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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Dave1 on March 28, 2003, at 14:50:49
Hi,
I was considering transcranial magnetic stimulation. Does anyone know if and where it is available non-experimentally?
Thanks,
Dave
Posted by Pfinstegg on March 29, 2003, at 10:41:03
In reply to rTMS available non-experimentally ?, posted by Dave1 on March 28, 2003, at 14:50:49
Hi.. I do. I had a three-week course of TMS given by Dr. Mark Hutto at the North Atlanta Psychiatric Associates in Atlanta, Georgia. He was recommended by the Emory University Dept. of Psychiatry. As you know, TMS is not approved by the FDA, as yet, so insurance does not cover the cost.
The treatment was slightly painful, although very bearable with codeine beforehand, and free of any side-effects such as short-term memory loss. It was also extremely effective! I had a 10-year treatment-resistant unipolar depression, which is now in complete remission.
I can recommend Dr. Hutto with complete confidence. He has had 20 years of experience with ECT, and, in addition to the training in TMS which he received at the University of South Carolina, has been giving it in his private practice for the past two years.
I hope this will be helpful.
Pfinstegg
Posted by SLS on March 29, 2003, at 11:11:28
In reply to Re: rTMS available non-experimentally ? » Dave1, posted by Pfinstegg on March 29, 2003, at 10:41:03
> As you know, TMS is not approved by the FDA, as yet, so insurance does not cover the cost.
> The treatment was slightly painful, although It was also extremely effective! I had a 10-year treatment-resistant unipolar depression, which is now in complete remission.
Hi.How much did it cost?
Do you need maintenance treatments?
Were you able to take medication during the treatment-period?
Are you taking medication now? How did you go about choosing medications?
Thanks.
- Scott
Posted by Pfinstegg on March 29, 2003, at 12:10:40
In reply to Re: rTMS available non-experimentally ? » Pfinstegg, posted by SLS on March 29, 2003, at 11:11:28
Hi.. The full cost was $170 per treatment, so about $2500 for three weeks of treatment. I think they do have a sliding scale, depending on one's income. You of course have to figure in the cost of travel to Atlanta and housing (they gave me the name of a residence motel which had a kitchen, so that kept the living costs down).
You can continue to take any medications which you are already taking, as far as I know. I did.
I am now taking Cytomel, synthroid, fish oil, lots of vitamins and minerals and tianeptine. This last one is an odd choice, but I have had excessive cortisol and DST non-suppression in the past, and wanted to protect my hippocampus from its effects, if I could. With the TMS, I reverted to being a DST suppressor, and I am really hoping to keep it that way!
They often re-treat people in Atlanta, usually giving two treatments a day for two or three days. I finished my initial course only two months ago, and am fine so far; however, if I need to, i would definitely return for further treatment.
Pfinstegg
Posted by Dave1 on March 29, 2003, at 17:04:34
In reply to Re: rTMS available non-experimentally ? » SLS, posted by Pfinstegg on March 29, 2003, at 12:10:40
1. -
Pfinstegg.. - Thanks for the info. - very helpful.
Also does tianeptine protect your brain from cortisol damage?2-
ANYONE else had rTMS, experimentally or not? If so did it help.Thanks,
Dave
Posted by Pfinstegg on March 30, 2003, at 21:27:26
In reply to Re: rTMS - Has anyone else had this successfully?, posted by Dave1 on March 29, 2003, at 17:04:34
In studies done at the German Primate Center, baby tree shrews with excess cortisol due to the stress of maternal separation had abnormalities in their hippocampuses( neuron loss, dendritic shortening and smaller total volume). If they were stressed in the same way while taking tianeptine, these abnormalities did not occur. This finding has been replicated several times in other research centers, but, as far as I know, there have not been any studies in human beings.
Pfinstegg
Posted by denise528 on March 31, 2003, at 6:50:03
In reply to Re: rTMS - Has anyone else had this successfully? » Dave1, posted by Pfinstegg on March 30, 2003, at 21:27:26
Hi
I've searched high and low on the internet and can't seem to find anybody else who has had this treatment apart from two who both said it didn't work. Maybe they had it a long time ago when the most effective stimulation and frequency hadn't been identified. However, if this treatment is any good why aren't others coming forward, the same thing applies to VNS?
Denise
Posted by Dave1 on March 31, 2003, at 18:47:13
In reply to rTMS How come no one else seems to have had this?, posted by denise528 on March 31, 2003, at 6:50:03
If you do a search on this site back through '98, they had alot of posts about it. For people who had tried it, there weren't that many, about half had success, half didn't. Of those who had success it didn't last very long, same as ECT. That's why I was intrigued by Pfinsteggs post about the place where you can do it commercially. That way you could get follow up, just like ECT. Also, maybe the pamelar + lithium which is supposed work so well for preventing relapse after ECT would work after TMS. I don't know, anythings better than ECT.
Dave
Posted by Dave1 on March 31, 2003, at 18:55:08
In reply to Re: rTMS - Has anyone else had this successfully? » Dave1, posted by Pfinstegg on March 30, 2003, at 21:27:26
I looked up tianeptine and the descriptions of the drug seem to support what you say. They said it was an antidepressant, but I couldn't tell what class it is from. Maybe you know. Also, I came across a called drug called ketoconazale (I think thats the spelling) that supposed to lower cortisol.
The reason I was so interested is that I have OCD and my worries cause alot of stress which I was worried was damaging my brain via cortisol. I mentioned it to my shrink and he said there are alot of chemicals that effect your brain. So maybe there are others, not identified yet, that are neurotoxic that are released during stress.
Thanks,
Dave
Posted by Pfinstegg on March 31, 2003, at 20:10:09
In reply to Re: rTMS - Has anyone else had this successfully? » Pfinstegg, posted by Dave1 on March 31, 2003, at 18:55:08
Hi Dave.. I think the cortisol surges are the best studied abnormalities in depression/anxiety- and I'm assuming OCD comes under that general heading- but there are also supposed to be excessive surges in glutamate and mineralo-corticoids, which are also harmful to the neurotransmitters and receptors in the hippocampus. So far, these illnesses are being treated by trying to normalize the levels of serotonin, nor-epinephrine and dopamine in the intercellular spaces. This is helpful, often, but it only minimally addresses the basic problem of CRF-ACTH-cortisol overactivity, and the resultant hippocampal damage. I guess it will be several years at least before the first CRF antagonist is available, but that would certainly be a huge step towards treating the basic disorder in the depressive illnesses.
One of the things which is exciting about both ECT and TMS is that, in about half of the treated cases, the CRF-DST or DST suppression tests revert to normal, indicating that less CRF is produced in response to routine stress. To be completely fair, there are also reports in the literature of the same thing occurring with successful AD treatment, including SSRI's, mood stabilizers and MAOI inhibitors. One of the things which is frustrating is that this is not routinely studied or reported, so we don't know how often it occurs. I think we'll see more information about this as the primacy of HPA axis dysregulation and abnormal glucocorticoid and mineralocorticoid secretion becomes more firmly established.
I think ketaconozodole is used primarily in Cushing's disease. It is effective in reducing cortisol secretion, but there are enough risks to liver function that it isn't used as an AD.
As done in Atlanta, TMS and ECT have almost identical improvement rates of about 63%. The TMS is always given to the left dorsolateral prefrontal cortex at high frequency. (There are studies going on at NIH and the University of Chicago using low-frequency pulses and right frontal application.) Although there is moderate spread of the electro-magnetic pulse to the left hippocampus, amygdala and basal ganglia, there is much less spread than there is with ECT- enough spread to be effective, but not enough to cause short-term memory loss. I think everyone working in this area fully expects that TMS will get FDA approval within a few years- it's now routinely used in Europe and Canada.
If anything I have said doesn't correspond to what you have learned, I hope you will let me know!
Pfinstegg
Posted by Pfinstegg on March 31, 2003, at 21:24:24
In reply to Re: rTMS - Has anyone else had this successfully? » Pfinstegg, posted by Dave1 on March 31, 2003, at 18:55:08
Hi.. I forgot to say what tianeptine is. It is considered an unusual tricyclic AD, but the molecular structure is not very close to the TCA's we are more familiar with. It does not have any anticholinergic effects, such as dry mouth, which all the other TCAs have. It also does not prolong the Q-T interval on EKG, and does not make you drowsy or feeling "flat".
The main thing it does in the brain is to INCREASE the uptake of serotonin- just the opposite of the SSRI's. The result is an increase in 5HT in parts of the hippocampus. It also increases the concentrations of norepinephrine in various parts of the brain, while decreasing them in other regions. It does not influence dopamine metabolism at all.
Most important, to me, is that it is thought to decrease the HPA axis response to stress, and to prevent damaging changes in the molecular structure of the hippocampus. HOW this occurs is not clear at all!
I hope this is relevant to your concerns.
Pfinstegg
Posted by denise528 on April 1, 2003, at 3:43:36
In reply to Re: rTMS How come no one else seems to have had this? » denise528, posted by Dave1 on March 31, 2003, at 18:47:13
Dave,
That's what I found, when you do a search on the web I can find posts going back up to about 2 years ago but nothing since. They've been experimenting with this treatment for years now and as the treatment is now available commercially I can't understand why there aren't more recent posts on it. I suppose I think if it was that good there would be more people broadcasting the fact.
Pfinstegg,
I have a question on cortisol, if a person had high levels of cortisol why wouldn't they develop the symptoms of Cushings syndrome and would it not show up on a normal hormone test? I think someone has answered this question before but I can't find the post.
Denise
Posted by Pfinstegg on April 1, 2003, at 7:53:23
In reply to Re: To Dave and pfinstegg, posted by denise528 on April 1, 2003, at 3:43:36
When stress begins to affect the HPA axis so that it functions abnormally and causes depression and anxiety, the total 24-hour cortisol usually remains normal. A number of studies of PTSD show that the 24-hour cortisol may be LOW. What is abnormal is that there are surges of cortisol in response to what should be normal everyday stressors. In a number of people, trying to shut off the cortisol-releasing function of the adrenals by giving dexamethasone (the DST suppression or CRF-DST suppression tests) indicate that there is chronic overactivity of the hypothalamus(CRF secretion) and of the adrenals (cortisol secretion),
Only a small minority of people develop elevated 24-hour urinary cortisols along with mental illness. You could say that those people do have Cushing's Syndrome, and would be candidates for ketanozodole or mefipristone treatment.
Pfinstegg
Posted by Dave1 on April 1, 2003, at 8:47:58
In reply to Re: To Dave and pfinstegg » denise528, posted by Pfinstegg on April 1, 2003, at 7:53:23
Hi,
FYI,
I posted the cortisol question on my OCD website and this was the response from one of the doctors.
"
There are somewhat conflicting reports on the effects of stress hormones and
chronic stress on the brain. It was recently thought that stress can
actually shrink the hippocampus in patients with PTSD, but i think more
recently studies (using twins - one exposed to severe stress and one not)
indicate that those with a small hippocampus prior to the stressful event
were more likely to develop PTSD.I suppose the bottom line on this is not in. however, i think there is
evidence that chronic stress is not healthy for the body overall.
"Pfinstegg - your info. was very knowledgeable and helpful. You seem to have a very advanced understanding of this brain stuff. I was premed in college but still don't have the understanding you have.
Regarding PTSD, I remember hearing about a study they were doing on car accident patients where they would give beta blockers to prevent PTSD by somehow using the beta blockers to block the accident memories from being imprinted in the accident patients minds. I thought that was interesting.
Dave
Posted by Pfinstegg on April 1, 2003, at 9:28:20
In reply to Re: fyi, more info on cortisol, posted by Dave1 on April 1, 2003, at 8:47:58
Hi Dave..I'm really glad the information was helpful. Actually, I am a doctor, but I didn't learn much of this in medical school. I have just been reading and searching because I have severe PTSD myself, with all the sequelae of anxiety and depression.
I am very grateful to you and many others on the PB board, who over time have provided a wealth of information and important references. I've gotten into a position now where my own psychopharmacologist defers to ME about what to do! So I'm counting on everyone keeping all the up-to-date information and references flowing!
All the very best to you in your endeavors to achieve a full remission from this incredibly tough illness.
Pfinstegg
Posted by Dave1 on April 1, 2003, at 11:55:45
In reply to Re: To Dave and pfinstegg, posted by denise528 on April 1, 2003, at 3:43:36
Hi Denise,
Also, I think if you search for TMS on PUBMED you will find alot of research on it and its success rates. I get alot of information from there and I am lucky because if I find an abstract that interest me on PUBMED I can go to the National Library Medicine and get the whole article because I live close to NIH. Pfinstegg also mentioned MEDLINE (PUBMED).
Thanks,
Dave
Posted by denise528 on April 2, 2003, at 8:03:23
In reply to Re: To Dave and pfinstegg » denise528, posted by Dave1 on April 1, 2003, at 11:55:45
Dave,
Didn't realise that this site existed, just had a look and can't believe how much up to date info there is.
Thanks.....Denise
Posted by denise528 on April 2, 2003, at 8:24:14
In reply to Re: fyi, more info on cortisol » Dave1, posted by Pfinstegg on April 1, 2003, at 9:28:20
.
Posted by denise528 on April 2, 2003, at 8:26:43
In reply to Re: Ureka! Thanks Dave, posted by denise528 on April 2, 2003, at 8:03:23
Dave,
Again, thanks for the site. It's a pity though thatI can't find any more people on the Web who have tried this treatment, I suppose you just have to try it yourself and hope that it works.
Denise
Posted by Dave1 on April 2, 2003, at 8:27:03
In reply to Re: Ureka! Thanks Dave, posted by denise528 on April 2, 2003, at 8:03:23
Yes,
Medline is very good. Two others that you might like.
clinicaltrials.gov - tells current clinical trials around the world.
moodgym.anu.edu.au - online cognitive therapy treatment for depression - free
Dave
Posted by denise528 on April 2, 2003, at 8:32:42
In reply to Re: Ureka! Thanks Dave » denise528, posted by Dave1 on April 2, 2003, at 8:27:03
Dave,
Yes I've been to the clinictrials.gov, trouble is they don't tend to do many trials for drugs for depression in the UK so don't really bother looking on there much.
All of the major trials for these type of drugs tend to be in the States.
Denise
Posted by Dave1 on April 2, 2003, at 8:51:03
In reply to Re: Ureka! Thanks Dave, posted by denise528 on April 2, 2003, at 8:32:42
Hi (not sure if this posted the first time),
Yes PUBMED is really good.
Two others you might like.
clinicaltrials.gov - tells about clinical trials around the world so you can see whats going on.
Note: I read that only 5% of phase I trials ever produce helpful results so most of these probably won't pan out. I guess higher phase trials would indicate some more promising treatments in a few years. I wonder how long it takes for a treatment to go from phase I to commercially available ? - 5 years ?moodgym.anu.edu.au - online cognitive therapy for depression - free. Pretty neat and helpful.
Dave
Posted by denise528 on April 6, 2003, at 12:57:21
In reply to Re: Ureka! Thanks Dave » denise528, posted by Dave1 on April 2, 2003, at 8:51:03
Dave,
Thanks for the site info, I'll take a look at the therapy one but I must admit I tend to shy away from the idea of therapy and am extremely cynical about it. I just don't think I can think/act/talk my way out of this.
I did have therapy years ago when the paxil was working really well, I only went a) so I could get out of work early and b) as the paxil was working so well I wanted to feel that I was constructively doing something to help myself rather than just enjoying the benefits of paxil, I also thought that maybe the therapy would help me to understand why I had been depressed but it didn't really. I think anyone can find reasons for why they could be depressed if they look hard enough. Anyway thanks for the site info again, I will take a look, you never know.
Let us know how you get on with the RTMS, I really hope it works for you, because if it works for you, who knows, it might work for me too.
Denise
Posted by strongu on October 25, 2003, at 1:04:07
In reply to Re: rTMS available non-experimentally ? » Dave1, posted by Pfinstegg on March 29, 2003, at 10:41:03
> Hi.. I do. I had a three-week course of TMS given by Dr. Mark Hutto at the North Atlanta Psychiatric Associates in Atlanta, Georgia. He was recommended by the Emory University Dept. of Psychiatry. As you know, TMS is not approved by the FDA, as yet, so insurance does not cover the cost.
>
> The treatment was slightly painful, although very bearable with codeine beforehand, and free of any side-effects such as short-term memory loss. It was also extremely effective! I had a 10-year treatment-resistant unipolar depression, which is now in complete remission.
>
> I can recommend Dr. Hutto with complete confidence. He has had 20 years of experience with ECT, and, in addition to the training in TMS which he received at the University of South Carolina, has been giving it in his private practice for the past two years.
>
> I hope this will be helpful.
>
> PfinsteggQuick question. Now that it's several months later, are you finding that your remission from depression has continued to hold? Thanks.
strongu
This is the end of the thread.
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