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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 noelle on August 3, 2006, at 23:45:13
Hi, I'm not having much luck with getting responses to my questions but maybe they aren't interesting enough. I really want to know if anyone has any feedback on this, I've heard its promising. I though maybe I could try to get into the center in LA
Noelle
Posted by MidnightBlue on August 4, 2006, at 0:23:07
In reply to Transmagnetic stimulation - need advice, posted by noelle on August 3, 2006, at 23:45:13
From what I understand there is about a 25% chance it will work. I tried to get into a clinical trial but flunked the EKG.
MidnightBlue
Posted by SLS on August 4, 2006, at 5:09:55
In reply to Transmagnetic stimulation - need advice, posted by noelle on August 3, 2006, at 23:45:13
I am conflicted when it comes to getting rTMS. Most of what I am left with after researching it is a feeling that it is a rather weak treatment if you are truly treatment-resistant (stage 5). However, because it is safe and relatively free of side-effects (except for headache), it seems like a reasonable thing to do if cost is not an issue.
What stage of treatment-resistance are you?
* Stage 1: Failure of an adequate trial of 1 class of major antidepressant
* Stage 2: Failure of adequate trials of 2 distinctly different classes of antidepressant
* Stage 3: Stage 2 plus failure of a third class of antidepressant, including a tricyclic antidepressant (TCA)
* Stage 4: Stage 3 plus failure of an adequate trial of a monoamine oxidase inhibitor (MAOI)
* Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
- Scott
Posted by fuchsia on August 4, 2006, at 6:34:13
In reply to Re: Transmagnetic stimulation - need advice » noelle, posted by SLS on August 4, 2006, at 5:09:55
I had rTMS as part of a trial in Melbourne, Australia. All of us subjects in the trial were treatment resistant and the experimenters claimed they had a good success rate (sorry but I can't remember what it was). Unfortunately it didn't work for me and it possibly made me worse. However I am bipolar and the bipolars were supposed to be on mood stabilisers for the trial and I wasn't.
Posted by SLS on August 4, 2006, at 6:47:19
In reply to Re: Transmagnetic stimulation - need advice » SLS, posted by fuchsia on August 4, 2006, at 6:34:13
> I had rTMS as part of a trial in Melbourne, Australia. All of us subjects in the trial were treatment resistant and the experimenters claimed they had a good success rate (sorry but I can't remember what it was). Unfortunately it didn't work for me and it possibly made me worse. However I am bipolar and the bipolars were supposed to be on mood stabilisers for the trial and I wasn't.
If I can get it paid for, I intend to try it. They are continually tweaking the settings on the machine to optimize the frequency, flux, coil placement, etc.
I really can't disclose names, but one of the primary investigators of rTMS counselled a former patient who is bipolar and TRD stage 5 that it was not worth for her to try it. This was quite awhile ago, though.
- Scott
Posted by fuchsia on August 4, 2006, at 7:08:40
In reply to Re: Transmagnetic stimulation - need advice » fuchsia, posted by SLS on August 4, 2006, at 6:47:19
> If I can get it paid for, I intend to try it. They are continually tweaking the settings on the machine to optimize the frequency, flux, coil placement, etc.
They didn't pay me to be in the trial but the active treatment I was supposed to be getting was, according to them, proven to have some success rate.
I know there was going to be a future trial where some of the participants would have a fish oil capsule (or was it vitamin E?) stuck on their head. Now I can't for the life of me remember what the design of that trial was but it made sense at the time. The capsule was just going to be a space occupier it wasn't anything spooky.
> I really can't disclose names, but one of the primary investigators of rTMS counselled a former patient who is bipolar and TRD stage 5 that it was not worth for her to try it. This was quite awhile ago, though.
>Can you tell me, in a bipolar patient, does a 'lack of response' include an unhelpful response, as in the induction of mania? This has always confused me.
Posted by SLS on August 4, 2006, at 7:31:32
In reply to Re: Transmagnetic stimulation - need advice » SLS, posted by fuchsia on August 4, 2006, at 7:08:40
> > If I can get it paid for, I intend to try it. They are continually tweaking the settings on the machine to optimize the frequency, flux, coil placement, etc.
>
> They didn't pay me to be in the trial but the active treatment I was supposed to be getting was, according to them, proven to have some success rate.
>
> I know there was going to be a future trial where some of the participants would have a fish oil capsule (or was it vitamin E?) stuck on their head. Now I can't for the life of me remember what the design of that trial was but it made sense at the time. The capsule was just going to be a space occupier it wasn't anything spooky.
>
>
> > I really can't disclose names, but one of the primary investigators of rTMS counselled a former patient who is bipolar and TRD stage 5 that it was not worth for her to try it. This was quite awhile ago, though.
> >
>
> Can you tell me, in a bipolar patient, does a 'lack of response' include an unhelpful response, as in the induction of mania? This has always confused me.Hmm.
This person had an ambiguous history of hypomania as an adolescent. As an adult, she experienced no mania at all, and cycled between severe major depressive episodes and dysthymia. I guess she would qualify as double depression along a bipolar spectrum. Knowing her history, I don't think her doctor was worried about a switch into mania. I think his comments were interpreted by her to mean that the rTMS treatments would not have any effect on her mood at all.Interestingly, if the magnetic coil is placed on the wrong side of the head or the frequency set improperly, it can actually make depression worse and perhaps even induce mania. There is still a lot of work yet to be done with this treatment - I hope.
- Scott
Posted by noelle on August 4, 2006, at 15:13:05
In reply to Re: Transmagnetic stimulation - need advice, posted by SLS on August 4, 2006, at 7:31:32
Yikes,
I thought it was a bit more reliable. I can't say I have tried all the steps on the resistance scale. I went straight from anti-depressant to anti-psychotics, and mood stablizers, I have this depression that cycles but I don't get hypo-manic. I have been helped somewhat by meds but have still have this persistant depression ahedonia, and severe anxiety. Its hard to find joy in life and I don't feel there are many other places to go with meds. I'm on four meds, I probably wouldn't fit the profile.
Noelle
Posted by Phillipa on August 4, 2006, at 16:30:34
In reply to Re: Transmagnetic stimulation - need advice, posted by MidnightBlue on August 4, 2006, at 0:23:07
Heart problems or a murmur? Love Phillipa
Posted by Phillipa on August 4, 2006, at 16:34:14
In reply to Re: Transmagnetic stimulation - SLS and all, posted by noelle on August 4, 2006, at 15:13:05
Is this the same or similar to VNS? Love Phillipa
Posted by MidnightBlue on August 4, 2006, at 19:53:22
In reply to Re: Transmagnetic stimulation - need advice » MidnightBlue, posted by Phillipa on August 4, 2006, at 16:30:34
Extra early beats. Regular doc said not even worth testing for.
Posted by MidnightBlue on August 4, 2006, at 19:54:18
In reply to Re: Transmagnetic stimulation - SLS and all, posted by Phillipa on August 4, 2006, at 16:34:14
Phillipi,
No. This is external. VNS is implanted like a pace maker.
MB
Posted by Phillipa on August 4, 2006, at 20:32:10
In reply to Re: Transmagnetic stimulation - need advice » Phillipa, posted by MidnightBlue on August 4, 2006, at 19:53:22
MB PAC's?. They are harmless. Love Phillipa
Posted by Phillipa on August 4, 2006, at 20:33:29
In reply to Re: Transmagnetic stimulation - SLS and all, posted by MidnightBlue on August 4, 2006, at 19:54:18
I thought so thanks MB. Love Phillipa
Posted by SLS on August 4, 2006, at 22:37:07
In reply to Re: Transmagnetic stimulation - SLS and all, posted by noelle on August 4, 2006, at 15:13:05
Hi Noelle.
> Yikes,
> I thought it was a bit more reliable.Gosh. I didn't mean to say that they still had no idea what they were doing with the rTMS. Don't worry. They won't accidentally make you more depressed. They know better - now. They have already gone through much of the trial-and-error period.
> I can't say I have tried all the steps on the resistance scale.
What prevents you from trying a tricyclic or an MAOI?
> I went straight from anti-depressant to anti-psychotics, and mood stablizers, I have this depression that cycles but I don't get hypo-manic.
Can you describe your cycle?
> I have been helped somewhat by meds
In what ways have meds helped? Which meds?
> but have still have this persistant depression ahedonia, and severe anxiety.
Sounds almost bipolar.
> Its hard to find joy in life and I don't feel there are many other places to go with meds. I'm on four meds, I probably wouldn't fit the profile.
What medications are you currently taking?
- Scott
This is the end of the thread.
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