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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 47. This is the beginning of the thread.
Posted by qwerty224466 on October 11, 2005, at 15:05:09
I have tried about 15 medications including MAOIs over the past three years and nothing has helped my depression. I am looking into TMS and ECT treatments. My job requires a good memory so I am going to try TMS first. But, I went to an appointment with a psychiatrist in my area and was told that because most of my medication trials were only two months, and therefore too short, that he could not give me TMS treatment. The reason for this is because I do not tolerate medicine very well, especially when taken for long periods of time. It makes my symptoms worse and gives me this very uncomfortable anxiety that benzos do not help.
He told me about a few other TMS centers at various places around the country, but I am worried that they will give me the same answer. Is there any place I can go to, perhaps canada or europe, where TMS has been approved and I will not have so many problems getting treatment? I have money saved up and am willing to travel for long periods of time, I just want to try this treatment as soon as possible.
Posted by qwerty224466 on October 11, 2005, at 16:15:32
In reply to TMS - where can I get it?, posted by qwerty224466 on October 11, 2005, at 15:05:09
Never mind, I did a search and was able to find the info I needed. In case anyone is interested, here is what I found.
1. Chicago Area - Dr. Steven Best - srdbest@theneurosciencecenter.org
2. Atlanta Area - Dr. Mark Hutto - http://www.centerfortms.com/
3. Vancouver Canada Area - http://www.mindcarecentres.com
Posted by twinb on October 11, 2005, at 19:49:57
In reply to Re: TMS - where can I get it?, posted by qwerty224466 on October 11, 2005, at 16:15:32
Thanks for sharing the info. Hope it works well for you. Keep us posted...
Posted by Pfinstegg on October 12, 2005, at 11:56:07
In reply to Re: TMS - where can I get it?, posted by twinb on October 11, 2005, at 19:49:57
Dr. Hutto and Dr. Best have excellent reputations; choose the one closest to you. I have been going to Dr Hutto, seven times in the last three years. At first, I had a course of 15 treatments over a three week period, and had an excellent remission for four months. Now, I have two daily treatments for either two or three days every few months. It works beautifully every time, but the effects aren't lasting- and aren't promoted by anyone as being that. If you are in the 50% who respond well, it is a wonderful, side-effect-free treatment. It does hurt physically, though, but mentally, you are as clear as can be.
Neonetics, the company who makes the machine, is planning on finishing their TMS studies at 19 university medical sites in early 2006, and are hoping to obtain FDA approval in mid-2006. I think a lot of psychiatrists will begin using it in conjunction with medications after that. I think the biggest aspect they are working on is how to give it. Dr. Hutto has patients who have one treatment every six months- all they need to stay in remission- and patients who need four treatments every three weeks. He gives it to the left frontal area, at close to the intensity which causes a motor response. I think you can do much of the work-up necessary at home before you go- such as having a complete physical and a recommendation. There are only two contra-indications that I am aware of-having metal in your skull, or a seizure disorder. Please let us know if you go ahead with it.
Posted by ravenstorm on October 13, 2005, at 12:52:31
In reply to Re: TMS - where can I get it? » twinb, posted by Pfinstegg on October 12, 2005, at 11:56:07
Pfinsstegg, I think you should point out that you also take medication, however, to stay in remission as well. I am currently in contact with all three of the resources listed and am having trouble getting a straight answer on wether just getting enough boosters of rTMS will let you stay off medication entirely.
Please do stay in touch, as I am trying to decide which of the three doctors/clinics to go to as well
Posted by Pfinstegg on October 13, 2005, at 22:25:11
In reply to Re: TMS - where can I get it? » Pfinstegg, posted by ravenstorm on October 13, 2005, at 12:52:31
Oh, yes, I definitely do, and the combination of TMS and medication seems to be much better for me than just medication alone. I take small doses of Wellbutrin (37.5 mg twice a day- because more causes too much of a rise in blood pressure), tianeptine 12.5 mg. three times a day, Cytomel .05 mcg twice a day, and lots of other stuff like fish oil, all the B vitamins. Vitamin D, magnesium, etc. I count on the medications, but so far have not found any that produce a remission; with the addition of TMS, I have about a 6-8 week real remission, during which i feel energy,joy and satisfaction in life. I didn't mean to mislead you!
Posted by Pfinstegg on October 13, 2005, at 23:45:19
In reply to Re: TMS - where can I get it?, posted by Pfinstegg on October 13, 2005, at 22:25:11
I should add that Dr. Hutto expects that all his patients will be on medication. He is using the TMS to help people with treatment-resistant depression. He is not offering it as a sole treatment; it can help a lot, but its effects do not last. You may want to do a Medscape search on it- there is a lot of excellent basic research done at Harvard, Yale, the Univ of So. Carolina, Rockefeller University, and in Europe (the German Primate Center), Israel, and Australia. All these studies, in general, show activation of the left frontal lobe and limbic structures, a decrease in overactivity of the HPA axis, with lower cortisol levels. higher levels of serotonin, dopamine and norepinephrine, and normalization of cells in the hippocampus. The study which impressed me the most was done on tree shrews, in Germany. Starting with two lines of animals bred for high and low anxiety, the ones with high anxiety went down to normal when given TMS- measured by the amount of time they were able to expend in the forced swim test, which is the way anxiety and depression is measured in animals. The low anxiety animals did just as well before and after TMS.
It is, to me, clearly a very beneficial, although temporary, treatment for brains which have been physiologically altered by some combination of genetics, trauma and environmental stress. It's not a permanent solution, but can be a very valuable part of our on-going efforts to get our brains back to as normal functioning as possible. Medications can be, too. And psychotherapy. I do all of them.
Posted by ravenstorm on October 14, 2005, at 8:21:11
In reply to Re: TMS - where can I get it?, posted by Pfinstegg on October 13, 2005, at 23:45:19
See, that is what I would have though too (about anxiety), but when I contacted Dr. Hutto, he indicated that rTMS doesn't work for anxiety. Weird.
Posted by Pfinstegg on October 14, 2005, at 20:22:00
In reply to Re: TMS - where can I get it?, posted by Pfinstegg on October 13, 2005, at 23:45:19
Well, Dr Hutto is my doctor, and I have a tremendous amount of respect for, and gratitude towards him, but I'm going to disagree! My anxiety levels are much lower for several weeks after each TMS treatment series.
Posted by ravenstorm on October 15, 2005, at 10:24:31
In reply to Re: TMS - where can I get it?, posted by Pfinstegg on October 14, 2005, at 20:22:00
His answer really put me off!! Next time you go down there, do you think you could ask him about the anxiety thing? In Canada they apparently do left side for depression and right side for anxiety. I would have thought just doing the depression side would help the anxiety because I always thought they were two sides of the same coin.
At this point I'm leaning towards going to the mindcare centers in Canada.
Dr. Best is only three hours away from me, but he requires some VERY expensive testing that Dr. Hutto and the mindcare centers don't, so he may be out just based on that.
I would wait until the FDA approves it here (suppossedly the people who have mind care centers in Canada are poised to open clinics here whenever approval comes through) but reallistically that probably won't be for more than a year. Neuronetics indicated that they will have all data collected early in 2006 but then it needs to be submitted and the FDA will have to go over it all. Doesn't the FDA take at least a year to make decisions on stuff?? I have emailed neuronetics but they haven't responded.
I wonder how Dr. Hutto feels about how the Canadian centers do two treatments a day so that you can get twenty sessions in during a two week stay?
Qwerty--have you contacted any of the three yet? Have any opinions on where you would go?
Posted by Pfinstegg on October 15, 2005, at 11:27:12
In reply to Re: TMS - where can I get it?, posted by ravenstorm on October 15, 2005, at 10:24:31
Dr. Hutto does two sessions a day, at least for maintenance; I don't know about his initial sessions, but I think the general feeling is that the total amount of electromagnetic stimulation is what counts- and that the intervals can be several hours apart. Dr. Hutto used to require an MRI and EEG, as Dr. Best still does, but now only requires a complete physical and approval of your internist.
The Canadian system of billateral stimulation is unique; everyone else I have read about does left frontal only- here in the US, but also in Europe, Irael and Australia. It is a stimulating treatment, designed to increase brain activity. The only thing it decreases is HPA overactivity, probably because of better feedback from the left hippocampal regions. Many people think the right hemisphere is overactive, and the left underactive, in depression. Like you, I am including anxiety with depression, as i know from personal experience that, with me at least, they increase and decrease together.
One thing to think about: if it helps you, it's almost always an on-going comittment, although you may need only occasional re-treatment. You might save money (on travel) in the long run if you go the the doctor nearest you. This might make Dr. Best a better choice for you. I know one person, from Chicago, who has been going to Dr. Best successfully for five years.
Posted by ravenstorm on October 15, 2005, at 11:44:29
In reply to Re: TMS - where can I get it? » ravenstorm, posted by Pfinstegg on October 15, 2005, at 11:27:12
Dr. Best is several thousand dollars more expensive than Dr. Hutto or the Canadian systems.
I find it interesting that you say you know someone who has gone to Dr. Best. I have dialogued with you several times over the last year or so about where to go for rTMS and you have never mentioned this before. Would this person feel comfortable talking to me (through this forum, or regular email) about their experience with Dr. Best?) Or do you have anything further to add about this. ie do you know how often they return for boosters, are they also on medication etc.
Also, I was confused by a comment you made earlier in regards to cortisol. I distinctly remember you saying previously that after you received rTMS you had testing with an endo and that your cortisol levels etc all were normal after rTMS and your doctor was amazed, yet recently you have stated that you have been afraid to have your cortisol etc tested after rTMS. Which statement is correct?
I will try to find the original post, but I think it was last year. Perhaps I am just confused.
Thanks, Kathleen
Posted by Pfinstegg on October 15, 2005, at 11:57:56
In reply to Re: TMS - where can I get it?, posted by ravenstorm on October 15, 2005, at 11:44:29
No, I'm sorry, but i can't give you that person's name. He first told me several years ago about his successful experience with Dr. Best, but asked that i maintain his privacy.
As to the cortisol question, I think you are a bit confused. I said that the total daily cortisol has always been normal. The parts that were abnormal were that I was a DST non-suppressor, and that my salivary evening cortisols were as high as the early morning ones, while they should be much lower.
I have tried to be as helpful and informative to you as I possibly could be. That naturally includes having been completely truthful. I do not appreciate at all being asked, "so which is correct?"
Posted by ravenstorm on October 15, 2005, at 12:48:25
In reply to Re: TMS - where can I get it?, posted by Pfinstegg on October 15, 2005, at 11:57:56
Sorry, I did not mean to offend or imply untruthfullness. But I am still confused. Does that mean cortisol levels for you (the evening high cortisol level-I guess) were positively impacted by rTMS, or is that impossible to say at this point? Would improved sleep quality after rTMS indicate to you that your cortisol was lowered in the evening? Gaaahhhhh. Never mind I am just confusing myself. Better sleep could just be from an antidepressant effect too.
This is all very overwhelming for me. Thanks for your attempts to help me. I will post back whenever I make a decision where to go and take a break from all this for awhile.
Posted by qwerty224466 on October 15, 2005, at 16:04:06
In reply to Re: TMS - where can I get it?, posted by ravenstorm on October 15, 2005, at 10:24:31
I contacted Dr. Hutto, hopefully I will have my initial evaluation within the next few weeks. I chose him because he is the closest.
I do not expect to have good results. None of the medicines have helped me in the slightest, in fact many of them have made me feel worse. If TMS makes me feel even 25% better it will be a miracle.
If it does help, I do not expect the effects to last very long. But I would gladly go in for maintenance treatment an hour each day if thats what it takes.
Posted by Pfinstegg on October 15, 2005, at 17:03:06
In reply to Re: TMS - where can I get it? » ravenstorm, posted by qwerty224466 on October 15, 2005, at 16:04:06
I do hope you have a good experience with Dr Hutto! Only medication-resistant patients go to him for TMS, at present, so you will be similiar to all of his other TMS patients. I hope you are in the 50% who get really good results! I do think it's reasonable to be at least somewhat hopeful. If you do get into remission, as I do, the next challenge is figuring out how often you need to come to stay that way. He is extremely helpful in helping you learn how to evaluate when the depression seems to be returning, and to get re-treated when it is at most moderate, not severe. That can make such a big difference. Be sure to let us know how it goes - and GOOD LUCK!
Posted by ravenstorm on October 15, 2005, at 17:21:05
In reply to Re: TMS - where can I get it?, posted by Pfinstegg on October 15, 2005, at 17:03:06
Qwerty--thats awesome that you have made a decision to proceed. Please do keep us informed of your progress. You have a 50-50 chance so stay optimistic! I would be particularly interested, if you do respond, to see if he wants to put you back on a medication.
I am still struggling with when/where to go. (the fun of having a severe anxiety disorder!) I know it makes more sense to go to Chicago for me because it is closer, but I get a better "vibe" from Dr. Hutto and the Canadian clinics. Also, might be nicer to get out of the cold this winter by going to Atlanta, but not nearly as convenient in the long run for getting boosters.
You will be in my thoughts. I'm keeping my fingers crossed for you! Do stay in touch.
Posted by SadDoggie on October 19, 2005, at 0:12:20
In reply to Re: TMS - where can I get it?, posted by ravenstorm on October 15, 2005, at 17:21:05
Do these places do low-frequency TMS, or TMS for OCD? I tried the regular high-frequency TMS but I did not fare well.
Posted by Pfinstegg on October 19, 2005, at 8:00:25
In reply to Re: TMS - where can I get it?, posted by SadDoggie on October 19, 2005, at 0:12:20
I think high frequency is used by the people we have been talking about. I did find out that the only active study going on at NIH now (with TMS) is for OCD. It might be worthwhile to find out how they are doing it, and what they think is most useful.
Posted by ravenstorm on October 19, 2005, at 8:27:01
In reply to Re: TMS - where can I get it?, posted by Pfinstegg on October 19, 2005, at 8:00:25
I think the mindcare centers in Canada refer to OCD treatment on their websites. They do a different procedure for anxiety vs depression, so perhaps they do something different for OCD as well. They reply very rapidly to e-mail. Where did you get your rTMS done?
Posted by ravenstorm on October 20, 2005, at 11:54:22
In reply to Re: TMS - where can I get it?, posted by ravenstorm on October 19, 2005, at 8:27:01
Have been in more contact with Dr. Best and he thinks Dr. Hutto would have more experience with a case like mine. He also indicated that a doctor in Milwaukee (very close to me) is doing rTMS but he did not indicate who it was and has not gotten back in touch with me again.
So, it looks like I'm down to Hutto or Mindcare centers at the moment.
Posted by ravenstorm on November 3, 2005, at 10:34:32
In reply to Re: TMS - where can I get it?, posted by ravenstorm on October 20, 2005, at 11:54:22
Qwerty, have you had your initial appointment with Dr. Hutto yet?
I have had further contact with the mindcare centres. They had sent me a lot of studies about rTMS for depression (left side rTMS) but nothing about the right sided they do for anxiety as well.
Yesterday I just got the studies for right side rTMS. They seem to deal mainly with PTSD. Am still trying to read through them.
Posted by qwerty224466 on November 3, 2005, at 11:00:21
In reply to Re: TMS - where can I get it?, posted by ravenstorm on November 3, 2005, at 10:34:32
Yes - I am in Atlanta now. So far I am having mixed results, but it is too soon to tell. I will provide more details in a week.
Posted by ravenstorm on November 3, 2005, at 11:33:43
In reply to Re: TMS - where can I get it?, posted by qwerty224466 on November 3, 2005, at 11:00:21
What did Dr. Hutto think about your previous experiences with meds?
Has he expressed any opinions about wanting you to take meds after treatment?
How long have you been receiving treatments?
Are you receiving one per day?
Does it hurt?
What does "mixed results" mean?
Sorry to bother you with all these questions!
Posted by qwerty224466 on November 4, 2005, at 1:14:31
In reply to Re: TMS - where can I get it?, posted by ravenstorm on November 3, 2005, at 11:33:43
He didn't really say much, I did all the talking. I told him that all of the meds have either done nothing or made me feel worse. Because this response is so unusual, he probably thought to himself that I was just exaggerating to get attention. But I don't really care, I am used to psychiatrists not believing a word I say.
He hasn't mentioned anything about taking meds after treatment.
I have received four treatments so far, at a rate of one per day. It does hurt, but it hurts less with each treatment.
On day 1, I felt about the same after the treatment as I did before. On day 2, I felt a slight but noticeable mood lift for about ten hours following the treatment. On day 3, things went sharply downhill for some unknown reason, and I felt bad (ie worse than before day 1) for twelve hours following the treatment. On day 4, which is today, my mood dropped even more sharply. Today has been awful. Given the possiblity of another significant drop following tomorrow's treatment, I have opted to instead take a few days off, and return for another try on Monday.
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