![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by sailboat77 on February 2, 2012, at 21:10:08
I should first start by saying that I'm somewhere on the bipolar spectrum (almost always depressed and at times even worse) or have something like treatment-resistant depression. I've tried all the antidepressants, atypical meds, and even ECT. MAOI's (Parnate) has actually helped, but only somewhat. My doctor decided ECT was my best shot considering nothing worked much till then. It's a big commitment though because of the time and especially the money.
Long story short, I'm doing much better --- I would say somewhere in the region between mild improvement and significant/huge improvement in mood.... somewhere in the middle. Remember though, everyone reacts differently. I had ECT for 50min a session, 5 days a week, and about 5 weeks in total.
Your mood improves "very gradually". It can be hard to tell you're even getting better. I didn't really start noticing until 2-3 weeks in. Apparently their are residual benefits, meaning your mood continues to improve even after treatments are done. Because it's so new, the science behind it is still unclear, but my doctor explained it as the strengthening or alteration of the actual neurons, instead of the specific chemical changes antidepressant meds target.
Overall, it was worth it, but it wasn't a silver bullet. I still have to take 40-60mg of Parnate, 200mg of Lamictal, and work with my psychologist on cognitive behavioral therapy (CBT). **** I never gave CBT as much credit as I do now, considering that I'm actually on a better path; it's vital. Also really important... great doctors who listen and are willing to try new things.
I'm sure some of you may have questions and I'm happy to answer them the best I can. But what I've said already is pretty much the whole picture.
-Best to you all
Posted by sailboat77 on February 2, 2012, at 21:18:30
In reply to TMS (8 weeks later), posted by sailboat77 on February 2, 2012, at 21:10:08
I mentioned ECT a bunch of times by mistake. I meant to say TMS
Posted by Phillipa on February 2, 2012, at 23:06:13
In reply to Re: TMS (8 weeks later), posted by sailboat77 on February 2, 2012, at 21:18:30
Was going to ask so glad it has worked for you and you're doing well. Phillipa
Posted by poser938 on February 3, 2012, at 8:53:04
In reply to TMS (8 weeks later), posted by sailboat77 on February 2, 2012, at 21:10:08
im glad to hear it helped you. it is great there is finally an effective treatment for depression without the possibillity HORRIBLE side effects you can get from regular meds.
Posted by Roslynn on February 3, 2012, at 11:12:52
In reply to TMS (8 weeks later), posted by sailboat77 on February 2, 2012, at 21:10:08
I am very glad it's helping you.
This is a stupid question but are you allowed to drive to the treatments? If not, are you supposed to take a bus? Everyone I know works Mon-Fri and would not be able to make the commitment to drive me.
Thank you,
Roslynn
Posted by sailboat77 on February 3, 2012, at 12:11:37
In reply to Re: TMS (8 weeks later), posted by Roslynn on February 3, 2012, at 11:12:52
Don't worry, there are no stupid questions concerning TMS; it's been FDA approved for only 3-4 years and not a whole lot is known about it in our mood disorder community. There are no issues or restrictions when it comes to driving there or back; I did it since the beginning. The only symptoms are mild headaches in the beginning and some discomfort. It's hard to describe the discomfort but it's kind of like a small woodpecker knocking in your brain. The discomfort really isn't that bad though. After a week, you will hardly notice it anymore or the initial headaches. One other thing, since your neurons are apparently being repaired or rewired, your brain will have significant "activation", meaning your brain is being juiced up and it can be difficult to sleep... similar to taking MAOI's, at least for me.
I hope this answers your question.
-Best of luck
Posted by sailboat77 on February 3, 2012, at 12:37:50
In reply to TMS (8 weeks later), posted by sailboat77 on February 2, 2012, at 21:10:08
I want to add one more important thing. TMS is quite expensive and it's a long process to get your healthcare provider to cover it. I have BlueCross BlueShield and they always reject your initial submission. They will say something like, "TMS is an unnecessary treatment and not proven to be effective" (aka they don't want to cover it). My doctor said this is a bunch of baloney considering the FDA approved it as a legitimate treatment for depression in those who have shown resistance to prior medications.... 4 years ago.
Luckily, the TMS psychiatrist will have an assistant/nurse in the office who will operate the magnetic machine once the doctor has done all the hard work to locate the exact area to be targeted. The nurse is doing all the paper work for me and will submit a document that gives FDA proof that it is a recognized a treatment for treatment-resistant depression and gives details concerning prior medications/treatments that have previously failed. This gets sent to my insurance provider and once they reject it, at least a majority of the time they do, the assistant will write another letter appealing the rejection. This all takes time and you can expect anywhere from 6 months to a year before eventual approval. Then again, apparently BlueCross BlueShield is the worst insurance provider to get approved.
Posted by Beckett on February 3, 2012, at 14:06:28
In reply to Re: TMS (8 weeks later), posted by sailboat77 on February 3, 2012, at 12:37:50
You mention that your illness is somewhere on the bipolar spectrum. Is there the expectation that any potential future bipolar episodes occur less frequently and or with diminished intensity?
I'm glad you are feeling and seeing improvement :-)
Posted by sailboat77 on February 3, 2012, at 17:19:29
In reply to Re: TMS (8 weeks later) » sailboat77, posted by Beckett on February 3, 2012, at 14:06:28
Yes, there is evidence that persons on the bipolar spectrum do get benefit from TMS. I myself am more unipolar, in that I'm mostly depressed and sometimes shift to being extremely depressed. I don't have much knowledge about those who have dramatic swings in mood, including mania.
Posted by poser938 on February 3, 2012, at 18:01:57
In reply to Re: TMS (8 weeks later), posted by sailboat77 on February 3, 2012, at 17:19:29
i just done with my 9th TMS treatment and still havent gotten a single benefit on my mood yet. dfgadfde
Posted by sailboat77 on February 3, 2012, at 18:40:11
In reply to Re: TMS (8 weeks later), posted by poser938 on February 3, 2012, at 18:01:57
I know that can be frustrating not seeing improvement as quick as you would like, I felt the exact same way. At one point, 10 treatments in, I told my doctor that I was having reservations of even continuing. But the benefits really are gradual and it's hard to tell you're getting better. It was only after 15-17 treatments that I started noticing my mood gradually improving. Remember, it takes a while for your neurons to repair after they've been damaged/faulty for so long.
There are a minority of persons who don't benefit from TMS but the large majority do see their mood improve. I really hope you start to feel better. Also important though is to get involved with CBT (cognitive behavioral therapy). I was always a doubter of psychologists and thought medication or TMS would be all I needed. But after being depressed for so long, I needed to reinforce the TMS benefits with changing my thought patterns of rumination, guilt, regret, and pessimistic tendencies.
-Best of luck
Posted by alchemy on February 3, 2012, at 19:01:38
In reply to TMS (8 weeks later), posted by sailboat77 on February 2, 2012, at 21:10:08
your depression history and diagnosis sounds similar to mine. i tried tms and only found it slightly helpful, and i wasn't completely sure that it helped. i was glad i tried it, but it wasn't worth the $10k...just an fyi to add to the thread.
Posted by Phillipa on February 3, 2012, at 20:51:26
In reply to Re: TMS (8 weeks later), posted by alchemy on February 3, 2012, at 19:01:38
No insurance covered it? I would think with people like myself that meds are more dangerous than the treatments as so many effects come from aging now we are talking 65 yes I am. And medicaire and united health care are what I have now. Phillipa
Posted by SLS on February 4, 2012, at 3:27:34
In reply to Re: TMS (8 weeks later), posted by sailboat77 on February 3, 2012, at 18:40:11
> But after being depressed for so long, I needed to reinforce the TMS benefits with changing my thought patterns of rumination, guilt, regret, and pessimistic tendencies.
Yes. You are right.
1. If you continue the patterns of thoughts and feelings that produced the depression in the first place (psychosocial stress), you risk relapse.
2. The same principle applies to those harmful thoughts and feelings that are acquired during the depression, even though they may not have been the source of the original episode.
- Scott
Posted by poser938 on February 4, 2012, at 12:27:26
In reply to Re: TMS (8 weeks later), posted by sailboat77 on February 3, 2012, at 18:40:11
so are you saying you felt nothing 10 tretments in? or that it was so gradual that you didnt really notice it until 15 treatments? sorry if this is a dumb question, i just find it hard to make sense of things lately.
Posted by sailboat77 on February 4, 2012, at 13:01:40
In reply to Re: TMS (8 weeks later), posted by poser938 on February 4, 2012, at 12:27:26
That's actually a good question. I didn't feel any improvement in mood until 15 sessions in and even then I could hardly tell. It wasn't till all my treatments were done that I realized my mood had actually changed over the course of time. My doctor actually increased the intensity of the pulses to kick-start improvement. Also, my doctor told me that there are residual effects with TMS, meaning that even after all your TMS treatments are over, you continue to improve weeks after. This proved to be true in my case. What happens is that the neurons are slowly being repaired so they continue to fix themselves even after you're treatments are over.
I understand any frustration you may feel, I certainly felt that way. I felt a bit hopeless because everything I tried before that had failed and I was really counting on TMS to be the answer. Just hang in there and be patient, as hard as it is, and be aware that your mood won't "noticeably" improve until many sessions in. Keep me updated and let me know how you do.
-Best of luck
Posted by poser938 on February 4, 2012, at 15:21:07
In reply to TMS (after it's done), posted by sailboat77 on February 4, 2012, at 13:01:40
well i'll just keep my fingers crossed.
ha i literally do cross my fingers everytime during before having it done.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.