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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Chris O on October 29, 2014, at 16:33:36
Hello, babblers:
Just thought I'd start a thread for anyone who is interested in anecdotal feedback about rTMS. My psychiatrist got a Neurostar TMS machine in his office a couple months ago, and my wife's insurance is now approving this as a treatment for people with many med failures (that would be me), so I decided to give it a try. I'll just give some general feedback and update sporadically if anyone is interested.
Well, even after one TMS treatment, I do feel slightly better, lighter. Not anything significant, mind you, but a bit easier to talk to people, do my daily tasks (which are fairly limited). I am cautiously optimistic about TMS based on what I've read here and what I've seen online, but I still do not see how this treatment can provide long-term relief. Yet, I'm so crippled by my anxiety and depression that I do not know what else to do.
Something I did not expect with TMS was the level of muscle contraction/zapping/pain in my face. Basically, when the TMS magnet activates, my face gets a mini seizure; it really contracts in a painful way. (I also just had trouble remembering how to spell "mini"; weird). The tapping noise didn't bother me at all with the earplugs in, but the level of muscle contraction in my face is greater than I thought it would be (based on watching the Neurostar marketing videos, which basically show people calmly sitting with no muscle contractions during the treatment). Also interesting is the way the magnet affected two dental crowns in my mouth. I really felt tingling in both of them, almost like they were being pulled around or electrocuted. I also had a slight headache and dizziness afterwards, but that is going away now. (I do notice myself having some trouble finding/spelling words while typing here, though. Odd.)
Anyway, my main worry with something like TMS is that it could somehow cause brain damage. As paranoia and anxiety are the main feature of my mental health issues though, I try to put this worry out of my mind.
There are other things I can share, but I will save that for future updates if anyone is interested. Happy to answer questions if anyone has them as well.
Hope everyone is doing well here.
Chris
Posted by Tomatheus on October 29, 2014, at 20:23:27
In reply to Had my first rTMS treatment today, posted by Chris O on October 29, 2014, at 16:33:36
Chris,
I just wanted to thank you for posting about your experience with rTMS so far. I think that all of us here on Psycho-Babble would like for your experience with the procedure to be a positive one. Good luck!
Tomatheus
Posted by Chris O on October 29, 2014, at 20:41:07
In reply to Re: Had my first rTMS treatment today » Chris O, posted by Tomatheus on October 29, 2014, at 20:23:27
Thanks, Tomatheus. I appreciate your support. I've posted on and off here since 2001, and it's always been a great community for sharing and getting wise feedback. Are you one of the babblers who have tried rTMS before? I really wasn't prepared for the level of muscle contraction that occurred in my face during the treatment. It's quite powerful and unpleasant. I can deal with it, mind you, but it's not something I saw in any of the Neuorstar rTMS marketing videos on YouTube. Anyway, I'll check back with updates.
Chris
Posted by Tomatheus on October 29, 2014, at 21:15:03
In reply to Re: Had my first rTMS treatment today » Tomatheus, posted by Chris O on October 29, 2014, at 20:41:07
Hi Chris,
Thank you for your response to my post. I have not tried rTMS, or any kind of TMS for that matter, myself. I haven't decided against ever undergoing the procedure for the affective component of my affective psychosis, although I'm currently focusing mainly on alternative treatments for my condition. I can't, unfortunately, say that utilizing alternative treatments has been very successful for me in the long run, and so I continue to keep my mind open to treatments like rTMS that might possibly be helpful at some point in the future.
The muscle contractions that you experienced during treatment with rTMS do indeed sound unpleasant, and I hope that that particular side effect at least won't become too unmanageable during your future sessions. Have you noticed any negative after-effects from your rTMS session up to this point, or did you only notice negative side effects right around the time of your session?
Tomatheus
Posted by Chris O on October 29, 2014, at 23:29:46
In reply to Re: Had my first rTMS treatment today » Chris O, posted by Tomatheus on October 29, 2014, at 21:15:03
"Have you noticed any negative after-effects from your rTMS session up to this point, or did you only notice negative side effects right around the time of your session?"
Well, today was my first session, so ... hard to say. Mild headache, some issues with spelling words when writing my babble post earlier today (but that could have just as easily been anxiety), and maybe the sense that my dental crowns have been knocked around. (Weird sensation with the dental crowns for me during the treatment. Kind of like electricity going through them.) Other than that, I guess not. I'll just take it day by day and push the worry that I could get brain lesions or other terrifying irrationalities out of my mind.
Chris
Posted by Chris O on October 30, 2014, at 15:52:32
In reply to Re: Had my first rTMS treatment today » Tomatheus, posted by Chris O on October 29, 2014, at 23:29:46
Felt worse after today's rTMS session. Hard to concentrate on anything. Felt anxious, like hiding. My normal guilt-ridden self.
Posted by Tomatheus on October 30, 2014, at 16:23:20
In reply to Felt a bit worse after today's rTMS session » Chris O, posted by Chris O on October 30, 2014, at 15:52:32
> Felt worse after today's rTMS session. Hard to concentrate on anything. Felt anxious, like hiding. My normal guilt-ridden self.
I'm sorry to hear this, Chris. Hopefully the way that you've been feeling since your session won't persist for too long, and you'll feel better after undergoing more sessions.
Thanks for letting us know how things went, even though the news that you had to share today wasn't good. Again, I hope that you'll have better news to share with us soon.
Tomatheus
Posted by Beckett on November 1, 2014, at 12:23:42
In reply to Re: Felt a bit worse after today's rTMS session » Chris O, posted by Tomatheus on October 30, 2014, at 16:23:20
Hey Chris. I imagine they know a major piece is anxiety. Are specific areas targeted, and if so, what are they? I'm very interested in your progress, so thank you for posting about it.
Good luck.
Posted by phidippus on November 4, 2014, at 16:47:18
In reply to Had my first rTMS treatment today, posted by Chris O on October 29, 2014, at 16:33:36
Chris,
What are you taking?
rTMS is simply magnetic energy which hasn't proven to be carcinogenic. In no way can rTMS cause brain damage. People working with far more powerful magnets have healthy brains.
In fact, one study found rTMS could reverse brain damage:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309377/Eric
Posted by Chris O on November 4, 2014, at 18:30:11
In reply to Re: Had my first rTMS treatment today » Chris O, posted by phidippus on November 4, 2014, at 16:47:18
Hey, Eric:
"What are you taking?"
Ha, that's a good one. Nothing in terms of psycho-pharmaceuticals, now. I guess you could say I'm "taking" anxiety-driven brain biology that has characterized my life since childhood.
Been "taking" it for 48 years. But in terms of meds, nothing now. Was on Brintellix 30mg for 5 months, but stopped in the summer. It was just doing not much. Before that--Viibryd, Serzone, Paxil, Prozac, Lexapro, Celexa, Luvox, Klonapin (useless for me), a bit of Effexor and Cymbalta, and a probably too short trial of Neurontin. This is over a 14 year period. I've been thinking of going the Nardil route for two years, but just never end up taking the prescription after I get it. I've also had Abilify on my shelf a bunch of times but never taken it. But my life is a mess. I certainly hope rTMS provides some relief. After 5 sessions, nothing yet; or nothing I notice. Still very overwhelmed, angry, unable to function. Feeling paranoid. I read the brain damage study. That's interesting. Hope it can reverse mine.Chris
Posted by phidippus on November 11, 2014, at 12:15:12
In reply to Re: Had my first rTMS treatment today » phidippus, posted by Chris O on November 4, 2014, at 18:30:11
>Still very overwhelmed, angry, unable to function. Feeling paranoid...
Is this all anxiety driven?
rTMS is a long shot. I don't have much faith in it myself.
Eric
Posted by Chris O on November 11, 2014, at 14:43:38
In reply to Re: Had my first rTMS treatment today » Chris O, posted by phidippus on November 11, 2014, at 12:15:12
Eric:
I believe that my mental illness is primarily anxiety driven. It is so all encompassing and so "lifetime" and I am so inside of it that it is hard to say anymore. I know that I do not move fast enough to function in the world, and that when I am in the world, everything is moving so fast that I cannot keep up. I am worried about being homeless all the time because I can't work and I am filled with guilt and rage because it is all so humiliating. It is especially humiliating in relationship to women because ... I cannot "be a man," so to speak, and radiate the outward flowing masculine energy that I know is stuck deep inside of me.
Anyway, I just finished my 10th treatment today. It's doing a bit of something; it's easier to push the anxiety-driven thoughts away; it might even be better than my Brintellix trial, but still not robust enough to get me functioning in the world. I noticed myself being more outgoing with people the last five days, but I am also feeling a bit lost inside. I use my anxiety; I fight against my anxiety to carve out an identity. Perhaps there is some relief and I am having trouble with that.
My psychiatrist was also suggesting rTMS-ing the right dorsal lateral prefrontal cortex for anxiety (versus the left, which is what is what is primarily what is done for depression). I don't know.
The whole rTMS thing does seem a bit sketchy to me, due to the number of variables and unknowns (for instance, placement location of the magnet on my head, which seems to slightly differ from day to day, and is done by one of the women working the phones in my psychiatrist's office, never by him) but I am desperate. If my relationship with my wife crumbles, I am in big trouble until I get myself back in working order.
Anyway, thanks for checking back with me. I hope all is well with you.
Chris
Posted by phidippus on November 11, 2014, at 15:51:21
In reply to Re: Had my first rTMS treatment today » phidippus, posted by Chris O on November 11, 2014, at 14:43:38
My struggles with anxiety began in 2006 and proceed to this day. But I got it under control and am mostly symptom free these days. I don't have GAD, I have OCD with panic disorder. But I remember being drenched in so much anxiety I couldn't complete school, having panic attacks in the middle of class. A lot of what helped was therapy, specifically ERP, ACT and DBT? Are you familiar with any of these? If you aren't you should go right away and find a good therapist who practices them.
Medicine wise it took a lot of trial and error to get the anxiety under control, but I found some that worked: Luvox, Clomipramine, Cymbalta, Viibryd and Brintellix-I took one of these as my base medication then augmented with other medication: Abilify, Invega, Geodon, Riluzole, Tramadol and Keppra.
And that's what I'd recommend to you, is start with a base, say Brintellix-something that gets you to 50-60% then augment with other medications. For GAD I'd recommend augmentation with Lyrica, Gabitril, Keppra or Riluzole. Any of the combination above will do. I might even recommend sprinkling a little risperdal on the top. I think with the severity of your anxiety multiple medications are warranted.
>It is so all encompassing and so "lifetime" and I am so inside of it that it is hard to say anymore.
do you know how to identify distorted thoughts?
>when I am in the world, everything is moving so fast that I cannot keep up.
does everything cause you anxiety?
>I am filled with guilt and rage because it is all so humiliating.
just something else you need to worry about. why does it have to be humiliating?
>I use my anxiety; I fight against my anxiety to carve out an identity.
If you're fighting your anxiety, it has already won. You need to let it wash over you and see if you're still standing when the waves have past. That's when you find yourself.
>If my relationship with my wife crumbles
another worry
Eric
Posted by Lamdage22 on November 17, 2014, at 6:51:18
In reply to Had my first rTMS treatment today, posted by Chris O on October 29, 2014, at 16:33:36
It didnt do squat for me besides making my wallet (much) lighter. And perhaps bring on another psychosis. Not sure about that though.
Posted by Chris O on November 17, 2014, at 9:03:41
In reply to Re: Had my first rTMS treatment today, posted by Lamdage22 on November 17, 2014, at 6:51:18
Well, that's frustrating. Just curious: Do you think the psychosis may have been brought on by the frustration of dealing with the whole rTMS experience (cost, hassle of going every day, other annoyances, etc.)? I am definitely anxious about having to deal with the woman in my p-doc's office who essentially "runs" everything.
But I do feel like there is already some benefit for me. But I'm irritated about having to "prove" this to the insurance company (they only approved 16 treatments so far), and irritated that not me, not my doctor, but a young late 20-something with no training in psychology or psychiatry who my doctor lets "deal with the insurance stuff," pretty much controls the whole thing, and seems irritated by me, or my anxiety disorder, to boot. If I don't get my second 16 approved today or tomorrow, I'll be having serious words with the p-doc. Anyway, hope are doing okay these days, Lamdage, despite lack of success with rTMS. I definitely share a lot of your sentiments toward psychiatry, if I remember our previous interactions on these boards.
Chris
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