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Dr. Bob is Robert Hsiung, MD,
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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
Posted by Chris O on November 20, 2014, at 17:05:43
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 20, 2014, at 15:06:31
Wow, that's quite the cocktail. But if it works, and the side effects are not bad, then that's awesome. My psychiatrist's flexibility and lack of pushiness have suited my fear-based personality well, but I sometimes wish he'd dole out some poly-pharmaceutical suggestions, in a compassionate way. He's definitely suggested adding Abify multiple times when I was taking an SSRI, but I always chicken out after holding on to the samples for a couple of months.
Just curious (and feel free not to answer if this is too personal): Are you able to work full time, make enough money to survive on your own, and manage your life well with this combo? That's really what I'm searching for. Right now, I just get too overwhelmed when faced with the prospect of managing finances, etc.
Anyway, the rTMS is definitely having a noticeable (mildly) antidepressant effect on me. I have found it much easier to talk to people the last few weeks; I am less codependent about their reactions to me (I am hypersensitive to people's facial expressions and moods), I feel less guilty about asserting myself (which for me just means talking to people), and I have slightly more energy. Sleep has improved a bit, though my sleep apnea sometimes makes it hard to know how much. I don't think it's placebo, but I wouldn't rule that out completely, as I am getting some attention everyday, and I am hoping/supposed to be "getting better" That in itself is a powerful elixir.
Also, my insurance did approve 15 more sessions, and I had more first one in that group today. The doctor advised doing a bilateral rTMS this round (half the 40 minute session on the left DLPFC, half on the right DLPFC), but I have to say, I felt worse after this treatment (I was feeling better before). And since the doctor wasn't there, and it is just the lady in the office who does the rTMS, I wasn't sure if she even did the treatment correctly. Not sure if it's supposed to be low frequency rTMS on the right side (many studies used low frequency rTMS for the right DLPFC treatments, high frequency for the left DLPFC), or if it even matters. As to your earlier comment (that you can't believe rTMS is even considered a valid treatment), there do seem to be too many variables to even know what's going on. My feeling thus far is that there is an overall lack of professionalism in the administration of rTMS, but ... I have too many thoughts about this topic to share right now.
Anyway, sorry for babbling. Hope you are doing well. Thanks for interacting with me.
Chris
Posted by phidippus on November 20, 2014, at 17:34:08
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 20, 2014, at 17:05:43
>Are you able to work full time, make enough money to survive on your own, and manage your life well with this combo?
This combo is brand new with the addition of the Carbamazapine and Zonegran as of the beginning of the week, but previous I was functioning just fine on the lithium, luvox, geodon and vyvanse. It just never fails that about a month into treatment with an ssri I become manic. So we had to add the carbamazapine. The Zonegran is just for fun-see if it improves mood and helps my ocd.
I was working a job part time-I started back in July. I just quit to focus on school. So I guess you can say I'm pretty functional (school and work would be too much, I will admit).
>but I sometimes wish he'd dole out some poly-pharmaceutical suggestions, in a compassionate way.
What are you taking and what is your diagnosis?
>I have found it much easier to talk to people the last few weeks
Interesting you would first measure the success of your treatments by the way you interact with people.
>my sleep apnea sometimes makes it hard to know how much.
I have sleep apnea too.
>it is just the lady in the office who does the rTMS, I wasn't sure if she even did the treatment correctly.
That's scary. Is she trained?
>Anyway, sorry for babbling. Hope you are doing well. Thanks for interacting with me.
You aren't babbling and I'm doing well. Interacting with you is a pleasure. You are my friend.
Eric
Posted by mogger on November 20, 2014, at 17:39:41
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 20, 2014, at 17:34:08
Keep us posted Eric regarding Zonegran and hopefully being effective for your ocd. Did you ever try topamax for ocd?
mogger
Posted by phidippus on November 20, 2014, at 18:13:10
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by mogger on November 20, 2014, at 17:39:41
Yes I did. Topomax was hilariously bad for my OCD. I became afraid that I wasn't going to be able to stand my inner voice anymore so I became anxious everytime I 'heard' my inner voice. I became a total nervous wreck on Topomax.
Eric
Posted by mogger on November 20, 2014, at 18:16:12
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » mogger, posted by phidippus on November 20, 2014, at 18:13:10
That's awful! Sorry to hear it. Perhaps I won't bring it up when I see my Dr. tomorrow!
Mogger
Posted by Chris O on November 20, 2014, at 18:50:40
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 20, 2014, at 17:34:08
Hey, Eric:
My diagnosis? That's a good question. I would say I'm on the PTSD/GAD/OCD/agoraphobia axis--chronic worrying, unable to feel like I have escape my childhood with my mother, worrying that people want to harm me (such as poison my food) if I assert myself too strongly. I am, basically, scared of everything. (I am even worried the woman giving the rTMS treatments will find this board and "punish" me for writing about her. Yep, I've thought about that many times.)
Anyway, the reason I measure my success by my personal interactions with others is because ... usually, in my day to day life, I try as much as possible to avoid interacting with others. I simply do not "extrovert" myself enough, and things often go very badly for me when I do interact with others, no matter how much I try to fight my anxiety. There is a sense inside of me (and I don't think I am wrong in a very deep way, even though it sounds irrational) that people "defeat" me, just by having more energy than I do. This is one thing that the rTMS has given me: a slight boost in energy so that I can stop ruminating about the past, and keep my energy in the present. This would be a great achievement for me if it lasted in any significant way.
And I still do not know how much I am projecting onto the young lady doing my rTMS treatments. Yes, she was trained, but there's something off with us, or at least that's my perception. I don't think she completely gets my anxiety disorder (I feel like I have to pretend nothing is wrong when I am around her or she becomes irritated), and it irritates me.
Posted by phidippus on November 21, 2014, at 14:14:10
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by mogger on November 20, 2014, at 18:16:12
Well, I just had a paradoxical reaction, one you may not have. Just know there are other anti-glutamatergic agents out there if Topomax proves unsavory for you: Rilutek, Gabapentin, Lyrica, Zonegran and Keppra. There me be others I don't know of...
Eric
Posted by SLS on November 21, 2014, at 22:44:50
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » mogger, posted by phidippus on November 21, 2014, at 14:14:10
> Well, I just had a paradoxical reaction, one you may not have. Just know there are other anti-glutamatergic agents out there if Topomax proves unsavory for you: Rilutek, Gabapentin, Lyrica, Zonegran and Keppra. There me be others I don't know of...
>
> EricMinocycline, among its many effects, is antiglutamatergic.
* NMDA modulator - mGlu autoreceptors co-agonist.
* regulation of p38 and Akt pathwaysIt has been suggested by some that a combination of Lamictal + minocycline is synergistic in the way each of them produces their antiglutamatergic effects.
A BNN report on other research regarding minocyline:
http://bipolarnews.org/wp-content/uploads/2010/05/2009.2.pdf
- Scott
Posted by mogger on November 25, 2014, at 13:14:40
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by SLS on November 21, 2014, at 22:44:50
I don't know what it is with me but some glutamate modulaters/inhibitors worsen my depression big time. Unfortunately Scott minocycline did badly as well as Gabapentin, Memantine and Tegretol. The only two that have helped my depression have been lamictal, NAC and riluzole.
Posted by phidippus on November 26, 2014, at 16:45:16
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 20, 2014, at 18:50:40
>worrying that people want to harm me (such as poison my food) if I assert myself too strongly.
This sounds almost paranoid.
>I am, basically, scared of everything.
I've been there before, but I had some paranoia going on.
>I am even worried the woman giving the rTMS treatments will find this board and "punish" me for writing about her.
More paranoia.
>things often go very badly for me when I do interact with others, no matter how much I try to fight my anxiety.
How do things go badly? Do they go badly in spite of your anxiety?
>There is a sense inside of me that people "defeat" me, just by having more energy than I do.
This 'sense', when you consider it, does it seem realistic?
>there's something off with us, or at least that's my perception.
It's hard to say if you're perception isn't colored by paranoia moreso than anxiety.
Do you take any AAPs?
Eric
Posted by Twinleaf on December 9, 2014, at 10:14:20
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 20, 2014, at 17:05:43
From your last post, it was starting to sound as though the rTMS was moderately helpful. As a veteran myself, I think it is a very benign, moderately helpful trestment which has the very valuable property of lowering chronically high cortisol levels and allowing the hippocampus to function more nearly as it does in health -producing new neurons each day.
But it is almost always a temporary trestment, increasing brain health only temporarily. You have indicated that you have some interpersonal difficulties (don't we all!). Have you had a good trial of therapy in which the relationship to the therapist is important and you can develop more intimate and satisfying ways of relating to others? Successful treatment always seems to involve both the physical and emotional aspects of anxiety and depression. I know I keep saying the same thing here, but it has really proven to be true for me!
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