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#1 Simba Cub

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Posted 22 August 2007 - 04:41 PM

Just felt that I should report this here: TMS (Transcranial Magnetic Stimulation) has been proven to be fairly ineffective after trials at the Maudsley Hospital, London (Institute of Psychiatry, Kings College London). Pity.



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#2 In_Remission_Malz

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Posted 06 October 2007 - 11:49 PM

Just felt that I should report this here: TMS (Transcranial Magnetic Stimulation) has been proven to be fairly ineffective after trials at the Maudsley Hospital, London (Institute of Psychiatry, Kings College London). Pity.



Rich::


Funny, because my sister is a scientist in trials in Seattle and it's actually pretty promising from what I've heard. Maybe they're using it differently.

#3 Wooster

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Posted 07 October 2007 - 09:24 AM

TMS is cited as an option in the NICE treatment protocols for ptsd (thanks to Silver for the resource!) as being more effective than the placebo version of TMS. I wonder how it works.

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#4 Silver

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Posted 07 October 2007 - 10:30 AM

Cochrane was still ambivalent on it last I checked. Now that I've started writing this, I can't get into the full Cochrane Review from home (my uni library remote access is a variable sort of thing.) I'll sit up and listen to anything Maudsley says.
I looked into it when I was arranging ECT, and the situation was dire enough I couldn't chance it. I was going to go to Canada, actually - closest option, and insurance wouldn't cover it anyway. But there was adequate evidence at that time for depression. That was a mixed state, and there wasn't enough evidence there.
I need to pull another review together. Or, better yet, let the nice folks here do it. :mad:

Or get into &@!%# Cochrane. I hate losing fulltext.

And, of course, depression, PTSD, BPAD, etc., are all different critters - giraffes and horses, etc.

Glad you're enjoying NICE, Wooster- fun, isn't it?
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#5 Jerod Poore

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Posted 02 September 2008 - 10:12 AM

Found this while looking up the trials of TMS for migraines:

Transcranial Magnetic Stimulation Effective for Depression in Large Trial

December 18, 2007 A large, randomized controlled trial finds that transcranial magnetic stimulation (TMS) is safe and effective for treatment-resistant major depression. Response and remission were better in patients who received 4 to 6 weeks of treatment with active TMS than with sham TMS.

[...]

The study was conducted at 20 sites in the United States, 2 sites in Australia, and 1 site in Canada. Eligible patients had major depression and had not benefited from 1 to 4 prior trials of antidepressant therapies.

A total of 301 patients (about 50% women; average age close to 50 years) were randomized to either active TMS or sham TMS with a device that had a magnetic shield.

TMS is a noninvasive technique that excites neurons in the brain by magnetic impulses introduced through the scalp. The TMS treatment in this study consisted of 3000 magnetic pulses per session given 5 days a week for 4 to 6 weeks. Treatment was done using a Neuronetics device at a repetition rate of 10 pulses/sec and at an intensity of 120% of the patient's resting motor threshold.

The primary efficacy outcome was the change the Montgomery-Asberg Depression Rating Scale (MADRS) symptom score at week 4. Secondary outcomes included changes in the 17- and 24-item Hamilton Depression Rating Scale (HAMD) and in response and remission rates.

"TMS Offers New Hope"

At week 4, after baseline score imbalance was corrected for, MADRS mean symptom scores were significantly better in patients treated with active TMS vs sham TMS. Mean HAMD17 and HAMD24 symptom scores at weeks 4 and 6 were also better with active treatment.

At 6 weeks, patients in the active-TMS group were about twice as likely to have achieved remission compared with those in the sham-TMS group (MADRS: 14.2% vs 5.2%; HAMD17: 15.5% vs 7.1%; HAMD24: 17.4% vs 8.2%).

TMS was safe and well tolerated. There was a higher incidence of scalp discomfort and pain with active treatment than with sham, but these events were generally mild or moderate, and the incidence diminished rapidly after week 1.

The dropout rate from active TMS was 7.7% at 4 weeks and discontinuation due to adverse effects was 4.5%.

[...]


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#6 medi

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Posted 25 November 2008 - 02:41 PM

Today my new baby shrink, MD resident in psychiatry who trains on me so I can afford psychiatric treatment, suggested this TMS. I had never heard of it. So, of course, I rushed home to crazymeds talk. It looks like a lot of work to read up all the links. And my quick impression is that it is a very mixed bag. One thing, I may not have to pay for it, since all these people are practicing on me, though the person administering it would be a "real" doctor and have done it.
Anyone wants to venture an opinion, even though I will do my homework. Anyone had it? Anyone had it and is now happy and productive and has no side effects?
Keep in mind, I was diagnosed BiPolar NOS by my old long-term psychiatrist but after a struggle. She had for the longest time believed I was MDD. The baby shrink does not mind ADDs to BD people on a mood stabilizier. But would TMS hurt a BD?
I even heard that it can help with migraine. Is it done differently for migraine?
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<p>Dx Axis 1: BD II. Had been diagnosed with MDD. Am sometimes also diagnosed with PTSD.Has undergone ECT in 2008.Current Meds: Lithium 600 mg, Synthroid 75 mcg, Inderal 40 mgs, Ativan 2 mg or more, as needed, Zolpidem.Have had experience with: Tricyclics (useless back then), Paxil, Celexa & Lexapro ( the three caused jitteriness&/or mixed states), Wellbutrin (also jitteriness, more severe), MAOI-B (Emsam patch)(hypomania, fun, but no way I could sit at my desk and think), Neurontin (innocuous), Depakote (too much weight gain, hair loss, sleepiness, lack of energy, and no noticeable benefit), Topamax (I'll only cite the suicidality obsession as of 75 mgs....), Lamictal (no benefit), Zyprexa (heart palpitations and shortness of breath at only 2.5 mgs), Abilify 2 mgs (serious GI pain), Calcium Channel Blockers (weak --- verrrry).

#7 medi

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Posted 28 November 2008 - 07:09 AM

Just felt that I should report this here: TMS (Transcranial Magnetic Stimulation) has been proven to be fairly ineffective after trials at the Maudsley Hospital, London (Institute of Psychiatry, Kings College London). Pity.



Rich::

Ineffective is one thing, and certainly valid if you're dishing out the exorbitant cost. Ineffective and costly on your brain function is another thing. It is mostly touted as having practically no side effects. From the readings I've done, it seems to me to be a hasty conclusion. TMS just has not been used long enough. In one aricle in the journal of american psychiatry, I read that it could change the structure of your brain.... Does ECT do that too? It just sounded way too weird. You turn into someone else, even if not depressed, is that good?
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<p>Dx Axis 1: BD II. Had been diagnosed with MDD. Am sometimes also diagnosed with PTSD.Has undergone ECT in 2008.Current Meds: Lithium 600 mg, Synthroid 75 mcg, Inderal 40 mgs, Ativan 2 mg or more, as needed, Zolpidem.Have had experience with: Tricyclics (useless back then), Paxil, Celexa & Lexapro ( the three caused jitteriness&/or mixed states), Wellbutrin (also jitteriness, more severe), MAOI-B (Emsam patch)(hypomania, fun, but no way I could sit at my desk and think), Neurontin (innocuous), Depakote (too much weight gain, hair loss, sleepiness, lack of energy, and no noticeable benefit), Topamax (I'll only cite the suicidality obsession as of 75 mgs....), Lamictal (no benefit), Zyprexa (heart palpitations and shortness of breath at only 2.5 mgs), Abilify 2 mgs (serious GI pain), Calcium Channel Blockers (weak --- verrrry).

#8 Suzani

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Posted 26 February 2009 - 04:25 PM

Just felt that I should report this here: TMS (Transcranial Magnetic Stimulation) has been proven to be fairly ineffective after trials at the Maudsley Hospital, London (Institute of Psychiatry, Kings College London). Pity.



Rich::

Ineffective is one thing, and certainly valid if you're dishing out the exorbitant cost. Ineffective and costly on your brain function is another thing. It is mostly touted as having practically no side effects. From the readings I've done, it seems to me to be a hasty conclusion. TMS just has not been used long enough. In one aricle in the journal of american psychiatry, I read that it could change the structure of your brain.... Does ECT do that too? It just sounded way too weird. You turn into someone else, even if not depressed, is that good?


There is now quite a lot of data showing that depression/BD causes changes in brain structure - shrinking of hippocampus, shriveling up of neurons, etc. So a treatment that reverses that by causing neuronal growth, for example, sounds like a good thing to me.
I don't think of being myself, only not depressed, as a BAD thing. If you are depressed enough you live with not being able to work or socialize, etc. - I for one am willing to sacrifice that part of myself.

Anyway, people have argued for years that antidepressants cause personality changes, i.e. one "turn[s] into someone else, even if not depressed." And most of us here are totally ok with that kind of change!

I think the real concern would be if a treatment is irreversible and, e.g., makes you crazy angry all the time or some other really negative change. I've heard of that sort of personality change from a stroke, but not from any psych treatment so far. New treatments are riskier, but some of us are desperate enough to try them so that eventually all will feel more comfortable with them. I needed Prozac when it first came out - but back then, meds were usually only given to people so sick they had to be hospitalized. Too bad I missed out on all those years.
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#9 Suzani

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Posted 28 February 2009 - 03:02 PM

Info I have gotten this week about rTMS treatment from local Dr.:

I really and truly have treatment-resistant depression. I have had recurrent major depression, dysthymia, and generalized anxiety since 1985, and was first given meds in 1995. I have tried almost every SSRI/SNRI (did not try Pristique since Effexor had zero effect on me), and I tried all of these drugs at high doses and in combinations with many other meds - atypical antipsychotics, mood stabilizers, etc. I achieved complete remission once, for close to a year. I have been in partial remission a number of times, but the SSRI's always poop out. I tried the MAOI patch (worst experience of my life), and have tried 2nd generation tricyclics (no help and bad weight gain). Never tried 1st gen tricyclics - weight gain would be even worse and I gained 90 lbs from Zyprexa and then the tricyclic, which I have not been able to get rid of. I have never had a traditional MAOI or ECT.

My pDOC mentioned rTMS as a possible option at our session a couple months ago to once again try to come up with a new strategy. He has sent patients for rTMS treatment for more than 5 years - first to Canada, then to 2 other local facilities when they became available, and he says he is impressed with the technology. I don't have numbers on the success rate.

A guy in my pdoc's office complex now does rTMS using a different device than the FDA approved Neuronetics machine. After a couple of months without too much improvement on m y new meds combo, I decided to do a little research on the rTMS option and called the rTMS doctor. Re: the device, he said he uses the machine by Magstim, he felt it was better in certain ways that we did not discuss. Since insurance will not cover rTMS treatment with either the FDA approved device or Magstim, that is not a factor at this point.

He told me the following about rTMS:
1) Fact that I had achieved complete remission from a drug regimen increases probability that rTMS will work for me
2) Efficacy: he sees 1/3 complete remission, 1/3 improvement (he may have said significant improvement), 1/3 no effect
3) Remission/efficacy lasts 3-9 months, although with top notch psychopharmacology treatment at the same time, he has seen remission of over a year
4) As #3 implies, you DO stay on meds during the treatment and prob afterwards, although meds may be adjusted for period of rTMS treatment
5) When mood starts to slip, you go in for a tune up, which might be 5 days in a row of treatment; the sooner you get back in, the easier it is to get you back in remission
6) Initial treatment is typically 40 minutes, 5 days a week for 4 weeks, although he has seen people who don't need the whole 4 weeks to reach remission. (However articles I have read talk about 6 week initial treatment so maybe he was being optimistic)
7) One of the risks is seizure, so if you have history of seizure I presume they do not recommend (I don't so didn't ask)
8) I am on 40 mg Adderall XR and would have to discontinue for course of treatment because of increased risk of seizure, then could restart it afterwards if needed. I could stay on cymbalta during treatment.
9) Cost is: $650 for initial evaluation, which would include reviewing my 2 volume file and talking to my pdoc and internist (and possibly my cardiologist), then $215 per 40 minute session with the machine ($4300 + $650= $4950 for 4 weeks).
10) This is sort of a minor point, but in case anyone is wondering, you can drive yourself home immediately after treatment. (Can't imagine needing a ride every day for 5 weeks.)

The daily treatment would make it tricky to do for someone working (I'm presently unemployed).

I'm tempted to try it because I do have the time right now since not working. $5k hurts but it would be cheap if it put me in remission. However, if it didn't work the $5K would really, um, annoy me.
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#10 Suzani

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Posted 08 May 2009 - 04:55 PM

Really appreciate you giving us your real life experience with rTMS. Wow, none! You sound like you've been going through all the same meds that I have tried, I'm guessing you are (like me) designated treatment resistant. I'm titrating up on Effexor XR now (equivalent to your Pristiq)- skeptical that it will work. I hope you're feeling better, treatment resistance is the worst.

Next week am going to be discussing options (including rTMS and ECT) with my Dr. who says he's been impressed with rTMS, he used to send patients to Canada but now uses a couple local places for treatment. Even the Dr. who does the rTMS told me ECT is much more effective.

I thought one advantage of rTMS over ECT would be less chance of pain but your experience shows there's no guarantee of that. Plus apparently it can induce a seizure - if I'm going to have a seizure I'd prefer to be unconscious a la ECT.

Edited by Jerod Poore, 05 August 2011 - 05:19 PM.
privacy issue

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#11 Wariogiant

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Posted 09 May 2009 - 05:29 PM

I'm seriously considering having this procedure done FIRST before ECT. I'll have to see what my doctor says about this on Monday. Luckily it's covered by our insurance and there's a clinic with a TMS device only a couple of miles from our home.
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#12 In_Remission_pass_fail

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Posted 30 October 2010 - 07:01 PM

Just thought I should post here after seeing all the pessimism. I had a full course of TMS this summer and it's really helped me, more than any other medication has (and I've tried almost all of them). It hurts like a bitch the first few times, but if you take some Aleve beforehand you should be okay on subsequent treatments. The cost is obviously very prohibitive, but it looks like it will be covered in the next year or two, so don't give up on it.

#13 Random Rabbit

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Posted 06 January 2011 - 11:23 AM

Anyway, people have argued for years that antidepressants cause personality changes, i.e. one "turn[s] into someone else, even if not depressed." And most of us here are totally ok with that kind of change!

I think the real concern would be if a treatment is irreversible and, e.g., makes you crazy angry all the time or some other really negative change. I've heard of that sort of personality change from a stroke, but not from any psych treatment so far.


I love risperidone/Risperdal. No drug has ever made me feel so in touch with my body and balanced it with my mind as well as risperidone and it did not make me a zombie. I am not sure if it is my wonder drug or a spectacular manic reaction. Sadly, risperidone has a metabolite (9-hydroxy-risperidone/paliperidone/Invega) with a moderately long half life that becomes the primary drug moiety in your blood. Invega makes me mean in a very bad way. Not quite permanent, but I re-trialed it with identical results. Anger in a psych pill.
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#14 crazycatnapper

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Posted 07 February 2011 - 06:29 PM

I am seriously thinking of trying this treatment. The only downside for me is the cost because I don't think it's covered, but I do not want ECT and my doc says that is my only choice. Next time I see her, I'm going to ask about TMS instead. I know it's done here in town, so I would love to talk to the doctor who does it, but so far I've had no luck getting to him. However, I know his daughter in law, so I'm going to contact her and ask is she can help me out and have him see me.

If I end up trying it, I'll post.
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#15 Simba Cub

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Posted 08 February 2011 - 09:35 AM

I am seriously thinking of trying this treatment. The only downside for me is the cost because I don't think it's covered, but I do not want ECT and my doc says that is my only choice. Next time I see her, I'm going to ask about TMS instead. I know it's done here in town, so I would love to talk to the doctor who does it, but so far I've had no luck getting to him. However, I know his daughter in law, so I'm going to contact her and ask is she can help me out and have him see me.

If I end up trying it, I'll post.


Hey, if there's a chance it'll work that will excuse you from ECT, I say go for it!



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Experience in: Alprazolam, Aripiprazole, Bupropion, Chlordiazepoxide, Citalopram, Clonazepam, Clozapine, Dothiepin, Duloxetine, ECT, EMDR, Fluoxetine, Imipramine, Lamotrigine, Lithium, Lorazepam, Mirtazapine, Moclobemide, Olanzapine, Paroxetine, Procyclidine, Propranolol, Quetiapine, Reboxetine, Risperidone, Sertraline, Sodium Valproate, rTMS, Tranylcypromine, Trifluoperazine, Venlafaxine, Zolpidem, Zopiclone.


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#16 Simba Cub

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Posted 08 February 2011 - 01:28 PM

On a related note, it has been found that TMS is a very effective treatment for chronic pain. And I mean effective.



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Experience in: Alprazolam, Aripiprazole, Bupropion, Chlordiazepoxide, Citalopram, Clonazepam, Clozapine, Dothiepin, Duloxetine, ECT, EMDR, Fluoxetine, Imipramine, Lamotrigine, Lithium, Lorazepam, Mirtazapine, Moclobemide, Olanzapine, Paroxetine, Procyclidine, Propranolol, Quetiapine, Reboxetine, Risperidone, Sertraline, Sodium Valproate, rTMS, Tranylcypromine, Trifluoperazine, Venlafaxine, Zolpidem, Zopiclone.


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#17 go.ask.alice.

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Posted 16 August 2011 - 12:53 PM

Just thought I should post here after seeing all the pessimism. I had a full course of TMS this summer and it's really helped me, more than any other medication has (and I've tried almost all of them). It hurts like a bitch the first few times, but if you take some Aleve beforehand you should be okay on subsequent treatments. The cost is obviously very prohibitive, but it looks like it will be covered in the next year or two, so don't give up on it.


++++++16 aug 2011++++++

Just thought I should post here after seeing all the pessimism. I had a full course of TMS this summer and it's really helped me, more than any other medication has (and I've tried almost all of them). It hurts like a bitch the first few times, but if you take some Aleve beforehand you should be okay on subsequent treatments. The cost is obviously very prohibitive, but it looks like it will be covered in the next year or two, so don't give up on it.


++++++++16 august 2011
i also wanted to add that i have had a very positive experience and response with tms. (see my personal page for details if you want). it currently has helped as no medication has been able to. i consider myself a cheerleader for tms treatment and will talk to anyone about it.

CONS:
1)EXPENSIVE it is not covered by most insurance and is a multi visit process (i.e. @Univ of Penn $200/session and treatment plan length depends on your depression level)

2)if you have a high motor threshold it can be slightly painful as the pulses must magnified to compensate effect. the motor threshold is a primary motor and premotor cortex excitabity indicator. (i have never experienced pain. my MT is within avg values and varies each session. i drive myself to and from appt. an hour each way and am absolutely fine. i am currently in maintenance which is not often and have been receiving treatment since april of this year with 0, not one, side effect.)
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issues:                   bipolar spectrum, MDD , c-PTSD
MEDICATIONS:    lamictal 100mg, tegretol 400mg(for sleep), klonopin 2-4mg, armour thyroid 30mg, synthroid .050mg
SUPPLEMENTS:   fish oil, d3, magnesium, probiotic, melatonin
THERAPY:             CBT, TMS
trial & error: abilify, ambien, cymbalta, effexor, halcion, lamictal, lexapro, lithium, lunesta, paxil, provigil, seroquel, silenor,trazadone, topamax, trofanil, wellbutrin, Zoloft, Geodon


 
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#18 Got the T-shirt

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Posted 27 October 2011 - 05:46 AM

I've had a fair bit of ECT and TMS over the years. If you can try TMS first as you need a general anaesthetic every time you have ECT. Also memory loss is very common. Mine was so bad I could not continue treatment. There are still holes in my memory. That said, I have not found TMS effective. Experienced no pain with it, quite a pleasant experience. Even had it twice a day for the past few hospital stays. Now they say they will do it unipolar as they believe it is more effective. Here in Australia it is only available as an experimental inpatient treatment. Very lucrative for the hospital and my private health fund has to pay for the whole stay.
Some people do though. Definitely would not pay for such poor results. Both treatments are given in addition to antidepressants.
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#19 Her

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Posted 26 November 2011 - 12:54 PM

This thread interests me, because I had a very weird experience with an MRI a few of years back, when I was depressed. I had never heard of TMS. I noticed that I came out of the machine feeling very calm; actually, serene would not be a bad word to describe how I felt. The effect lasted for a few days before I got depressed again. I asked my tdoc if he had ever heard of such a thing happening before-this would've been in the early spring of 2008-and he told me about TMS. It is emphatically not covered by my insurance, so I never pursued it.

A friend of mine who has both bipolar and MS, and thus gets regular MRIs to check the progress of the lesions on his brain, reports the same effect that I got.

And I found this on PubMed today. I wish the doctors doing the experiment hadn't taking the patients off their meds, but it still made for interesting reading.
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Give us this day our daily meds: 150 lamotrigine, 75 topiramate, 150 Seroquel XR, 100 Seroquel IR, 12.5 Ambien CR,  60 mgs Cymbalta

 

4000 i.u. Vit. D3,

 

Etodolac 400 mgs  2x/daily and Votaren Gel 2 grams 2x/daily for joint pain NOS

Azelastine nasal spray 2x/per nostril 2x daily

 

Cyclobenzaprine and Midrin PRN

 

Past, failed attempts: Effexor XR, Celexa, amitriptyline, Depakote, escitalopram, Geodon, klonopin, ativan, bupropion, busipirone, lithium, trazodone, Lunesta, Rozerem, gabapentine, mirtazapine, Wellbutrin, Temazepam, Sonata.

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#20 Simba Cub

Simba Cub

    Would-be Neurologist

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Posted 27 November 2011 - 03:12 PM

This thread interests me, because I had a very weird experience with an MRI a few of years back, when I was depressed. I had never heard of TMS. I noticed that I came out of the machine feeling very calm; actually, serene would not be a bad word to describe how I felt. The effect lasted for a few days before I got depressed again. I asked my tdoc if he had ever heard of such a thing happening before-this would've been in the early spring of 2008-and he told me about TMS. It is emphatically not covered by my insurance, so I never pursued it.

A friend of mine who has both bipolar and MS, and thus gets regular MRIs to check the progress of the lesions on his brain, reports the same effect that I got.

And I found this on PubMed today. I wish the doctors doing the experiment hadn't taking the patients off their meds, but it still made for interesting reading.


Very interesting indeed. In the same way, I remember having seizures and feeling very happy afterwards. Well, I don't remember the actual seizures, but you get the idea. Proof of ECT working in nature?



Rich::
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Diagnosed with: Schizophrenia with co-morbid Depression; Panic; GAD; OCD; Transient Ischaemic Attacks

Experience in: Alprazolam, Aripiprazole, Bupropion, Chlordiazepoxide, Citalopram, Clonazepam, Clozapine, Dothiepin, Duloxetine, ECT, EMDR, Fluoxetine, Imipramine, Lamotrigine, Lithium, Lorazepam, Mirtazapine, Moclobemide, Olanzapine, Paroxetine, Procyclidine, Propranolol, Quetiapine, Reboxetine, Risperidone, Sertraline, Sodium Valproate, rTMS, Tranylcypromine, Trifluoperazine, Venlafaxine, Zolpidem, Zopiclone.


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#21 inOr

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Posted 18 January 2012 - 08:14 PM

I wouldn't correlate MRI and ECT. The latter uses electric currents to cause seizures, which presumably are good for you. MRI puts you in an intense magnetic field, and weak radio waves. If it's an effective psychotropic treatment for depression/anxiety, my money is on magnetic effects.
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