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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Babbler20 on June 20, 2014, at 22:38:11
As a depressed person, I'm naturally a skeptic of everything. Fortunately, about half the time I assume the worst, I'm pleasantly surprised. I hoped this would be the case with TMS, but it did absolutely nothing. It was expensive and an enormous waste of time. The article below is proof of what I experienced. According to this article, TMS works for 14 % of the people that try it. With a success rate like that, you have to question the credibility of the FDA. http://well.blogs.nytimes.com/2013/07/01/new-approach-to-depression/?_php=true&_type=blogs&_r=0
Posted by Chris O on June 20, 2014, at 23:04:38
In reply to TMS Effective in 14% Of Patients, posted by Babbler20 on June 20, 2014, at 22:38:11
Thanks for posting that article, though it did offer a positive view of TMS in many respects. My psychiatrist just got a machine in his office because he saw radical improvement in four of his patients after they completed their TMS sessions. It looks like my insurance may cover it, but I'm still not sure if I should try it.
Chris
Posted by Babbler20 on June 21, 2014, at 1:01:55
In reply to Re: TMS Effective in 14% Of Patients » Babbler20, posted by Chris O on June 20, 2014, at 23:04:38
No problem, my psychiatrist told me he had an 80% success rate with it which simply isn't true. If you haven't tried all the meds first, I'd say try all of them before spending the money and time on TMS. The thing that actually helped me more than anything was long-term exercise. Northwestern did a study on long-term exercise that showed huge improvements in sleep and mood after 16 weeks. Before, 16 weeks, patients didn't improve, however. Look up the study online and give it a shot within the parameters, especially if you have insomnia.
Posted by Beckett on June 21, 2014, at 1:20:15
In reply to TMS Effective in 14% Of Patients, posted by Babbler20 on June 20, 2014, at 22:38:11
If my insurance covered rTMS, I would try it. Deep TMS sounds very good.
Posted by Linkadge on June 21, 2014, at 9:28:06
In reply to Re: TMS Effective in 14% Of Patients, posted by Beckett on June 21, 2014, at 1:20:15
I read the article. It didn't say 14%, it said it was effective in 30% vs. 14% of the control group. Also, it wasn't clear if these were treatment resistant patients or not. For instance, in a group of TRD patients Parnate was only effective in about 18%.
Linkage
Posted by Phillipa on June 21, 2014, at 9:49:26
In reply to Re: TMS Effective in 14% Of Patients, posted by Linkadge on June 21, 2014, at 9:28:06
So about even? Phillipa
Posted by Chris O on June 21, 2014, at 18:19:35
In reply to Re: TMS Effective in 14% Of Patients, posted by Babbler20 on June 21, 2014, at 1:01:55
Exercise does work for me too, but it's extremely mild. Plus, because my symptoms are so physical, it's almost like an extra layer of crap on top of me when I exercise, which makes it so torturous. Right now, on the Brintellix, even though it's a mild effect, it is a lot easier for me to exercise. I wish that exercise alone could treat my anxiety and depression but it just doesn't. But I hear what you're saying. When I ride my bike 8-miles-ish a day for 1-2 months, there is a difference.
Posted by tom2228 on June 21, 2014, at 23:24:25
In reply to TMS Effective in 14% Of Patients, posted by Babbler20 on June 20, 2014, at 22:38:11
> As a depressed person, I'm naturally a skeptic of everything. Fortunately, about half the time I assume the worst, I'm pleasantly surprised. I hoped this would be the case with TMS, but it did absolutely nothing. It was expensive and an enormous waste of time. The article below is proof of what I experienced. According to this article, TMS works for 14 % of the people that try it. With a success rate like that, you have to question the credibility of the FDA. http://well.blogs.nytimes.com/2013/07/01/new-approach-to-depression/?_php=true&_type=blogs&_r=0
Okay, to start, the article says:
"TMS is approved specifically for patients whose depression does not respond to antidepressants or who cannot tolerate the drugs side effects..."
which is a highly weasel-worded statement. As it's worded the article makes it seem like the FDA approval is for people who have run the whole gamut of meds and have not responded.... which sets the stage for their larger point that this procedure that is approved for people for whom (most/all) antidepressants don't work isn't even that effective for them! -- i.e. that TMS is just another failure for the (truly) treatment-resistant just like the meds.In actuality, however the FDA approved it for people who have failed to achieve satisfactory improvement from just ONE(!!) prior antidepressant medication at or above the MINIMAL effective dose and duration in the current episode. I.e., the article is referring to TMS as a procedure for "antidepressant resistance/ intolerance" when by definition of the FDA approval that person includes someone who has tried nothing but say 5mg Lexapro for 4 weeks!! That's hardly a fraction of a degree of "antidepressant resistance" (as the article proclaims) considering the multitude of medications many of us here, myself included, have tried with unsatisfactory results. So really, TMS is largely used in, and has mostly been studied in, people who are NOT truly antidepressant-resistant as we know it here, and includes people who simply do not want to be on meds rather than the meds not working for them.
As well, the official TMS studies are mostly of people who are NOT taking medications when they undergo treatment, By theoretical logic, TMS has has a synergistic effect with medications, and this is not accounted for the studies. Many people in the clinical setting who are not studied, like myself, ARE taking multiple meds while doing TMS.
As the article states:
"In industry-financed studies that allowed subjects to continue their antidepressant medications while undergoing TMS treatment, which experts say is a more likely situation in the real world, response rates were significantly higher than in the randomized trial conducted by Dr. George. "
Like so most of the official studies follow the conditions of the FDA approval and do not necessarily reflect the population that TMS is used in in the clinical setting, where results and success rates may be different. For example, TMS is approved and insured for people with *unipolar* depression but doctors including mine have successfully fought insurance companies to cover TMS for bipolar patients and are treating them as well.And these numbers -- 14% and 30% -- are for *remission*. The article touches upon the phenomenon that concurrent medications increased success rates, but it leaves out that there is a greater percentage for whom TMS is still "effective" on their symptoms even though they don't reach remission. SSRIs "don't work" for at least 2/3 of patients.
Either way, it is working for some people who have had a troublesome experience with meds (whatever that may be). If a treatment allows some population to get better in a new way, in my opinion that warrants merit.
Posted by tom2228 on June 22, 2014, at 0:06:40
In reply to Re: TMS Effective in 14% Of Patients, posted by tom2228 on June 21, 2014, at 23:24:25
> > As a depressed person, I'm naturally a skeptic of everything. Fortunately, about half the time I assume the worst, I'm pleasantly surprised. I hoped this would be the case with TMS, but it did absolutely nothing. It was expensive and an enormous waste of time. The article below is proof of what I experienced. According to this article, TMS works for 14 % of the people that try it. With a success rate like that, you have to question the credibility of the FDA. http://well.blogs.nytimes.com/2013/07/01/new-approach-to-depression/?_php=true&_type=blogs&_r=0
>
> Okay, to start, the article says:
> "TMS is approved specifically for patients whose depression does not respond to antidepressants or who cannot tolerate the drugs side effects..."
> which is a highly weasel-worded statement. As it's worded the article makes it seem like the FDA approval is for people who have run the whole gamut of meds and have not responded.... which sets the stage for their larger point that this procedure that is approved for people for whom (most/all) antidepressants don't work isn't even that effective for them! -- i.e. that TMS is just another failure for the (truly) treatment-resistant just like the meds.
>
> In actuality, however the FDA approved it for people who have failed to achieve satisfactory improvement from just ONE(!!) prior antidepressant medication at or above the MINIMAL effective dose and duration in the current episode. I.e., the article is referring to TMS as a procedure for "antidepressant resistance/ intolerance" when by definition of the FDA approval that person includes someone who has tried nothing but say 5mg Lexapro for 4 weeks!! That's hardly a fraction of a degree of "antidepressant resistance" (as the article proclaims) considering the multitude of medications many of us here, myself included, have tried with unsatisfactory results. So really, TMS is largely used in, and has mostly been studied in, people who are NOT truly antidepressant-resistant as we know it here, and includes people who simply do not want to be on meds rather than the meds not working for them.
>
> As well, the official TMS studies are mostly of people who are NOT taking medications when they undergo treatment, By theoretical logic, TMS has has a synergistic effect with medications, and this is not accounted for the studies. Many people in the clinical setting who are not studied, like myself, ARE taking multiple meds while doing TMS.
>
> As the article states:
> "In industry-financed studies that allowed subjects to continue their antidepressant medications while undergoing TMS treatment, which experts say is a more likely situation in the real world, response rates were significantly higher than in the randomized trial conducted by Dr. George. "
>
> Like so most of the official studies follow the conditions of the FDA approval and do not necessarily reflect the population that TMS is used in in the clinical setting, where results and success rates may be different. For example, TMS is approved and insured for people with *unipolar* depression but doctors including mine have successfully fought insurance companies to cover TMS for bipolar patients and are treating them as well.
>
> And these numbers -- 14% and 30% -- are for *remission*. The article touches upon the phenomenon that concurrent medications increased success rates, but it leaves out that there is a greater percentage for whom TMS is still "effective" on their symptoms even though they don't reach remission. SSRIs "don't work" for at least 2/3 of patients.
>
> Either way, it is working for some people who have had a troublesome experience with meds (whatever that may be). If a treatment allows some population to get better in a new way, in my opinion that warrants merit.
>Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study.
http://www.ncbi.nlm.nih.gov/pubmed/15652875I am currently getting TMS (high-frequency left-side and low-frequency right-side) I've had 3 sessions so far, can't say whether I'm any better, but I've definitely noticed something is different. It's complicated because I had finally gotten my meds right before and was starting to do well in my life, so part of me is frustrated/depressed that I am feeling differently, while the other part of me knows I was only partially responding and deserve better. I just hope that if I don't like the results I can go back to feeling the way I did before I started the TMS, that it's not permanent... I guess we'll see.
It's interesting though how the abstract^ mentions significant improvements were noted after only the first week, similar to how I am feeling something already. I'm not taking amitriptyline, but for my own selfish purposes :P I am going to generalize the concept to my antidepressant cocktail, which does include a TCA like amitriptyline.
In addition to the mood stabilizers (lithium, Lamictal XR, Abilify) and my stimulant (Desoxyn), I am on the following ADs:
Marplan 40mg
Deplin 30mg
desipramine 75mg
Mirapex ER 0.375mgSo hopefully there will be some synergy with the TMS as the weeks go by. And hopefully it is an effect that I like -- like I said my meds were the most optimal they have been before the TMS and while I would like to be less depressed, I don't exactly want to screw up what I had going with the meds...
One last thing, they *say* there's no side effects... but if there's synergy between TMS and the meds, and the meds have side effects, then logically the TMS could amplify some of the meds' side effects?
I don't buy the whole no-side-effects thing. My doctor has admitted to me that he's had a patient experience agitation from the treatment -- obviously a side-effect. I myself have noticed a difficulty focusing, thinking/producing fluent thoughts and speech as well as before, and a difficulty in my mathematics skills that was absent before. This is only after 3 treatments but I noticed it after the very first one. Perhaps like meds TMS can cause some disturbances related to the initial effects that level off with continued usage? I sure hope so. Before the TMS my focus was finally at 100% after years of fiddling with the meds..
Posted by tom2228 on June 22, 2014, at 9:06:58
In reply to TMS accelerates response to and effect of (an) AD, posted by tom2228 on June 22, 2014, at 0:06:40
I would like to add that the article mentions only two studies, and they are not meta-analyses.
I have been reading more and there are some studies that have more favorable rates. Some include bipolar patients or concomitant medication, but in each case only one medication was used along side the TMS. I am curious to see how the procedure would fare in people taking multiple agents, like me.
If I am unsatisfied after TMS treatment, I will likely get ketamine treatments, if I can afford it that is.
This is the end of the thread.
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