Posted by Eric on January 9, 2000, at 23:43:32
In reply to Re: New ECT-type thing? - rTMS - bad info, posted by Scott L. Schofield on January 9, 2000, at 15:52:30
the man is board certified in both psychiatry and neurology plus on top of that he is a radiologist! Is your psychiatrist all of that? Doubt it LOL.
> > Scott, unless you know something I dont, some of the things you said about rTMS was incorrect.
>
> Thanks for the corrections. I really should not have relied solely on my memory, and I am truly sorry for disseminating misinformation.
>
No it's totally cool dude...dont sweat the load.>
> A real good review of transcranial magnetic stimulation may be found at:
>
> http://archpsyc.ama-assn.org/issues/v56n4/full/ynv8319.html
>
>
> How are you?Im not doing very well, currently off all meds getting ready to try Paxil plus Zyprexa. After that I am trying my first MAOI...probably Parnate. Im petrified of starting the Zyprexa...read all the stuff about neuroleptics causing TD and other movement disorders. I realize the chance is very low with low dose Zyprexa but my anxiety rating is currently off the wall with the knowledge I am going to try that stuff.
> Are you still receiving treatments?
noooooooo way. I was in the clinical trials first back in March 99. I received rTMS the first time in "blinded" or closed trials I believe is what they called it. For two weeks...or 10 magnetic stimulations sessions...I received rTMS. Had to be off all psych meds except for Ambien for sleep for the whole period. Then a month after the session was over I came back to MUSC for my "unblinding." Found out I got the placebo!!! Luckily I didnt "crash" during that period off meds. I personally attest to my not crashing when I went off meds due to the fact that I disciplined myself to swim laps and work out aerobically during that period...even though I hated doing it and felt like absolute crap. I still disciplined myself to do it and that kept me somewhat afloat when off meds.
Then after my unblinding and finding out I had placebo rTMS, I was invited to come back for two weeks of "open trial rTMS" in which I was allowed to be on antidepressants(Effexor XR). I as well as the Docs giving me the rTMS in open trial knew I was getting rTMS this time. I returned in July 99 for the two week session and received 10 treatment sessions.
I did improve on it but I was disappointed in the amount I improved. I experienced an increase in mood and cognitive function for several hours after each morning session. Overall I felt better for several hours after each session. However, it would dissipate after lunch. There was one point about midway thru the two weeks where I did experience "real" improvement and I remember that afternoon going to Folly beach outside of Charleston feeling fantastic several hours after treatment. However, that one dramatic improvement only lasted a few hours...it was not sustained at all. I will say I did feel better overall after my rTMS session in the weeks and months afterwards. However, I am not sure if this was from the rTMS or from the fact that I increased my Effexor XR from 150 mg all the way to 375 mg in the phase immediately after ending rTMS. I think it was some of both, but honestly I think the Effexor XR at high doses did more for me than the rTMS. I might be wrong however, perhaps the rTMS helped me more than I realized.
My Effexor XR did seem to "stick better" and not fade out or poop out as badly after the rTMS.
> What are the current thoughts regarding maintenance therapy?
I dont know what the official word is as I am not in contact with those people anymore. However, my personal opinion about rTMS is that it would probably work a lot better if they could give maintenance treatments. I dont think it has a lot of value when they are just doing it for two week treatment sessions and then its "goodbye see you buddy" and its all over. If however, they could do it for AT LEAST two weeks initially and then follow it up with weekly maintenance rTMS sessions I think it would work better.
I also had the gut instinct that perhaps if they had been able to keep going with me for another two weeks that perhaps I would have gotten a more solid response from it.
My personal opinion of it is that it is not as effective as ECT, but obviously much safer and more realistic to be able to use it in a maintenance fashion. Plus it is a lot cheaper and simpler to administer because you dont have to be anesthesiaized. The very fact that it does not require anesthesia makes it much more desirable than ECT from a cost perspective. Anesthesia is really expensive!!
From what I have heard of ECT, it is VERY effective oftentimes but it does not last oftentimes. But giving maintenance ECT sessions on a maintenance basis to me is just not realistic. Personally, I cant see getting shocked once a month or whatever for the rest of my life even though I know there are a few who do just that.
I was told at Duke psychiatry that they have people who come to Duke once a month just to get a maintenance ECT session!! I just cant see that for myself...more power to them if it works for them though.
But with rTMS, you could theoretically have safe maintenance treatments for the rest of your life...or at least very long term...with no real side effects...it is very safe.
Personally, Im waiting for the scientists to come up with the first genetic engineering treatment for depression...I will be the first one to get it if I can help it. Thats the real future for mental illness...genetic engineering. Bypass all this drug crap and ECT and stuff. Get to the root cause of depression...your genes.
>Eric
poster:Eric
thread:17934
URL: http://www.dr-bob.org/babble/20000101/msgs/18508.html