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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by Chris O on November 13, 2014, at 18:31:26
If anyone is interested, I'm going into my third week of rTMS and it hasn't (so far) given me a hugely noticeable benefit. Perhaps there is robustly mild antidepressant and anxiolytic effect, but nothing to get me into the workforce, or even the school of the long-term conversation. Still burdened by a heaviness, a feeling of being overwhelmed, and an inability to conduct daily affairs (other than running errands) with any semblance of functionality. If I could just remove this feeling of anxiety that darkens the world, I know I would move forward with my life. Right now, not feeling like rTMS is going to do much, but I've still got 16 more treatments to go (if insurance approves). Also, my psychiatrist mentioned switching the magnet to the right dorsal lateral prefrontal cortex (versus the left) as that region of focus has been more successful in treating PTSD, GAD, OCD, SAD, etc. Anyway, I'll write another post in a couple of weeks if anyone is interested.
Chris
Posted by Phillipa on November 13, 2014, at 20:05:31
In reply to rTMS after two weeks--Meh. Wish it weren't so., posted by Chris O on November 13, 2014, at 18:31:26
Chris of course we are interested. Give it some time it's early in treatment. Phillipa
Posted by Tomatheus on November 13, 2014, at 22:35:53
In reply to rTMS after two weeks--Meh. Wish it weren't so., posted by Chris O on November 13, 2014, at 18:31:26
Thank you for checking in with us, Chris. It is, of course, too bad that you're only benefiting minimally from your rTMS sessions, but as Phillipa said, maybe with more time you'll notice more improvements, especially if you end up getting the placement of the magnet changed. Good luck with your future sessions.
Tomatheus
Posted by Chris O on November 13, 2014, at 22:38:17
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by Tomatheus on November 13, 2014, at 22:35:53
Thanks, Tomatheus. We'll see what happens. I've had 16 "treatments" so it doesn't feel "early," but if it's harmless and it works, I'm fine with doing this as long as it takes.
Chris
Posted by Chris O on November 13, 2014, at 22:38:59
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by Phillipa on November 13, 2014, at 20:05:31
Thanks, Phillipa. Always appreciate your encouraging words.
Chris
Posted by Phillipa on November 14, 2014, at 21:03:26
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Phillipa, posted by Chris O on November 13, 2014, at 22:38:59
Chris you are welcome and sincerely hope the treatments start working well really soon for you. Phillipa
Posted by Hugh on November 15, 2014, at 11:59:21
In reply to rTMS after two weeks--Meh. Wish it weren't so., posted by Chris O on November 13, 2014, at 18:31:26
Is your psychiatrist ready to try the right side now? Or does he want you to do the remaining 16 sessions on the left side first?
Posted by Chris O on November 15, 2014, at 14:50:04
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by Hugh on November 15, 2014, at 11:59:21
Hugh:
Thanks for checking in. I think we talked a bit before when I was on Brintellix earlier this year. Hope you are doing well.
Right vs. left: That's a good question. I just met with my psychiatrist yesterday. It sounds like he is open to trying anything, but he was leaning toward keeping the magnet on the left side to "finish out the protocol." (I have had 14 treatments so far. I think "the protocol" is 30-40 in most of the trials.) But I almost felt like he was leaving it up to me on some level. I have no idea what to do, really.
I think there is some benefit to what is happening on the left side, but it is not nearly strong enough, and it's not removing this layer of anxiety that coats my world in a dim shade of fear (even though most people around me do not seem to notice this). I am not able to work and still do not sleep for more than (it seems) 1-2 hours at a time, even with my CPAP machine.
I am also having some issues with the young woman who operates the rTMS machine. Because she is "treating" me, I am trying to be honest with her about the level of dysfunction my anxiety symptoms cause me. Yet, she seems ... I don't want to say irritated... but not completely empathetic to how negatively my anxiety impacts my life. It seems to irritate her, like she thinks I am "faking it" or something, like I am getting a free ride by not working and that my complaints are all whining. She also seems irritated when I pretend my anxiety isn't there and try to relate as best I can as "normal." There is probably some projection going on here, as I often do this with women. (I am thinking inside she thinks I am a "loser" and don't really have anything wrong with me and am leeching off my wife, which is the way I perceive myself, but even if she did feel that way, I want to be able to say "So what?" inside and move on, but I can't. If I were anxiety free, I could.)
It also bothers me that my psychiatrist basically passed me off to another person who I have to be intimate with about my issues, but who seems not to get them. Obviously, the psychiatrist cannot manage the 20 or so patients doing the treatment, but ... the whole thing bugs me. (I wrote a long tirade about this, but just deleted it. It doesn't matter, in the end.)
Anyway, right now, not super hopeful about this treatment for me. I'm slightly less overwhelmed by everything, notice myself talking to people more, but still feel quite out of it everyday, like I have to force myself to do everything, including getting dressed and getting out of bed. We shall see.
Chris
Posted by phidippus on November 15, 2014, at 17:00:49
In reply to rTMS after two weeks--Meh. Wish it weren't so., posted by Chris O on November 13, 2014, at 18:31:26
I still have a hard time believing this is a medical therapy.
Eric
Posted by Phillipa on November 15, 2014, at 19:19:35
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Hugh, posted by Chris O on November 15, 2014, at 14:50:04
Chris but you're doing it and that's an improvement isn't it? The heck with the lady and the machine. I will say it for you go jump in a lake lady you are not the one with the illness and if you did have it you would do just about anything to be rid of it. So Chris I told her for you. Phillipa
Posted by Mogger on November 15, 2014, at 20:23:41
In reply to rTMS after two weeks--Meh. Wish it weren't so., posted by Chris O on November 13, 2014, at 18:31:26
My fingers and toes are crossed for you Chris O hoping this helps you. Definitely keep us updated. Hang in there,
Mogger
Posted by Chris O on November 15, 2014, at 22:12:38
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by Mogger on November 15, 2014, at 20:23:41
Mogger:
Thanks for the support. I really appreciate it. I hope you are doing well, too.
Chris
Posted by Chris O on November 15, 2014, at 22:14:59
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by Phillipa on November 15, 2014, at 19:19:35
Phillipa:
Thanks for that. One of my issues is feeling guilty when I am more assertive and direct. I find myself really struggling with this dynamic with her. I will just see what happens.
Chris
Posted by Chris O on November 15, 2014, at 22:30:38
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 15, 2014, at 17:00:49
"I still have a hard time believing this is a medical therapy."
Eric:
Yes, I do, too. It seems that there are too many variables with magnet location, strength, number of pulses, amount of time needed, etc. If it does activate neurons in a positive way and the benefit is robust, well, great. If not, it's a lot of money to dole out, and I can even see how the dreaded insurance companies would be reluctant about covering it. I am desperate, though. I definitely have a severe, biologically-based anxiety disorder and it's so disabling and perception distorting and self-negating that I must do anything I can to heal my brain.
Chris
Posted by mogger on November 15, 2014, at 22:52:36
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 15, 2014, at 22:30:38
Chris,
Have you tried mostly serotonergic based medications for your anxiety? I have perception distorting (I have never heard that description before and it fits me perfectly) anxiety since I was 5 years old. I have ocd but have managed with medication to cut down on my rituals but I still have crippling anxiety. Rilutek (Riluzole) was incredible for my anxiety and boosted my mood but I had to discontinue due to a strange side effect of not being able to put a sentence together but I am convinced it was because I was taking it with lamictal and klonopin. Anyways, it targets anxiety a different way than serotonergic meds. just a thought.
Posted by Zyprexa on November 16, 2014, at 1:09:00
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 15, 2014, at 22:30:38
Chris,
Do you take any meds right now. You might get faster action out of your rTMS if you mix it with meds?
Posted by Chris O on November 16, 2014, at 11:44:39
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by mogger on November 15, 2014, at 22:52:36
Mogger:
Thanks for the suggestion. I know nothing about this Riluzole. (Just read the Wikipedia article on it.) I'd be willing to try it if my psychiatrist could convince me it's worth it, and that it's safe.
Chris
Posted by Chris O on November 16, 2014, at 11:48:38
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by Zyprexa on November 16, 2014, at 1:09:00
No meds at the moment. It looks like all of the serotonin-based drugs are failing me on some level. So, not sure where to go next. Psychiatrist is flexible, but doesn't seem to have a strong opinion either (obviously open to MAOI Inhibitors, TCAs, antipsychotics, but nothing truly novel), probably because of so many failures. Thanks for the feedback. I appreciate it.
Chris
Posted by Hugh on November 16, 2014, at 20:35:06
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Hugh, posted by Chris O on November 15, 2014, at 14:50:04
I'm sorry to hear that your rTMS technician makes you feel judged. Whether it's projection or the real thing, it's a lousy feeling.
A couple Babblers who did rTMS didn't respond until about the 20th session. Some responded much earlier and some never responded. Since your psychiatrist seems to be open to trying anything, if and when you decide to treat the right side, rTMS appears to be significantly more effective if priming stimulation is used. This means a brief exposure to 6 hertz, followed by a much longer exposure to 1 or 2 hertz. Here's an article about it:
Posted by Chris O on November 16, 2014, at 23:15:31
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by Hugh on November 16, 2014, at 20:35:06
Hugh:
Thanks for that information. I will definitely mention it to my psychiatrist the next time I see him. I actually feel like I am getting some benefit out of rTMS already, though it's like "robust tepid," or something like that.
Another thing that bothered me after my last session (my 14th) was that the woman in charge of the rTMS machine had not gotten approval for my next 16 sessions (insurance only approved 16 so far). So, I told her that even though I was not sure I was experiencing robust improvement yet, I wanted to make certain I got approval for the next 16. She (in my eyes at least) huffed off and said, "Chris, we'll work on getting approval." I know I can be annoying with my anxiety, but if I do not get approval, I will definitely be having words with the psychiatrist about his letting this young lady be in charge of my care. That is going to piss me off royally if I go in there tomorrow or Tuesday and do not get approved for more sessions.
Chris
Posted by phidippus on November 18, 2014, at 17:11:06
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 15, 2014, at 22:30:38
Have you considered deep brain stimulation or Vagus Nerve Stimulation?
Eric
Posted by Chris O on November 19, 2014, at 0:19:50
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 18, 2014, at 17:11:06
Eric:
Well, not really. Having a device implanted in my brain horrifies me, though I guess if it caused miraculous recovery, allowing me to take complete authority and control over my life--career, property, fulfilling personal relationships, the works--I'd consider it. Short of that, I don't think so. What about you?
Chris
Posted by phidippus on November 19, 2014, at 12:49:30
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 19, 2014, at 0:19:50
Nah, I have a cocktail that's working for me. Though I was assessed for DBS a couple years ago.
Eric
Posted by Chris O on November 19, 2014, at 15:20:40
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 19, 2014, at 12:49:30
Eric:
Now that you mention it, I think I remember you talking about that. Glad to hear that your cocktail is doing the trick. My p-doc is having a peer-to-peer review with my insurance company to see if I get to continue rTMS for another 16 sessions. I think it's doing something positive, so I'd at least like to continue this current trial before moving on to something else.
Chris
Posted by phidippus on November 20, 2014, at 15:06:31
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 19, 2014, at 15:20:40
My cocktail is ridiculous, however. Check it out:
Lithium 1050 mg
Carbamazapine 800 mg
Zonegran 200 mg
Geodon 160 mg
Luvox 100 mg
Vyvanse 70 mgSo what kind of benefit do you perceive you are getting from the rTMS?
Eric
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