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CrazyEddie

TMS for treatment resistant depression?

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I've been on a lot of meds for depression over the years. Most didn't help at all and had really bad side effects. The exceptions were Abilify (which seemed to help a little, but the side effects were intolerable) and Latida (side effects were minimal, but it didn't actually do anything for the depression)

I was recently recommended Transcranial Magnetic Stimulation therapy. It sounds a bit scary and has a big time investment... but noting else has worked so far and I'd like to avoid another major side effect episode like I had on bulsomera, paxil, or Zoloft.

Insurance will probably cover most of it.

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Hi and welcome!

I live with TRD, it is difficult. I haven't tried any of the electromagnetic treatments yet or ECT. I'm skeptical of TMS and iTBS, in well-controlled trials they haven't shown that they significantly outperform a sham version of the treatment (placebo). However, both sham and real TMS treatments seem to relieve symptoms in a very impressive number of TRD patients, although it's short term. 

The side effect most often mentioned is the short term memory loss. What do you think about the trade-off for short term relief? 

 

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I had a series of TMS treatments four years ago. I don’t remember how many, but it was during a period of several weeks. It didn’t seem to have much if any effect. I was eventually given ECT treatments, which I believe has had an effect on my attention span. I oddly didn’t have many issues with memory of events before or after, but my attention span since has been shorter.

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3 hours ago, CrazyEddie said:

Memory loss is definitely a problem with ECT, but I cant find anything to suggest that it's a side effect of TMS.

Correct. I got the two confused, sorry about that. 

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I saw the doctor about TMS last week. He thinks that I'm a good candidate (and even said that they can work on my tinnitus during the sessions! A big contributor to my depression is poor sleep, and tinnitus contributes to that (in addition to being a PITA in general))

Now to see if insurance will approve it.

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You are certainly in a good position to try, if insurance will copsy. Your investment is the time. There is a short burst high intensity option for TMS, ask about it, you get reduced treatment time I believe. I have heard no negatives on TMS other than a mild headache after treatment

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do you have anxiety as well? i saw some research tms helps with anxiety too..

let us know how it goes...and from what i've read here in the USA most insurances will cover it.. (someone else had posted it on the forum a while ago too) Good luck!

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6 hours ago, ladysmurf said:

do you have anxiety as well? i saw some research tms helps with anxiety too..

let us know how it goes...and from what i've read here in the USA most insurances will cover it.. (someone else had posted it on the forum a while ago too) Good luck!

I do have some problems with anxiety, but it's pretty mild compared to my depression and Buspar handles most of it.

The doctor told me that they could also work on it, but my priorities are the depression and the tinnitus. They might not have enough time to work on the anxiety much after working on those areas (as each problem requires treatment in a different area and a session is of limited duration)

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On 2/3/2019 at 10:31 AM, CrazyEddie said:

A big contributor to my depression is poor sleep, and tinnitus contributes to that

Hi CrazyEddie,

Nine or so years ago I developed tinnitus after cisplaten was used in my chemo mix for cancer treatment.  Drove me nuts for some time.  I studied and went to several docs, ending up with a well known wizard in the field in Stanford, CA.   The death of what are commonly called the "hairs" in the pool in the inner ear had died in my case, causing some hearing loss and lots of tinnitus. 

I never did find a cure, though many are sold.  The rejuvenation of the cilia of the inner ear was not something that could be done at that time.  Hopefully you have another cause, or there has been a remedy found.  I don't know how long you've suffered from tinnitus, but over time my brain adjusted, tuned it out.  I can still hear it clearly in a noiseless environment if I attend it, otherwise it's no longer a concern.

When it was unhinging me, I used "masking" to sleep.  There was and still is I imagine, a great website I can't remember the name of, that offered a number of masking sounds that you could adjust in timbre, tone, etc., into white noise, brown noise, green noise, lots of colors of noise, until you found one that worked for you.  I then paid a buck for a sound snippet of it, loaded it onto my computer and looped it so it played straight through the night and I could pretty much get to sleep. 

Good luck in finding a reliable treatment, could be out there now

Bulgakov

 

Edited by Bulgakov

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I just got a letter from my insurance company stating that it was approved. We'll see how it works.

Though I've been feeling somewhat better lately on my own. Not up to where I want to be (my overall thoughts still trend pretty negatively), but a big step up from my normal (suicidal ideation is less intense and frequent, though still there). My fatigue is still in force, so maybe (if I'm lucky) it'll help with that.

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Yes, please update us when you have more to report. Whether your symptoms respond to the treatment or not, it's helpful to know. You also might consider creating a blog here as a journal of your TMS experience, it helped me to track changes in my response to Ketamine treatments. 

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I'm a few sessions in, and have yet to see any difference.

They're using about 15 minutes of slow pulses on the right side followed by about 5 minutes of fast pulses on the left. The slow pulses are pretty manageable, but the fast pulses are rather unpleasant, and make my jaw twitch a lot. It's not enough to make me want to stop, though.

I also saw my sleep doctor today, and he said that he wants to do sleep apnea surgery with an implant to help keep obstructions from occurring, but the AHI was slightly too low for insurance to cover it, though he says that the take home sleep study that I did has a tendency to under report that number. The current plan there is for him to negotiate an in-lab sleep study with my insurance.

I'll probably have to get that taken care of, too, to really recover from this thing.

Edited by CrazyEddie

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i just finished a series of 35 TMS - i also had bilateral - the right for anxiety and the left for depression.  Not sure how much it helped because i also had a change in medication.  I think i had a response, but haven't remitted.  Will probably have another top up in 6 weeks.  It was  very easy treatment to have

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Another week in, and I think that I'm seeing some improvement. My mood is a fair bit better, though problems are still there.

It's also giving some perspective on what's from the depression and what's from the sleep apnea/excessive daytime sleepiness. I'll definitely need to find a better way to manage the sleep issues (whether its the surgery or another attempt at CPAP is still up in the air)

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20 sessions in. Other people (such as friends and my therapist) have commented on how much better I seem, and I'm generally in a lot better mood, and it's easier to engage in conversation.

The treatments thrmselves are still moderately unpleasant, but otherwise I have no side effects to report. This is vastly preferable to the side effects that I've had on meds (and unlike meds, I'm actually seeing improvements)

Sleep / energy is still problematic, but insurance finally approved the in-lab sleep study, which I'll have this weekend. Hopefully they can find something to treat that.

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And the flip-side of it is... it wears off. 

I was feeling better for a good part of last year, but started feeling worse in the fall, and it’s progressed until now. I’m currently dealing with insurance to get it redone, but they rejected my initial claim.

For the sleep apnea, I ended up settling on a Sonowave oral appliance. It brought my AHI level down to the 7 range (below 5 is normal) so the doctors consider it to be well-treated, though excessive daytime sleepiness persists.

As for energy levels, I saw a doctor that thinks that it is chronic active Epstein-Barr. Blood tests showed high Nuclear Antigen Ab, IgG levels, and Ab VCA, IgG levels were beyond the 600 level, which was the highest value on their scale. Though paradoxically, EA Ab IgG levels are low. He gave me Valtrex, low-dose Naltrexone, and a ton of supplements, in addition to recommending more protein in my diet and to avoid sugar, and also to do whatever I can to minimize stress. He also wants me to do blood ozone treatments, which are expensive and not covered by insurance. I did them for two months, saw a slight improvement, then stopped because of the cost. I might resume them, even though they’re $200 each. My HSA is completely empty, so it’s all directly out-of-pocket, and my bank account isn’t looking too hot, either. My fatigue had me bedridden on Monday, so I need to find something that can help.

My counselor also thinks that moving is a good idea, since I’m living in a particularly rough place for outsiders (Utah County) and the isolation that that brings is making things worse.

Edited by CrazyEddie

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It took a while, but the clinic is going to be starting round 2 of TMS on Monday. Things are going crazy in the world right now, so my insurance company has a big backlog, but the clinic will charge me as if it were approved, and will handle any necessary appeals on the backend.

I also lost my job and will be moving in with my folks until lockdowns end, once this is completed. I’ve wanted to move for a long time, anyway, but this is what’s forcing my hand now. Once things started getting really bad, the original plan was to just stay put in my job, since it was a stable one and now was a bad time to look at switching, but that fell apart at the first sign of trouble, even though as a programmer, I can easily work from home.

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It's not surprising that you were assigned rTMS after medications didn't work. rTMS is common in such cases. It usually takes five days a week for up to six weeks and the therapy shows nice results. However, you should know about the side affects, although they are minimal: lightheadedness, mild headaches, temporary hearing problems resulting from the magnet noise, tingling in the face,  jaw or scalp, scalp irritation where the magnetic pulses were directed. Don't worry because you can get rid of all the side affects with over-the-counter pain medifications.

 

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