Posted by tom2228 on June 22, 2014, at 0:06:40
In reply to Re: TMS Effective in 14% Of Patients, posted by tom2228 on June 21, 2014, at 23:24:25
> > As a depressed person, I'm naturally a skeptic of everything. Fortunately, about half the time I assume the worst, I'm pleasantly surprised. I hoped this would be the case with TMS, but it did absolutely nothing. It was expensive and an enormous waste of time. The article below is proof of what I experienced. According to this article, TMS works for 14 % of the people that try it. With a success rate like that, you have to question the credibility of the FDA. http://well.blogs.nytimes.com/2013/07/01/new-approach-to-depression/?_php=true&_type=blogs&_r=0
>
> Okay, to start, the article says:
> "TMS is approved specifically for patients whose depression does not respond to antidepressants or who cannot tolerate the drugs side effects..."
> which is a highly weasel-worded statement. As it's worded the article makes it seem like the FDA approval is for people who have run the whole gamut of meds and have not responded.... which sets the stage for their larger point that this procedure that is approved for people for whom (most/all) antidepressants don't work isn't even that effective for them! -- i.e. that TMS is just another failure for the (truly) treatment-resistant just like the meds.
>
> In actuality, however the FDA approved it for people who have failed to achieve satisfactory improvement from just ONE(!!) prior antidepressant medication at or above the MINIMAL effective dose and duration in the current episode. I.e., the article is referring to TMS as a procedure for "antidepressant resistance/ intolerance" when by definition of the FDA approval that person includes someone who has tried nothing but say 5mg Lexapro for 4 weeks!! That's hardly a fraction of a degree of "antidepressant resistance" (as the article proclaims) considering the multitude of medications many of us here, myself included, have tried with unsatisfactory results. So really, TMS is largely used in, and has mostly been studied in, people who are NOT truly antidepressant-resistant as we know it here, and includes people who simply do not want to be on meds rather than the meds not working for them.
>
> As well, the official TMS studies are mostly of people who are NOT taking medications when they undergo treatment, By theoretical logic, TMS has has a synergistic effect with medications, and this is not accounted for the studies. Many people in the clinical setting who are not studied, like myself, ARE taking multiple meds while doing TMS.
>
> As the article states:
> "In industry-financed studies that allowed subjects to continue their antidepressant medications while undergoing TMS treatment, which experts say is a more likely situation in the real world, response rates were significantly higher than in the randomized trial conducted by Dr. George. "
>
> Like so most of the official studies follow the conditions of the FDA approval and do not necessarily reflect the population that TMS is used in in the clinical setting, where results and success rates may be different. For example, TMS is approved and insured for people with *unipolar* depression but doctors including mine have successfully fought insurance companies to cover TMS for bipolar patients and are treating them as well.
>
> And these numbers -- 14% and 30% -- are for *remission*. The article touches upon the phenomenon that concurrent medications increased success rates, but it leaves out that there is a greater percentage for whom TMS is still "effective" on their symptoms even though they don't reach remission. SSRIs "don't work" for at least 2/3 of patients.
>
> Either way, it is working for some people who have had a troublesome experience with meds (whatever that may be). If a treatment allows some population to get better in a new way, in my opinion that warrants merit.
>Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study.
http://www.ncbi.nlm.nih.gov/pubmed/15652875I am currently getting TMS (high-frequency left-side and low-frequency right-side) I've had 3 sessions so far, can't say whether I'm any better, but I've definitely noticed something is different. It's complicated because I had finally gotten my meds right before and was starting to do well in my life, so part of me is frustrated/depressed that I am feeling differently, while the other part of me knows I was only partially responding and deserve better. I just hope that if I don't like the results I can go back to feeling the way I did before I started the TMS, that it's not permanent... I guess we'll see.
It's interesting though how the abstract^ mentions significant improvements were noted after only the first week, similar to how I am feeling something already. I'm not taking amitriptyline, but for my own selfish purposes :P I am going to generalize the concept to my antidepressant cocktail, which does include a TCA like amitriptyline.
In addition to the mood stabilizers (lithium, Lamictal XR, Abilify) and my stimulant (Desoxyn), I am on the following ADs:
Marplan 40mg
Deplin 30mg
desipramine 75mg
Mirapex ER 0.375mgSo hopefully there will be some synergy with the TMS as the weeks go by. And hopefully it is an effect that I like -- like I said my meds were the most optimal they have been before the TMS and while I would like to be less depressed, I don't exactly want to screw up what I had going with the meds...
One last thing, they *say* there's no side effects... but if there's synergy between TMS and the meds, and the meds have side effects, then logically the TMS could amplify some of the meds' side effects?
I don't buy the whole no-side-effects thing. My doctor has admitted to me that he's had a patient experience agitation from the treatment -- obviously a side-effect. I myself have noticed a difficulty focusing, thinking/producing fluent thoughts and speech as well as before, and a difficulty in my mathematics skills that was absent before. This is only after 3 treatments but I noticed it after the very first one. Perhaps like meds TMS can cause some disturbances related to the initial effects that level off with continued usage? I sure hope so. Before the TMS my focus was finally at 100% after years of fiddling with the meds..
poster:tom2228
thread:1067129
URL: http://www.dr-bob.org/babble/20140609/msgs/1067188.html