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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by poser938 on February 7, 2012, at 18:33:59
well i completed my 13th session of rTMS today and still zero benefits from it. but, an idea popped into my head, i have read about how TMS is done in different frequencies. 1-HZ and 20HZ. and differnt patients respond to different frequencies. im wondering what the protocol fequency is that they use when having this done? if nobody on psychobabble nows, i will be asking my doc tommorrow. my idea is i might need to get it changed to a different frequency to receive benefits from it.
Posted by Emily Elizabeth on February 7, 2012, at 19:07:47
In reply to different frequencies for rTMS, posted by poser938 on February 7, 2012, at 18:33:59
I posted to you above wondering how your treatment was going. I am sorry to hear that it isn't helping. I don't know the answer to your question, but def ask your doc. Ask lots of questions! Fingers crossed for you!
Best,
EE
Posted by Phillipa on February 7, 2012, at 19:09:49
In reply to Re: different frequencies for rTMS, posted by Emily Elizabeth on February 7, 2012, at 19:07:47
I'm hoping it begins to work for you. Phillipa
Posted by SLS on February 7, 2012, at 22:52:13
In reply to different frequencies for rTMS, posted by poser938 on February 7, 2012, at 18:33:59
> well i completed my 13th session of rTMS today and still zero benefits from it. but, an idea popped into my head, i have read about how TMS is done in different frequencies. 1-HZ and 20HZ. and differnt patients respond to different frequencies. im wondering what the protocol fequency is that they use when having this done? if nobody on psychobabble nows, i will be asking my doc tommorrow. my idea is i might need to get it changed to a different frequency to receive benefits from it.
10 Hz applied to the left side at 120% motor threshold is probably the most commonly used parameters for applying rTMS. 1 Hz applied to the right side can work, but probably not as well. Some protocols involve administering both treatments. However, 1 Hz applied to the left side can make depression worse.
The original studies of rTMS used 20 Hz.
- Scott
Posted by poser938 on February 7, 2012, at 22:53:26
In reply to Re: different frequencies for rTMS, posted by Phillipa on February 7, 2012, at 19:09:49
hmm.. okay i just found where it says gthe FDA approved treatment parameters are set at 10hz.
there are studies of it being used at 1 hz. 10hz. and 20 hz. 1hz is actually supposed to inhibit brain activity. and 20hz stimulates brain activity. and 10hz is somewhere in the middle.
i dont know if you can change the setting to 20hz on the machine, but since its not FDA approved would my doc still be able today it if possible?
Posted by SLS on February 7, 2012, at 23:17:14
In reply to Re: different frequencies for rTMS, posted by poser938 on February 7, 2012, at 22:53:26
> hmm.. okay i just found where it says gthe FDA approved treatment parameters are set at 10hz.
> there are studies of it being used at 1 hz. 10hz. and 20 hz. 1hz is actually supposed to inhibit brain activity. and 20hz stimulates brain activity. and 10hz is somewhere in the middle.
> i dont know if you can change the setting to 20hz on the machine, but since its not FDA approved would my doc still be able today it if possible?20 Hz might not work as well as 10 Hz. More is not always better. Both frequencies are stimulatory, though. It might depend upon the frequency of depolarization of the neurons being induced and the occurrence of accommodation as to whether 20 Hz is less effective. Too high a frequency of rTMS might inhibit action potentials (firings) in a certain potential of neurons.
- Scott
Posted by poser938 on February 8, 2012, at 9:45:50
In reply to Re: different frequencies for rTMS » poser938, posted by SLS on February 7, 2012, at 23:17:14
yes, i know more may not be better. it could be worse. i just know my problem feels like too little brain activity. my emotions are blank and my head feels empty, like i dont even have a brain. i guess that sounds weird, but thats is how i feel. they didnt do a brain scan like they sometimes do before doing rTMS, but i did have a PET scan done about 2 years ago. they might be able to get that and look at and igure out which frequency might be best for me. i will just see what gthe doc thiks.. she seems much better than my regular doc.
Posted by SLS on February 8, 2012, at 10:46:31
In reply to Re: different frequencies for rTMS, posted by poser938 on February 8, 2012, at 9:45:50
> i just know my problem feels like too little brain activity. my emotions are blank and my head feels empty, like i dont even have a brain. i guess that sounds weird, but thats is how i feel.
I know the feeling only too well. Cases like yours and mine are sometimes called "flat-liners".
My PET scan was blue in the cerebral cortex with the exception of the visual cortex, a region that always lights up. The blue regions indicate hypoactivity. These illnesses can strip one of their humanity. At my baseline depression, I feel sub-human. My level of function is certainly sub-human.
- Scott
Posted by Twinleaf on February 8, 2012, at 12:56:20
In reply to Re: different frequencies for rTMS » poser938, posted by SLS on February 8, 2012, at 10:46:31
One of the things which TMS has been repeatedly reported to do is to stimulate the left frontal area, increasing neuronal activity and therefore blood flow to that region - turning blue to orange.
I know it's very very hard, but try to stick with the regular frequency - that should give you your best chance. Increasing the intensity of the pulses might be a good move.
Posted by Bob on February 8, 2012, at 12:56:41
In reply to Re: different frequencies for rTMS » poser938, posted by SLS on February 8, 2012, at 10:46:31
> > i just know my problem feels like too little brain activity. my emotions are blank and my head feels empty, like i dont even have a brain. i guess that sounds weird, but thats is how i feel.
>
> I know the feeling only too well. Cases like yours and mine are sometimes called "flat-liners".
>
> My PET scan was blue in the cerebral cortex with the exception of the visual cortex, a region that always lights up. The blue regions indicate hypoactivity. These illnesses can strip one of their humanity. At my baseline depression, I feel sub-human. My level of function is certainly sub-human.
>
>
> - Scott
>
>
What's amazing to me with these type illnesses is the unbelievable distress - or lack of energy on the other side of the coin - that can be caused without the physical body giving out. There have been times when I thought my body was eventually going to give way and it didn't. I guess eventually it would happen but it's already surprising.Bob
Posted by Twinleaf on February 8, 2012, at 13:10:46
In reply to Blue areas..., posted by Twinleaf on February 8, 2012, at 12:56:20
Just wanted to say -I have had TMS 12 times over the past 8 years, first as part of a study, then "off-label" until it became approved. I originally had severe MDD, which is now pretty much in remission. I consider intensive psychotherapy and TMS to be the two things that helped the most (the only medication which helped was tianeptine, which I still take).
TMS acts in a number of ways to normalize the brain towards its pre-depression state, and it does no harm, so it is worth the fullest trial you are able to give it.
Posted by SLS on February 8, 2012, at 13:13:48
In reply to Blue areas..., posted by Twinleaf on February 8, 2012, at 12:56:20
My PET scan looked like this:
http://www.slschofield.com/medicine/pet_scan_depression.jpg
- Scott
Posted by SLS on February 8, 2012, at 13:15:56
In reply to Blue areas..., posted by Twinleaf on February 8, 2012, at 12:56:20
> Increasing the intensity of the pulses might be a good move.
I hadn't thought of that. I guess it can't hurt to ask.
- Scott
Posted by b2chica on February 8, 2012, at 15:53:12
In reply to Re: Blue areas... » Twinleaf, posted by SLS on February 8, 2012, at 13:15:56
what about decreasing the frequencies?
you will actually increase the wave size doing that.
the higher the frequency the closer the waves are together the periodicity changes.
lower might be an option to?
cant remember what you said you were at 20?
might try 10 or 5 too.
our brains process different frequencies differently.Best wishes.
Posted by poser938 on February 8, 2012, at 18:13:46
In reply to Re: Blue areas..., posted by b2chica on February 8, 2012, at 15:53:12
well im going to try and write, i'm a little wore out mentally at the moment, but i got back from my 15th treatment and still no results. like, i said before.. they are doing 2 treatments on me a day since i am 3 hours from home and staying a hotel. right now i cant recall some things, but today they increased the number of times it taps. i can remember the exact numbers but it went from being like 3 seconds long to 4 seconds. i just had 2 sessions today with it like and no results yet, but they are going to be getting my PET scan results that i had done 2 years ago to see if they can adjust the treatment from what it shows on the scan. im quite a bit worse now, then i was when i had the PET scand done, but it is still the same basic problem.
Posted by Twinleaf on February 8, 2012, at 18:40:30
In reply to Re: Blue areas..., posted by SLS on February 8, 2012, at 13:13:48
Oh, Scott, that's extremely blue! Did you see my post above about my pdoc giving formulated oral ketamine to a severely bipolar patient? It sounds like you need something outside of the ordinary- that might be worth a try, and is apparently available right now with more forward-thinking psychiatrists.
Posted by sailboat77 on February 8, 2012, at 18:55:12
In reply to Re: Blue areas..., posted by poser938 on February 8, 2012, at 18:13:46
I don't know if anyone has a similar experience or has more knowledge on this subject, but I've experienced a "residual effect" almost 2-3 weeks after my TMS treatments have ended. My mood seems to be gradually still improving. Sometimes it takes a while for your depression to get better. My treatments were increased in both duration and intensity, which may have helped.
Again, I'm not entirely certain if my understanding is 100% accurate, but from what I understand, neurons are being repaired and reactivated by the magnetic pulses. So instead of the classic approach of balancing neuro-chemicals with medications, TMS focuses on the actual structure of the brain.
Posted by SLS on February 9, 2012, at 6:33:08
In reply to Re: Blue areas..., posted by Twinleaf on February 8, 2012, at 18:40:30
> Oh, Scott, that's extremely blue! Did you see my post above about my pdoc giving formulated oral ketamine to a severely bipolar patient? It sounds like you need something outside of the ordinary- that might be worth a try, and is apparently available right now with more forward-thinking psychiatrists.
If necessary, I will lobby my doctor to try ketamine. Thanks for the encouragement. I am currently watching Morgan Miller's trial of LDN (low-dose naltrexone) to treat his depression.
We do have quite a few guinea pigs here.
I like the idea of rTMS, too.
I am currently experiencing a significant improvement in depression due to the addition of prazosin (Minipress) to my treatment regime. My doctor chose it when he learned of my history of childhood abuse and neglect. I almost didn't try prazosin. It seemed like too great a reach, and I didn't buy my doctor's explanation that I may have occult PTSD. I don't have PTSD, but rate very high in the "prisoner of war" subscale of the MMPI. My doctors at the NIH acted as if they had never seen that before in a case of depression. I have truly been imprisoned for decades, so this didn't surprise me. It's funny, but when they saw my PET scan, they revealed to me that I was "very sick". No kidding. I don't need a PET scan to tell me that. It is helpful to educate people, though, and convince them that I have a disorder of brain function.
My concern is that my current improvement may plateau early in treatment. I am no more than 25% improved right now. That's a lot for me, but not nearly enough to get me back to work, which is my goal.
I don't understand how someone with depression can be employed. It doesn't make sense to me.
Without treatment, I score 34-37 on the HAM-D depression rating scale. That's ridiculous. Even a 25% improvement still leaves me severely affected.
Sorry to complain. Some people here accuse me of "showing off" whenever I describe in some detail what I experience as depression. It is not a contest, but I find comparisons helpful sometimes.
- Scott
Posted by SLS on February 9, 2012, at 6:42:26
In reply to Keep at it, posted by sailboat77 on February 8, 2012, at 18:55:12
> I don't know if anyone has a similar experience or has more knowledge on this subject, but I've experienced a "residual effect" almost 2-3 weeks after my TMS treatments have ended.
> My mood seems to be gradually still improving.
Are you more than 50% improved? How many weeks has it been since your last treatment?
> Sometimes it takes a while for your depression to get better. My treatments were increased in both duration and intensity, which may have helped.
Do you know what frequency was used?
> TMS focuses on the actual structure of the brain.
Successful antidepressant treatment leads to structural changes in the brain also.
I hope your gradual improvement leads to remission.
- Scott
Posted by Twinleaf on February 9, 2012, at 7:07:33
In reply to Re: Keep at it » sailboat77, posted by SLS on February 9, 2012, at 6:42:26
As you know, I think TMS can be very helpful; of all the treatments available, it appears to be the most physiologically apt. It is almost always never a permanent solution, though, and the cost of initial and repeat treatments can be very high. I do think it is very worth a try, because it's wonderful, and side-effect-free, when it does work.
The bipolar patient treated successfully with oral ketamine had a strong combination of genetic and traumatic factors: there were several close relatives who were also bipolar, and he had been abandoned by his mother (because of her bipolar illness). His pdoc, who is also mine, looked frankly amazed and thrilled that ketamine had had such a beneficial effect!
Posted by sailboat77 on February 9, 2012, at 13:41:58
In reply to Re: Keep at it » sailboat77, posted by SLS on February 9, 2012, at 6:42:26
I'm uncertain of the frequency, just that the intensity was increased or the amount of pulses given per minute. My last TMS treatment was probably 5 weeks ago. To scale my improvement in mood, I would say I went from a 4 to 7.5 (1 being completely debilitated and a 10 being without signs of depression). As a side note, I'm still on Parnate and we're now trying Lamicatal again. Also, CBT (cognitive behavioral therapy) has been real important because my thought process had been distorted by depression since the age of 13. I'm now 25.
I'm unsure of whether I'll need follow-up treatments in the future. My doctor said not everybody needs it, but some do.
Posted by Emily Elizabeth on February 9, 2012, at 16:40:18
In reply to Re: Keep at it, posted by sailboat77 on February 9, 2012, at 13:41:58
I almost feel bad posting this because I know poser is struggling right now and not having a response to TMS. But I thought it might be valuable/hopeful information for others.
I have had 9 treatments so far and I have had dramatic improvement. If I had to rate the change in my mood on a scale from 1-10, I would say I went from a 2 to an 8.5. I still have a little more I am hoping to improve, but I have at least 6 treatments left.
Best,
EE
Posted by Twinleaf on February 9, 2012, at 17:08:47
In reply to Re: Keep at it, posted by Emily Elizabeth on February 9, 2012, at 16:40:18
That is wonderful to hear - thanks for letting us know. It's also good to hear that others have had a more gradual, but still robust response.
Posted by poser938 on February 9, 2012, at 18:18:47
In reply to Re: Keep at it, posted by Twinleaf on February 9, 2012, at 17:08:47
well, i just got back from my 17th treatment and still nothing. so far it has been no more valuable for me than going to my friens house and have him poke me with a stick for 45 minutes.
but, elizabeth, what percent of motor threshhold do they have you on?
Posted by Emily Elizabeth on February 9, 2012, at 19:03:02
In reply to Re: Keep at it, posted by poser938 on February 9, 2012, at 18:18:47
I actually don't know about the motor threshold question. I can ask tomorrow. I know at one point he bumped it up to make sure I was getting maximum benefit.
Actually, today he had it angled a little funny and it was making my teeth chatter until he adjusted it. Kinda freaky!!
Take care. I hope things improve for you soon. I hate to voice this aloud, but what is your pdoc's plan if this doesn't work for you? Sending healing thoughts your way.
Best,
EE
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