certain way...I could pick up Playboy Channel on any TV I was watching. :-) Oh, and while I was getting the treatments...I was staying in a Holiday Inn Express.
Posted by bassman on May 24, 2006, at 12:00:19
In reply to Re: TMS, posted by ttee on May 24, 2006, at 11:21:22
You know the list they have for treatments that list the adverse events and the percent of people that experienced them? Maybe for TMS they should have a "picked up extra TV channels" category. :>}
This is the end of the thread.
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