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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Zatar on November 14, 2013, at 18:23:04
I finished 35 sessions of 10 hz LPFC rTMS. Didn't see any improvement until session 22 or so. I had so many side effects from medications that I could never get to therapeutic levels so it was worth a trial for me.
I have much more energy, am less irritable, talk more. I could literally fall asleep any time of the day before rTMS. My husband noticed the changes before I did. I am like hakuna matata again, more my old self! I also notice that my Fibromyalgia tender points are less painful, about a 30-40% improvement. Unfortunately my myofascial pain and trigger points have not improved, but that is a totally different issue. I am happy with my results!
The doctor who did the treatment was at Shands, and he said the number of treatment sessions to show improvement ranged from literally one treatment in one man, up to 26, with many showing improvement after 10. Once you see improvement, you make the decision if you need to go up to the 30 sessions recommended for depression by the FDA.
Since it took me longer, I did 30 daily treatments followed by tapering down over two weeks. The nurse said they had one fellow who didn't go to the movies in over 15 years, then started going with friends and talking to servers in restaurants after two weeks of rTMS, a big change for him.
I will be going once a month for a "tune up" of one session. Follow up varies; some come once a month, some every 6 months, some when they feel symptoms returning. Since I am older and it took me longer, I personally feel that once a month is about right.
Now I'm wrangling with insurance to cover it. Not cheap at $300+ per session, but worth it even if insurance does not cover it. Who needs a new car?
I'm wondering if some of the treatment failures reported are due to stopping too soon. My doctor only does rTMS and was very knowledgeable about the pros and cons of it. Glad I took his advice to stay the course when I didn't notice anything at 20 sessions.
-Zatar
Posted by ihatedrugs on November 14, 2013, at 18:31:27
In reply to rTMS worked for me, posted by Zatar on November 14, 2013, at 18:23:04
> I finished 35 sessions of 10 hz LPFC rTMS. Didn't see any improvement until session 22 or so. I had so many side effects from medications that I could never get to therapeutic levels so it was worth a trial for me.
>
> I have much more energy, am less irritable, talk more. I could literally fall asleep any time of the day before rTMS. My husband noticed the changes before I did. I am like hakuna matata again, more my old self! I also notice that my Fibromyalgia tender points are less painful, about a 30-40% improvement. Unfortunately my myofascial pain and trigger points have not improved, but that is a totally different issue. I am happy with my results!
>
> The doctor who did the treatment was at Shands, and he said the number of treatment sessions to show improvement ranged from literally one treatment in one man, up to 26, with many showing improvement after 10. Once you see improvement, you make the decision if you need to go up to the 30 sessions recommended for depression by the FDA.
>
> Since it took me longer, I did 30 daily treatments followed by tapering down over two weeks. The nurse said they had one fellow who didn't go to the movies in over 15 years, then started going with friends and talking to servers in restaurants after two weeks of rTMS, a big change for him.
>
> I will be going once a month for a "tune up" of one session. Follow up varies; some come once a month, some every 6 months, some when they feel symptoms returning. Since I am older and it took me longer, I personally feel that once a month is about right.
>
> Now I'm wrangling with insurance to cover it. Not cheap at $300+ per session, but worth it even if insurance does not cover it. Who needs a new car?
>
> I'm wondering if some of the treatment failures reported are due to stopping too soon. My doctor only does rTMS and was very knowledgeable about the pros and cons of it. Glad I took his advice to stay the course when I didn't notice anything at 20 sessions.
>
> -ZatarDo you mean Shands in Gainesville? How long have you been feeling well? I live near Gainesville. Who is your doctor? if you don't mind me asking. I'm so happy for you. You fill me with hope.
Thanks
Posted by Phillipa on November 14, 2013, at 21:49:43
In reply to Re: rTMS worked for me » Zatar, posted by ihatedrugs on November 14, 2013, at 18:31:27
Fantastic!!!! Phillipa
Posted by linkadge on November 16, 2013, at 15:11:27
In reply to Re: rTMS worked for me » Zatar, posted by ihatedrugs on November 14, 2013, at 18:31:27
I have had success with rTMS. I actually experienced greater improvement with right side stimulation. That being said, I am left handed.
Linkadge
Posted by nix on November 21, 2013, at 1:33:55
In reply to rTMS worked for me, posted by Zatar on November 14, 2013, at 18:23:04
Glad to hear it. I had 35+5 taper sessions; I'm not sure exactly what the motor threshold was... "maximum", I was told. I definitely had some response, and, also only saw a noticeable difference after ~20 sessions.
Unfortunately, I can't myself say it was worth it, even with partial partially insurance coverage. I ended up paying out of pocket about $200/session. It helped. I just can't say it eight-thousand-dollars helped. I can't help thinking paying 20% of that and a few memories for a course of ECT might not have been more worthwhile.
And I really do need a new car.
Posted by stargazer2 on November 27, 2013, at 18:38:20
In reply to Re: rTMS worked for me, posted by linkadge on November 16, 2013, at 15:11:27
Hi,
Did you just have TMS once, when was that and what were your results? Did your results last, or fade? Were you on meds during the TMS and are you still on them? Have you changed meds?
I am probably going to have it in JAnuary as part of a research study so that helps with the cost. I may get the treatment but may get the "fake" one so that is a concern.
Thanks for your feedback and happy you feel it was helpful. Do you consider the treatment the best one you've had for depression so far?
Stargazer
Posted by Zatar on February 3, 2014, at 15:18:37
In reply to Re: rTMS worked for me » Zatar, posted by ihatedrugs on November 14, 2013, at 18:31:27
Richard Holbert, MD. He's in the UF Physicians building at 8616 NW 39th Ave.; 352-265-4357. Really nice guy. Tiffany is the nurse who coordinates rTMS therapy.
Posted by Zatar on February 3, 2014, at 15:26:52
In reply to Re: rTMS worked for me/Linkage, posted by stargazer2 on November 27, 2013, at 18:38:20
The TMS clinic is getting a new deep TMS machine in early April. I discussed switching to deep TMS for my once a month maintenance therapy. More to see what it might do as I'm interested in it for my daughter who has treatment resistant depression.
I've had 3 maintenance rTMS sessions so far. My energy levels are still pretty good. Mood has been a bit rocky, but that is probably due to some serious family issues going on. TMS doesn't "bullet proof" you. I'm more relaxed in general.
I'm still glad I did it, though you're right that the cost is $$$$. I still have lots of pain issues, but I have Fibromyalgia and Myofascial Pain and that is a whole different ball of wax. I believe that is why I still have some scalp pain at the treatment site. My muscles are wonky all over my body. They are using TMS over the motor cortex, but they don't do it here.
Dr. Holbert said that existing studies show that TMS primarily affects dopamine. There might be more going on, but more studies are needed.
-Zatar
Posted by SLS on February 3, 2014, at 16:44:57
In reply to Re: Deep TMS, posted by Zatar on February 3, 2014, at 15:26:52
What is the impression your doctors have of deep TMS compared to shallow TMS? Is the response rate higher or the magnitude of improvement greater?
Thanks.
- Scott
Posted by ihatedrugs1 on February 5, 2014, at 23:06:17
In reply to Re: rTMS worked for me » ihatedrugs, posted by Zatar on February 3, 2014, at 15:18:37
> Richard Holbert, MD. He's in the UF Physicians building at 8616 NW 39th Ave.; 352-265-4357. Really nice guy. Tiffany is the nurse who coordinates rTMS therapy.
Hi Zatar,
I'm scheduled to start my treatments this upcoming monday with Dr. Holbert @ Shands. I really hope it works. Thanks for the info.
Continued success.ihatedrugs
Posted by Zatar on February 11, 2014, at 8:07:34
In reply to Re: Deep TMS » Zatar, posted by SLS on February 3, 2014, at 16:44:57
> What is the impression your doctors have of deep TMS compared to shallow TMS? Is the response rate higher or the magnitude of improvement greater?
>
> Thanks.
>
>
> - ScottI'm not sure they know. Shands has not used the deep TMS before (expecting it in April). The advantages are that treatment time is cut in half (20 minutes vs 40 minutes) and overall time is shorter (2 weeks vs 4 weeks). Jaw pain can be an issue. I have wonky muscles from Fibromyalgia and Myofascial Pain so I can expect to get jaw pain.
I will ask what the studies show. I know Johns Hopkins has had a deep TMS machine for awhile and there is a clinic in south Florida that has been using one.
I've also read that right side TMS sometimes produces results when left did not. I'll ask about that and get back to you.
Shands is doing the standard left prefrontal cortex regimen which is FDA approved. Will need to look at research studies to see other results.
-Zatar
Posted by SLS on February 11, 2014, at 8:14:40
In reply to Re: Deep TMS » SLS, posted by Zatar on February 11, 2014, at 8:07:34
Posted by Zatar on February 11, 2014, at 8:14:55
In reply to Re: Deep TMS » SLS, posted by Zatar on February 11, 2014, at 8:07:34
Now I'm wondering if simply switching to deep TMS for once a month maintenance therapy will be enough. I'm still willing to try it.
-Zatar
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280107/Neuropsychiatr Dis Treat. 2012; 8: 5564.
ECT, rTMS, and deepTMS in pharmacoresistant drug-free patients with unipolar depression: a comparative review
Results
The comparative evaluation of HDRS percentage variations shows ECT as the most effective method after 4 weeks of therapy; on the other hand, a better efficacy is obtainable by deepTMS after 2 weeks of therapy. DeepTMS is the technique that gives the best improvement of cognitive performances. The percentage of remitted patients obtained with ECT treatment is the same obtained in the deepTMS group. Both techniques have a remitted patients percentage two times larger than the rTMS. DeepTMS shows a tolerability, measured by the number of dropped-out patients, worse than ECT.
Conclusion
Our investigation confirms the great therapeutic power of ECT. DeepTMS seems to be the only therapy that provides a substantial improvement of both depressive symptoms and cognitive performances; nevertheless it is characterized by a poor tolerability. rTMS seems to provide a better tolerability for patients, but its therapeutic efficacy is lower. Considering the small therapeutic efficacy of deepTMS in the last 2 weeks of treatment, it could be reasonable to shorten the standard period of deepTMS treatment from 4 to 2 weeks, expecting a reduction of dropped-out patients and thus optimizing the treatment outcome.
This is the end of the thread.
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