![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by royubu on January 3, 2000, at 19:55:46
Has anyone heard anything about studies with something *like* ECT, but without the bad side effects? (no brain seizure, no forgetfulness) If so, what's it called? (the name is made up of initials)
Thanks...
Posted by Noa on January 3, 2000, at 21:57:24
In reply to Re: New ECT-type thing?, posted by s on January 3, 2000, at 21:39:39
Perhaps you are thinking of Transcranial Magnetic Stimulation (TMS). There are some posts about this a couple of months ago, including someone who participated in a study. You can read some abstracts on it through pubmed, and other search engines.
Posted by Zeke on January 3, 2000, at 22:56:33
In reply to New ECT-type thing?, posted by royubu on January 3, 2000, at 19:55:46
Also take a look at this URL for more...
Alternative To Electroconvulsive Therapy Now Under Study
http://unisci.com/stories/0630983.htmThis is from June 98 and more has been written about TMS since but this is what I found on the fly.
Posted by royubu on January 4, 2000, at 8:23:48
In reply to Re: New ECT-type thing?, posted by Noa on January 3, 2000, at 21:57:24
> Perhaps you are thinking of Transcranial Magnetic Stimulation (TMS). There are some posts about this a couple of months ago, including someone who participated in a study. You can read some abstracts on it through pubmed, and other search engines.
Yep, this must be it ... now that I know the name, I can research it myself! Thanks!
Posted by Scott L. Schofield on January 6, 2000, at 11:17:09
In reply to Re: New ECT-type thing?, posted by royubu on January 4, 2000, at 8:23:48
> > Perhaps you are thinking of Transcranial Magnetic Stimulation (TMS). There are some posts about this a couple of months ago, including someone who participated in a study. You can read some abstracts on it through pubmed, and other search engines.
> Yep, this must be it ... now that I know the name, I can research it myself! Thanks!The proper abbreviation for this treatment is rTMS – repetitive Transcranial Magnetic Stimulation. I know only a tiny bit about it. It has been used with some success in pilot studies, but I haven’t followed up on whether or not large clinical trials have begun.
In a similar fashion to ECT, two magnetic stimulation pads are placed on the forehead separated by some distance. The placement of the pads between the left temporal lobe and the frontal cortex seems to be the focus of the investigations. When activated, a very strong magnetic field is created between them. The field is actually turned on and off repeatedly – thus the “r” for repetitive. One of the objects of the studies is to find the optimal frequency of this on-off cycle to induce an antidepressant effect. (I don’t know if it is being studied for any other indication – mania for instance). It is not necessary to induce convulsions for rTMS to have its therapeutic effect.
Dr. Mark George at the University of South Carolina has had perhaps the most experience regarding this treatment. I believe another major site of investigation is located in Australia.
- Scott
Posted by Eric on January 9, 2000, at 13:17:38
In reply to Re: New ECT-type thing? - rTMS, posted by Scott L. Schofield on January 6, 2000, at 11:17:09
> The proper abbreviation for this treatment is rTMS – repetitive Transcranial Magnetic Stimulation. I know only a tiny bit about it. It has been used with some success in pilot studies, but I haven’t followed up on whether or not large clinical trials have begun.
>
> In a similar fashion to ECT, two magnetic stimulation pads are placed on the forehead separated by some distance. The placement of the pads between the left temporal lobe and the frontal cortex seems to be the focus of the investigations. When activated, a very strong magnetic field is created between them. The field is actually turned on and off repeatedly – thus the “r” for repetitive. One of the objects of the studies is to find the optimal frequency of this on-off cycle to induce an antidepressant effect. (I don’t know if it is being studied for any other indication – mania for instance). It is not necessary to induce convulsions for rTMS to have its therapeutic effect.
>Hi there. I had rTMS and I was even in the trials at MUSC at Charleston, SC. In fact, Dr. Mark George personally did some of my rTMS. A mult-faceted physician and researcher, the man is board certified in both psychiatry and neurology plus on top of that he is a radiologist! Is your psychiatrist all of that? Doubt it LOL.
Dr. George not only does research in rTMS but he was also one of the main pioneers of the VNS or "vagal nerve stimulation" project for refractory depression. In fact if I am not mistaken, the very first VNS implant for the purposes of treating refractory depression was done at MUSC at Charleston about a year and a half ago...I dont know exactly when. It was very recent however.
Scott, unless you know something I dont, some of the things you said about rTMS was incorrect. When I had my rTMS sessions they did not place two stimulation pads on my forehead...they only placed one pad and they arent really pads they are more like a chunk of metal a couple inches thick and wide. They place a big, lunky chunk of metal on the left side of your forehead and fire magentic bursts into your left "prefrontal cortex." It is not like there are magnetic impulses going between two pads placed on your forehead as you described. The magnetic impulses you describe in fact are more like "bursts" and they are fired directly into your left forehead. Like a magnet gun. It hurts a little, feels like a woodpecker pecking on your head...makes your eyes water some. Some anxiety from fear of the unknown but nothing bad. But overall it is not sh** and I found that there were no side effects really. The treatments I thought were actually fun.
They are also doing rTMS for bipolar. From what I have been told for bipolar they place the magnet stimulator on the right side of your forehead instead of left. For unipolar major depression placement is left side, for bipolar placement is right side.
Posted by Scott L. Schofield on January 9, 2000, at 15:52:30
In reply to Re: New ECT-type thing? - rTMS, posted by Eric on January 9, 2000, at 13:17:38
> > The proper abbreviation for this treatment is rTMS – repetitive Transcranial Magnetic Stimulation. I know only a tiny bit about it. It has been used with some success in pilot studies, but I haven’t followed up on whether or not large clinical trials have begun.
> Hi there. I had rTMS and I was even in the trials at MUSC at Charleston, SC. In fact, Dr. Mark George personally did some of my rTMS. A mult-faceted physician and researcher, the man is board certified in both psychiatry and neurology plus on top of that he is a radiologist! Is your psychiatrist all of that? Doubt it LOL.Don’t laugh too loudly.
I thought he was pretty good stuff when he was still working at the NIH. A dear friend of mine still stays in touch with him. If you need his e-mail address, I can send it to you.
> Scott, unless you know something I dont, some of the things you said about rTMS was incorrect.
Thanks for the corrections. I really should not have relied solely on my memory, and I am truly sorry for disseminating misinformation.
A real good review of transcranial magnetic stimulation may be found at:http://archpsyc.ama-assn.org/issues/v56n4/full/ynv8319.html
How are you?
Are you still receiving treatments?
What are the current thoughts regarding maintenance therapy?Thanks for the info.
- Scott
Posted by Eric on January 9, 2000, at 23:43:32
In reply to Re: New ECT-type thing? - rTMS - bad info, posted by Scott L. Schofield on January 9, 2000, at 15:52:30
the man is board certified in both psychiatry and neurology plus on top of that he is a radiologist! Is your psychiatrist all of that? Doubt it LOL.
> > Scott, unless you know something I dont, some of the things you said about rTMS was incorrect.
>
> Thanks for the corrections. I really should not have relied solely on my memory, and I am truly sorry for disseminating misinformation.
>
No it's totally cool dude...dont sweat the load.>
> A real good review of transcranial magnetic stimulation may be found at:
>
> http://archpsyc.ama-assn.org/issues/v56n4/full/ynv8319.html
>
>
> How are you?Im not doing very well, currently off all meds getting ready to try Paxil plus Zyprexa. After that I am trying my first MAOI...probably Parnate. Im petrified of starting the Zyprexa...read all the stuff about neuroleptics causing TD and other movement disorders. I realize the chance is very low with low dose Zyprexa but my anxiety rating is currently off the wall with the knowledge I am going to try that stuff.
> Are you still receiving treatments?
noooooooo way. I was in the clinical trials first back in March 99. I received rTMS the first time in "blinded" or closed trials I believe is what they called it. For two weeks...or 10 magnetic stimulations sessions...I received rTMS. Had to be off all psych meds except for Ambien for sleep for the whole period. Then a month after the session was over I came back to MUSC for my "unblinding." Found out I got the placebo!!! Luckily I didnt "crash" during that period off meds. I personally attest to my not crashing when I went off meds due to the fact that I disciplined myself to swim laps and work out aerobically during that period...even though I hated doing it and felt like absolute crap. I still disciplined myself to do it and that kept me somewhat afloat when off meds.
Then after my unblinding and finding out I had placebo rTMS, I was invited to come back for two weeks of "open trial rTMS" in which I was allowed to be on antidepressants(Effexor XR). I as well as the Docs giving me the rTMS in open trial knew I was getting rTMS this time. I returned in July 99 for the two week session and received 10 treatment sessions.
I did improve on it but I was disappointed in the amount I improved. I experienced an increase in mood and cognitive function for several hours after each morning session. Overall I felt better for several hours after each session. However, it would dissipate after lunch. There was one point about midway thru the two weeks where I did experience "real" improvement and I remember that afternoon going to Folly beach outside of Charleston feeling fantastic several hours after treatment. However, that one dramatic improvement only lasted a few hours...it was not sustained at all. I will say I did feel better overall after my rTMS session in the weeks and months afterwards. However, I am not sure if this was from the rTMS or from the fact that I increased my Effexor XR from 150 mg all the way to 375 mg in the phase immediately after ending rTMS. I think it was some of both, but honestly I think the Effexor XR at high doses did more for me than the rTMS. I might be wrong however, perhaps the rTMS helped me more than I realized.
My Effexor XR did seem to "stick better" and not fade out or poop out as badly after the rTMS.
> What are the current thoughts regarding maintenance therapy?
I dont know what the official word is as I am not in contact with those people anymore. However, my personal opinion about rTMS is that it would probably work a lot better if they could give maintenance treatments. I dont think it has a lot of value when they are just doing it for two week treatment sessions and then its "goodbye see you buddy" and its all over. If however, they could do it for AT LEAST two weeks initially and then follow it up with weekly maintenance rTMS sessions I think it would work better.
I also had the gut instinct that perhaps if they had been able to keep going with me for another two weeks that perhaps I would have gotten a more solid response from it.
My personal opinion of it is that it is not as effective as ECT, but obviously much safer and more realistic to be able to use it in a maintenance fashion. Plus it is a lot cheaper and simpler to administer because you dont have to be anesthesiaized. The very fact that it does not require anesthesia makes it much more desirable than ECT from a cost perspective. Anesthesia is really expensive!!
From what I have heard of ECT, it is VERY effective oftentimes but it does not last oftentimes. But giving maintenance ECT sessions on a maintenance basis to me is just not realistic. Personally, I cant see getting shocked once a month or whatever for the rest of my life even though I know there are a few who do just that.
I was told at Duke psychiatry that they have people who come to Duke once a month just to get a maintenance ECT session!! I just cant see that for myself...more power to them if it works for them though.
But with rTMS, you could theoretically have safe maintenance treatments for the rest of your life...or at least very long term...with no real side effects...it is very safe.
Personally, Im waiting for the scientists to come up with the first genetic engineering treatment for depression...I will be the first one to get it if I can help it. Thats the real future for mental illness...genetic engineering. Bypass all this drug crap and ECT and stuff. Get to the root cause of depression...your genes.
>Eric
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.