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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Ash on November 16, 2000, at 22:44:05
Hi all,
For the benefit of readers here, I thought I would put down my recent experience with repetitive transcranial magnetic stimulation (TMS).
A little background first: Like many here, I am one of those treatment resistant individuals that has not responded to a single A/D. I've tried the gamut -- TCA's, MAOI's, SSRI's, antipsychotics, various augmentation strategies -- everything ( maybe that is too absolute a term? well, then almost everything) short of ECT.
A university teaching hospital was conducting a research study on TMS (no placebo arm) and I agreed to participate in the 2 week treatment protocol. At the first session, the treating doctor calibrates the strenght of the magnetic field that is to be applied --one that barely causes involuntary twitching of the muscle of the thumb. Thereafter on a daily basis, the doctor gives the treatment via a figure 8 shaped magnetic coil that is placed a couple of inches above the head a little above the right side temple. The magnetic field is appled on a repetitive rapid off/on basis in two sessions of about two minutes each seperated by a break of a couple of minutes. The sensation is sort of someone rapidly tapping one's head, only slightly uncomfortable. Thus the active phase of the treatment lasts about a total of six minutes. The most common side effect is a mild headache that is easily treated with Tylenol. Changes in my mood were evaluated every other day through a HAMD questionaire.
I understand that the success rate of TMS as reported in the literature, as well as through unpublished studies is as high 40-50%. This is not all bad for a group of treatment resistant patients who have failed an average of 6 A/D trials. Unfortunately (and perhaps not surprisingly) TMS did nothing for me. All I got from it was a moderate headache on the second day of treatment.
And so the quest for the proverbial light at the end of the the pitch black tunnel continues... though many times it seems even too hard to put forth the effort.
Ash
Posted by shellie on November 19, 2000, at 14:32:41
In reply to Experience with Transcranial Magnetic Stimulation, posted by Ash on November 16, 2000, at 22:44:05
Ash, Thanks for the information. I'm sorry it didn't TMS didn't work for you.
I was under a very different impression last time I spoke to a pdoc at NIMH about it. He recommended against it because said that two week trials had proved too short a time for success. He also said there was no followup available for retreatment if there was temporary success. Since then I thought I had read that the numbers were pretty bad. Where did you get your percentages from? Was that your study, or a combination of all centers, doing two weeks and I think four weeks.
Thanks for any additional information you could point me to. Shellie
Posted by SLS on November 19, 2000, at 17:38:38
In reply to Re: Experience with Transcranial Magnetic Stimulation » Ash, posted by shellie on November 19, 2000, at 14:32:41
> Ash, Thanks for the information. I'm sorry it didn't TMS didn't work for you.
>
> I was under a very different impression last time I spoke to a pdoc at NIMH about it. He recommended against it because said that two week trials had proved too short a time for success. He also said there was no followup available for retreatment if there was temporary success. Since then I thought I had read that the numbers were pretty bad. Where did you get your percentages from? Was that your study, or a combination of all centers, doing two weeks and I think four weeks.
>
> Thanks for any additional information you could point me to. Shellie
One of the pioneering researchers off rTMS while at the NIMH, Mark George (now with the Medical University of South Carolina), had become disappointed in it pretty early on. I think he dropped the project, and is now one of the investigators of VNS (Vagal Nerve Stimulation).
- Scott
Posted by Ash on November 21, 2000, at 8:42:53
In reply to Re: Experience with Transcranial Magnetic Stimulation » Ash, posted by shellie on November 19, 2000, at 14:32:41
Shellie:
The impression I got from my treating doctor prior to the start of treatments was that TMS is one of the more promising tools on the horizon for treatment resistant depression. It is still in the research stage though and needs fine tuning in terms of the optimal intensity and frequency of treatments and so forth. I guess some of this represents bias on the part of the researcher. A website (don't have URL here with me)representing a group of TMS researchers presents results of various studies, shows a highly variable success rate, but 40% or so is not uncommon. For non-psychotic depression, a double blind study showed it to be of equivalent efficacy to ECT.
At the conclusion of the acute treatment phase, many individuals who responded favorably may revert to their pretreatment depressed stage. In the particular study I was involved in, responders were scheduled for additional treatments but in a sort of weaning off manner - first thrice a week, then twice and so on. It is also possible that A/D medications that were previously ineffective may now prove to have therapeutic value.
I agree though that TMS at this time at least is not the magic (magnetized) wand that will solve all the problems of us poor depressed (demagnetized?) souls.
Ash
> Ash, Thanks for the information. I'm sorry it didn't TMS didn't work for you.
>
> I was under a very different impression last time I spoke to a pdoc at NIMH about it. He recommended against it because said that two week trials had proved too short a time for success. He also said there was no followup available for retreatment if there was temporary success. Since then I thought I had read that the numbers were pretty bad. Where did you get your percentages from? Was that your study, or a combination of all centers, doing two weeks and I think four weeks.
>
> Thanks for any additional information you could point me to. Shellie
This is the end of the thread.
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