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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by poser938 on January 10, 2012, at 0:40:42
since it isnt approved by the FDA for depression, how possible is it for someone to have this therapy?
im about to be having rTMS done, and am hoping it works for me.. but i like to pan ahead just in case it doesnt work for me. medication isnt really an option for me anymore because because 90% of the time when i take a med and it ha its effect on me, whether bad or good, it is permanent. my brain doesnt see the need to go back to normal after stopping a med.. and it has truly ruined my life. but like i said, if rTMS doesnt work for me, is it next to impossible to have DBS done? do you just have to be lucky to participate in a trial for it? i am very suicidal and just need something to help me feel better.
Posted by SLS on January 10, 2012, at 7:28:09
In reply to how possible is it to have DBS done, posted by poser938 on January 10, 2012, at 0:40:42
> since it isnt approved by the FDA for depression, how possible is it for someone to have this therapy?
> im about to be having rTMS done, and am hoping it works for me.. but i like to pan ahead just in case it doesnt work for me. medication isnt really an option for me anymore because because 90% of the time when i take a med and it ha its effect on me, whether bad or good, it is permanent. my brain doesnt see the need to go back to normal after stopping a med.. and it has truly ruined my life. but like i said, if rTMS doesnt work for me, is it next to impossible to have DBS done? do you just have to be lucky to participate in a trial for it? i am very suicidal and just need something to help me feel better.You can try contacting:
http://wwwp.medtronic.com/Newsroom/NewsReleaseDetails.do?itemId=1235065362795&lang=en_US
I hope the rTMS works for you. 5 days per week?
Twinleaf has had success with rTMS. Perhaps you can ask him/her more about it.
DBS. I am still afraid of it. However, I was fast approaching a decision to try it. I was down to my last drug. I had a feeling that my brain's Brodmann Area 25 was hyperactive. That's what DBS is meant to treat. DBS really is not a nerve stimulator. It is a nerve blocker.
I am having success treating my depression with an old antihypertensive drug called prazosin. It crosses the BBB readily and makes its way into the brain, where it blocks NE alpha-1 receptors.
It occurred to me that prazosin might quiet those neurons that are observed to be hyperactive in cingulate cortex (Brodmann areas 24, 25) in indviduals with MDD. If so, it would effectively mimic DBS. This is a wild guess on my part.
Personal question, I know: Were you physically or emotionally abused as a child? What about parental neglect? PTSD? These are some of the things that prazosin might be able to treat. I am still trying to characterize what types of depression prazosin might be an effective treatment for. It is certainly safe enough.
I cannot yet recommend prazosin to anyone, but it would be a quick 4 week trial. Perhaps it makes sense to look into prazosin before going with DBS.
- Scott
Posted by SLS on January 10, 2012, at 7:39:34
In reply to Re: how possible is it to have DBS done » poser938, posted by SLS on January 10, 2012, at 7:28:09
I forgot to mention that I need my other antidepressant medication in order for the prazosin to work.
- Scott
Posted by Phillipa on January 10, 2012, at 10:23:56
In reply to Re: how possible is it to have DBS done, posted by SLS on January 10, 2012, at 7:39:34
Did I mention in the past that the woman in 40's across the street is taking same I think for PTSD nightmares and it works? Phillipa
Posted by Bob on January 10, 2012, at 14:31:38
In reply to how possible is it to have DBS done, posted by poser938 on January 10, 2012, at 0:40:42
> since it isnt approved by the FDA for depression, how possible is it for someone to have this therapy?
> im about to be having rTMS done, and am hoping it works for me.. but i like to pan ahead just in case it doesnt work for me. medication isnt really an option for me anymore because because 90% of the time when i take a med and it ha its effect on me, whether bad or good, it is permanent. my brain doesnt see the need to go back to normal after stopping a med.. and it has truly ruined my life. but like i said, if rTMS doesnt work for me, is it next to impossible to have DBS done? do you just have to be lucky to participate in a trial for it? i am very suicidal and just need something to help me feel better.This is another link to the other major study involving DBS for depression in the U.S. The link Scott gave you is for the device made by Medtronic which supplies the study being conducted by the Cleveland Clinic. The BROADEN study is being carried out by St. Jude Medical which is not affiliated with the Medtronic/Cleveland Clinic program. One fact to keep in mind: the two different camps are stimulating two different areas of the brain. The Cleveland Clinic/Medtronic group is addressing an area in the nucleus accumbens, while St. Jude Medical (BROADEN) is using the Cg25 (Cingulate) area.
Posted by SLS on January 10, 2012, at 14:48:22
In reply to Re: how possible is it to have DBS done » poser938, posted by Bob on January 10, 2012, at 14:31:38
> One fact to keep in mind: the two different camps are stimulating two different areas of the brain.
>
> The Cleveland Clinic/Medtronic group is addressing an area in the nucleus accumbens, while St. Jude Medical (BROADEN) is using the Cg25 (Cingulate) area.
Is the area of the nucleus accumbens to be treated hyperactive? How does the treatment work?
- Scott
Posted by Bob on January 10, 2012, at 14:58:21
In reply to Re: how possible is it to have DBS done » Bob, posted by SLS on January 10, 2012, at 14:48:22
> > One fact to keep in mind: the two different camps are stimulating two different areas of the brain.
> >
> > The Cleveland Clinic/Medtronic group is addressing an area in the nucleus accumbens, while St. Jude Medical (BROADEN) is using the Cg25 (Cingulate) area.
>
>
> Is the area of the nucleus accumbens to be treated hyperactive? How does the treatment work?
>
>
> - ScottI guess that's what they would posit. The going theory for the mechanism at work regardless of what site is being stimulated is that the electrical activity disrupts the normal signaling in the brain in some sort of sphere shaped area around the electrode, the size of which is related to the magnitude and parameters of the stimulation signal.
I think the whole reason this DBS idea got off the ground was its ostensible relation to the psychosurgical techniques employed in the past at similar brains targets, which produced a physical lesion at the area in question using a heat ablation. Obviously a lesion in the brain would occlude any signal activity in that region thus forcing the brain to develop a workaround. I feel there are some serious questions as to whether the DBS technique is actually mimicking the ablative methods as is currently thought though. It seems more likely to me that there is some sort of complicated interaction between the electrical signals and the natural electro-chemical activity of the brain.
Posted by SLS on January 10, 2012, at 15:00:44
In reply to Re: how possible is it to have DBS done » poser938, posted by Bob on January 10, 2012, at 14:31:38
"One week of DBS significantly increased metabolism in the nucleus accumbens, amygdala, and dorsolateral and dorsomedial prefrontal cortex, and decreased metabolism in the ventral and ventrolateral medial prefrontal cortex. These latter regions have been described to be hypermetabolic in depressed states."
Neuropsychopharmacology (2007), 110
Posted by poser938 on January 10, 2012, at 19:22:14
In reply to Re: how possible is it to have DBS done, posted by SLS on January 10, 2012, at 15:00:44
i like reading about what you all have to say about DBS, since i have really no idea how it is thought to work. i dont really undeerstand which parts of the brain are supposed to do what, or if they would know which part of my brain to us the DBS on since my problem has been caused by medication having seemiingly permanent effects on me. i have dystonia/tardive dyskinesia in the muscles in my face. blank emotions. constantly feeling like i havent slept in 2 days. and my mood is very sensitive to foods i eat. i believe the same mechanism that is causing my tardive dyskinesia is also causing my sensitivity to foods.
im also wondering what the difference between tardive dyskinesia and dystonia is? i know DBS has been approved for dystonia,, so maybe it could help me with that, while also helping me with my sensitivity to foods.
Posted by poser938 on January 14, 2012, at 16:16:10
In reply to Re: how possible is it to have DBS done » poser938, posted by SLS on January 10, 2012, at 7:28:09
so, DBS is like a modern day labotomy? instead of removing a part of the brain, it lowers the ability of part of it to function?
Posted by SLS on January 14, 2012, at 18:30:19
In reply to Re: how possible is it to have DBS done, posted by poser938 on January 14, 2012, at 16:16:10
> so, DBS is like a modern day labotomy? instead of removing a part of the brain, it lowers the ability of part of it to function?
Pretty much. It is more of a disruptor than it is a stimulator.
- Scott
Posted by Deahoidar on December 26, 2012, at 13:04:08
In reply to Re: how possible is it to have DBS done » poser938, posted by SLS on January 14, 2012, at 18:30:19
> > so, DBS is like a modern day labotomy? instead of removing a part of the brain, it lowers the ability of part of it to function?
>
> Pretty much. It is more of a disruptor than it is a stimulator.
>I can't vouch for the comparability of the results (lobotomy vs. deep brain stimulation), but they are very dissimilar in significant aspects.
Lobotomy is irreversible.
DBS is reversible. The stimulation can be reduced or even shut off. And the probes can be explanted (removed).
DBS seeks to down-regulate over-active circuits in the brain. In market contrast, lobotomy sought to severe/damage connections between regions of the brain.
DBS is showing promise for those that suffer refractory depression and do not benefit from other known treatments.
This is the end of the thread.
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