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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Babbler20 on July 2, 2014, at 22:06:47
Has anyone recently completed TMS? What were you results, if any?
Posted by tom2228 on July 3, 2014, at 6:29:52
In reply to Any Recent TMS Experiences?, posted by Babbler20 on July 2, 2014, at 22:06:47
> Has anyone recently completed TMS? What were you results, if any?
Yes!! Not completed yet but definitely results. I'm at 2.5 weeks right now and I can honestly say that this has been a life-saving procedure for me so far. I'm getting rTMS by the way.
I've been -- I had been, really -- in a deep, highly resistant bipolar depression for about a year.
When I say highly resistant, I mean, and all of which I'm still taking:
Marplan 40mg
Desipramine 75mg
Desoxyn 22.5mg
Deplin 30mg
Mirapex ER 0.375
lithium carb. 900mg
Abilify 9mg
Lamictal XR 100mgWith the desipramine I was feeling a lot better, even happy despite residual depression, but still lots of symptoms including suicidality. I'd been suicidal for the past year, quite potently the past few months. No thoughts now, or fleeting enough that I can shake them off easily -- I'm sure my brain is conditioned to think them even if it's not how I feel. I know it doesn't reflect how I feel right now.
I started noticing benefits towards at the end of the first week. Actually, initially the TMS was f*ck*ng with me/ causing some side effects like tiredness, disinhibition (looking back, positive in some respects), and difficulty concentrating in my calculus course. But then we realized that the protocol (left and right side) we were using perhaps wasn't the most suitable for me and switched.
Supposedly, whereas high-frequency stimulation to the left dorsolateral prefrontal cortex is mainly used in practice for depression, low-frequency stimulation of the right dorsolateral PFC can be good for depression and anxiety, mania (at high frequencies) and PTSD issues. The low-frequency actually decreases activity in the given area by causing repetitive hyperpolarization leading to long-term depression. I was mainly on it for anxiety and to prevent mania, but I was actually quite calm before and well stabilized on my bipolar cocktail, so we ditched it hoping it would deal with the adverse effects I was having.
I was still having benefits anyway, which have continued, and all the adverse effects are GONE. No side-effects. I have more energy, I am more social (!!!), and just not depressed generally! My mom says it's as if a weight has been lifted off my shoulders; I feel much more positive and light. More motivated, even-keel. Wow!!
The TMS has gotten me much closer to remission, and perhaps I'm there already. I'm really excited to see what the next few weeks bring!
I would really encourage those who are still struggling. Even though I am only one case, the fact that it has helped someone who is highly treatment resistant and really run the gamut with meds... has shattered my expectations and the pessimism that I've seen here about rTMS. There's some conception that TMS would only be worth it if it were the deep TMS. F*ck that. Give it a shot if you have the money and/or the insurance (mine is covering it in FULL! even for bipolar depression) and the time 40 minutes a day, 5 days a week for 6-8 weeks). We have to be open-minded despite our past failures with meds.
Speaking of, since I am feeling better I am noticing that perhaps I am a tad bit overmedicated. While I don't want to mess up my progress or cloud the effect of TMS, but perhaps after I'm done I can work on possibly getting off Mirapex or lowering the Abilify by another mg or two.
Best to all of you, and babbler, I'm glad to have this opportunity to respond with my story -- thanks. Will update if you guys are interested.
Posted by SLS on July 3, 2014, at 9:02:56
In reply to Re: Any Recent TMS Experiences?, posted by tom2228 on July 3, 2014, at 6:29:52
Thanks for posting, Tom.
I am beginning to think that rTMS should be my next move.
Are you to go for maintenance treatments for the long-term?
- Scott
Posted by Babbler20 on July 3, 2014, at 10:13:41
In reply to Re: Any Recent TMS Experiences?, posted by tom2228 on July 3, 2014, at 6:29:52
That is awesome! It didn't do anything for me, but I'm glad it helped you.
Posted by tom2228 on July 4, 2014, at 8:33:37
In reply to Re: Any Recent TMS Experiences? » tom2228, posted by SLS on July 3, 2014, at 9:02:56
> Thanks for posting, Tom.
>
> I am beginning to think that rTMS should be my next move.
>
> Are you to go for maintenance treatments for the long-term?
>
>
> - ScottAh, I was hoping you'd see this, Scott. I was at a point where I was satisfied with my meds (finally) but my doctor pushed me not to be content with a state below remission "We're going to get you feeling even better" . The benefits may not be extreme but have made such a difference. I feel more comfortable with myself and socially, more connected to the world as well.
Whether I'll do "maintenance" has yet to be determined. The plan is to finish the 30 treatments and then attempt to taper to see whether I will need subsequent "booster" sessions. From what I've heard "boosters/ maintenance" can be as spare as a few times to once a month to a few times a year. A lot also depends on manipulating the insurance company.
But we did my weekly rating scales again yesterday. On one of the depression scales I had mostly 0/4 with one 1/4 and two 0.5/4 out of 21 questions. The other depression scale had mostly 1/4s and maybe a 0 or two. Anxiety reduced as well. No mania. I was baffled, and the technician called in the doctor who shook my hand and gave me a big hug.
Immediately after, the rest of the day was not bad but less happy to a significant degree. Talk about homeostasis, lol. Go figure. Today's a new day.
Best,
Tom
Posted by ihatedrugs1 on July 24, 2014, at 10:43:43
In reply to Any Recent TMS Experiences?, posted by Babbler20 on July 2, 2014, at 22:06:47
> Has anyone recently completed TMS? What were you results, if any?
I recently completed six weeks of rtms and felt about 65% better. Unfortunately, after 2 months the symptoms came creeping back up. I spent $12,000 out of pocket hoping my insurance will eventually cover it under appeal. In the meantime all the improvement has gone down the tubes because I don't have the money for the maintenance treatment. If my insurance ends up approving it, I'll be the first one in line.
ihatedrugs
Posted by SLS on July 25, 2014, at 11:18:13
In reply to Re: Any Recent TMS Experiences?, posted by ihatedrugs1 on July 24, 2014, at 10:43:43
> > Has anyone recently completed TMS? What were you results, if any?
>
> I recently completed six weeks of rtms and felt about 65% better. Unfortunately, after 2 months the symptoms came creeping back up. I spent $12,000 out of pocket hoping my insurance will eventually cover it under appeal. In the meantime all the improvement has gone down the tubes because I don't have the money for the maintenance treatment. If my insurance ends up approving it, I'll be the first one in line.
>
> ihatedrugsYou must be bitterly disappointed and demoralized. I'm sorry that you must wait to feel better again. It's a torturous tease. I know what that feels like. I guess you can feel optimistic that your brain is responsive to TMS treatment.
Good luck with your appeal.
http://clinicaltmssociety.org/newsletter/fall2013/insurance.php
http://neurostar.com/hcp/reimbursement-support/reimbursement-support-materials/
- Scott
Posted by ihatedrugs1 on July 26, 2014, at 11:25:14
In reply to Re: Any Recent TMS Experiences?, posted by SLS on July 25, 2014, at 11:18:13
Posted by babbler20 on July 26, 2014, at 22:54:13
In reply to Re: Any Recent TMS Experiences?, posted by ihatedrugs1 on July 24, 2014, at 10:43:43
Hi, I have Blue Shield and they cover it. Try switching to them.
Posted by johnLA on July 27, 2014, at 5:17:02
In reply to Re: Any Recent TMS Experiences?, posted by babbler20 on July 26, 2014, at 22:54:13
i will be trying tms as well.
i have blue shield and yes they cover it.
i also put in a call to a doc who does both tms and deep tms. i will report back on what she has to say about each.
i have been reading-up on tms quite a bit. it seems to have the usual %'s as meds; 1/3 a 1/3 a 1/3. meaning 1/3 get real good results, a 1/3 get some improvement and a 1/3 have no improvement. i am reading that 60% or so are getting some type of positive result. i should post some links...
i am very curious if deep tms will prove more effective. as i said, i will report back what the doc in my area says. she has been doing tms for over 4 years and just started this past year doing the deep version. she is one of the first to get the deep tms machine here in LA.
john 'sleepless' in LA :)
Posted by SLS on July 27, 2014, at 10:07:21
In reply to Re: Any Recent TMS Experiences?, posted by johnLA on July 27, 2014, at 5:17:02
> i am very curious if deep tms will prove more effective. as i said, i will report back what the doc in my area says. she has been doing tms for over 4 years and just started this past year doing the deep version. she is one of the first to get the deep tms machine here in LA.
I will be very interested in what you learn about deep TMS.
Good luck.
- Scott
Posted by johnLA on July 27, 2014, at 19:42:38
In reply to Re: Any Recent TMS Experiences? » johnLA, posted by SLS on July 27, 2014, at 10:07:21
hi scott-
good to hear from you. i know you have been struggling lately.
hoping for all of us to find some relief sooner than later.
well, the pdoc i contacted called me back on a sunday. surprised by that. she left 2 long messages.
to answer your specific question;
she said she has seen a 'higher rate of efficacy' with the deep tms than the regular tms. she did not give a %'s or stuff like that.
she also mentioned that there is a little bit more pain associated with the deep tms. mostly involving the facial muscles and jaw area.
also, the time and length of deep tms is shorter typically than regular tms. again according to her.
regular tms can be 30+ treatments (6 weeks) with some maintenance. each session is about 40 minutes.
deep tms is 30 min and 10 to 15 treatments (about 2 or 3 weeks with possible maintenance.)
we have been 'messaging' thru voicemail, so again not too much info, but i find the little she did say to be a positive.
for me the problem is she is not a provider on my insurance. my insurance does cover tms. i am assuming that deep tms will be covered hopefully in the near future as it has been fda approved. and, hopefully studies will show that it has a higher rate of success than just regular tms as this kind pdoc has mentioned.
i will keep you and everyone else posted on whatever i continue to find out.
thanks to hugh for giving me the 'push' to go for this by the way!
i am going to push to start regular tms as soon as i can. my plan is if that doesn't work i will then try deep tms regardless of the cost. (deep tms is about $10k.)godspeed good health to us all.
john
Posted by babbler20 on July 27, 2014, at 21:56:00
In reply to Re: Any Recent TMS Experiences?, posted by johnLA on July 27, 2014, at 5:17:02
Hi, I live in L.A. too. TMS didn't do anything for me, but I didn't do the deep version. You are lucky that you know a doctor that does the deep version of it.
Posted by b2chica on August 3, 2014, at 14:19:54
In reply to Re: Any Recent TMS Experiences?, posted by ihatedrugs1 on July 24, 2014, at 10:43:43
Does anyone know if dTMS. Is better/worse for MDD or bipolar??
This is the end of the thread.
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