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  #1  
Old 07-06-2011, 03:45 PM
Spice Weasel Spice Weasel is offline
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Ask the woman receiving transcranial magnetic stimulation for depression

A few folks asked me to start a thread regarding my experience with TMS (transcranial magnetic stimulation) for depression. I was originally going to wait until the treatment was over, but I thought some people might appreciate following my progression through the full 6 week course. Today was my very first day.

We'll start with the basic definition:

Quote:
Transcranial magnetic stimulation (TMS) is a noninvasive method to cause depolarization or hyperpolarization in the neurons of the brain. TMS uses electromagnetic induction to induce weak electric currents using a rapidly changing magnetic field; this can cause activity in specific or general parts of the brain with minimal discomfort, allowing the functioning and interconnections of the brain to be studied. A variant of TMS, repetitive transcranial magnetic stimulation (rTMS), has been tested as a treatment tool for various neurological and psychiatric disorders including migraines, strokes, Parkinson's disease, dystonia, tinnitus, depression and auditory hallucinations.
Basically, they hook up a machine to your head and blast you with low-level electromagnetic pulses in order to alter neural activity.

Ask away.
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  #2  
Old 07-06-2011, 03:47 PM
Living Well Is Best Revenge Living Well Is Best Revenge is offline
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Are there side effects afterward? Bad headache?
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Old 07-06-2011, 03:49 PM
Ferret Herder Ferret Herder is offline
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Interesting coincidence, I just reviewed a study on TMS for major depression today! Are you doing it daily?
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Old 07-06-2011, 03:52 PM
Anne Neville Anne Neville is offline
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What is it like, getting this treatment?

How long does a session take? How often do you go?

When are you supposed to know if it's helping you?
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  #5  
Old 07-06-2011, 03:55 PM
Spice Weasel Spice Weasel is offline
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Originally Posted by Living Well Is Best Revenge View Post
Are there side effects afterward? Bad headache?
Well, my first session today hurt more than I expected it to, but only during those 4-second intervals where you receive the pulse. The pain is difficult to describe... like having a monster headache with a little hammer striking you repeatedly at the source of your pain. The weird thing is, the pain vanishes the second the pulsing stops, and as of one hour post-treatment I have no headache or other symptoms.

They told me the pain goes away after the first few sessions. I guess the nerves in your scalp become desensitized with time. I admit I'm not especially excited about doing this again tomorrow.

Quote:
Originally Posted by Ferret Herder View Post
Interesting coincidence, I just reviewed a study on TMS for major depression today! Are you doing it daily?
30 sessions over 6 weeks. 5x a week for 4 weeks; then tapering off over the last two weeks.
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Old 07-06-2011, 03:56 PM
levdrakon levdrakon is offline
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Do metal objects stick to you now?
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Old 07-06-2011, 04:02 PM
Spice Weasel Spice Weasel is offline
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Quote:
Originally Posted by Anne Neville View Post
What is it like, getting this treatment?

How long does a session take? How often do you go?

When are you supposed to know if it's helping you?
It's 37 minutes a day, five days a week for the first four weeks. The first time takes longer because they have to establish a ''motor threshold''... basically they zap you until your fingers start twitching the right way and that allows them to set the pulse intensity based on your individual motor threshold.

You sit in a chair, kind of like a dentist's chair, and they wrap tape around your head and kind of stick you into the chair nice and firm. You have to wear earplugs because the clicking is apparently loud enough to damage your ears. Then they put this sort of helmet-thing on... it looks like this and feels like your head is being squished in a vise (not painful... just pressure.) Once the coil is targeting your left prefrontal cortex, they start the machine.

*chime* *4 second zap* *26 seconds of nothing*

Repeat for 37 minutes.

You're supposed to know it's helping because they take both self-report and physician report measurements of your symptoms. They do this every week so ideally, the scores on these scales will improve with time.

Last edited by Spice Weasel; 07-06-2011 at 04:04 PM..
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  #8  
Old 07-06-2011, 04:04 PM
Toucanna Toucanna is offline
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Is this only for uni-polar (or generalized or major) depression or can it also work for the depressive phases of Bi-Polar I and Bi-Polar II?

Did you have a tendency to bang your head as a child? (This is a serious question.) Have you tried listening to recordings that try to shift your brain waves to alpha/theta states and did this work at all?

Thanks for your time! I hope you feel better.
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Old 07-06-2011, 04:15 PM
Spice Weasel Spice Weasel is offline
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Originally Posted by Toucanna View Post
Is this only for uni-polar (or generalized or major) depression or can it also work for the depressive phases of Bi-Polar I and Bi-Polar II?
This treatment in many ways is still in the experimental stage. In the United States, it is currently only approved for recurrent major depressive disorder in individuals who have not had success with at least one anti-depressant medication. In fact, it's only this specific device that is approved by the FDA. While it has been identified as a promising evidence-based treatment, we are still way off from fine-tuning and exploring the practical applications of this technology.

Quote:
Did you have a tendency to bang your head as a child? (This is a serious question.)
I used to hit myself in the head with books when I was frustrated, but as a little kid I don't think I did much head-banging.

Quote:
Have you tried listening to recordings that try to shift your brain waves to alpha/theta states and did this work at all?

Thanks for your time! I hope you feel better.
Nope, I don't believe I have any experience with that. Thanks!

Living Well, one thing I wanted to add is that this treatment is often recommended for patients who have difficulties with medication side-effects because TMS is virtually side-effect free. It doesn't enter the system the same way medication does, so you don't have to worry about fatigue and nausea and lowered libido and all that stuff that often comes with meds. The headaches tend to be mild and only last a few days.

Last edited by Spice Weasel; 07-06-2011 at 04:16 PM..
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  #10  
Old 07-06-2011, 04:16 PM
Spice Weasel Spice Weasel is offline
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Originally Posted by levdrakon View Post
Do metal objects stick to you now?
Let's just say I'm giving a certain Marvel super-villain a run for his money.
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  #11  
Old 07-06-2011, 04:29 PM
Antigen Antigen is offline
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I am fascinated by this treatment and I've given it a little bit of thought for my own depression. I have it somewhat controlled with medication and CBT but it never seems to be enough. I can say that I feel better, but I can't say that I feel good. Does that make sense?

From some of your other posts, I know you've been fighting depression for a long time and were having a lot of success with CBT, so I was surprised to see you starting the TMS treatments. Has something changed?

Practical questions:

Is it expensive? Does the average insurance company cover it?

Once the course of treatment is done, how is it that it continues to work? I can see the direct stimulation affecting your mood and even lasting a while, but once you're done with your six-week treatment, how are you "cured"? Or do you need to go back periodically?
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Old 07-06-2011, 04:41 PM
chiroptera chiroptera is offline
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Same practical questions as Antigen.

I tried reading up on transcranial magnetic stimulation but the descriptions were too scientificamal for me to really understand. Do you know of a site/book that explains it in lay terms, or can you give explaining it a shot for the masses?

Thanks and I hope it makes yoiu feel better!
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Old 07-06-2011, 05:12 PM
Asimovian Asimovian is offline
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Taking a different approach (and please disregard if this is too personal), how does your husband feel about you doing an experimental treatment? Have you shared this with family and friends? And if so, have you gotten positive responses? Do you feel any sort of stigma attached to the fact that you're dealing with an experimental treatment like this?

My best wishes for tremendous success.
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  #14  
Old 07-06-2011, 05:25 PM
Spice Weasel Spice Weasel is offline
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Quote:
Originally Posted by Antigen View Post
I am fascinated by this treatment and I've given it a little bit of thought for my own depression. I have it somewhat controlled with medication and CBT but it never seems to be enough. I can say that I feel better, but I can't say that I feel good. Does that make sense?
Yes, that makes perfect sense, and conveniently answers your question. CBT has helped me a lot, but it wasn't until I returned to therapy that I realized how much depression I was really willing to put up with and still call my life ''good.'' According to the scales, I'm severely depressed. ''Really?'' I thought. ''But I'm doing so much better.'' It's great that I have learned not to catastrophize so much and that I've cut out all of the nasty self-talk that can perpetuate despair, but at the end of the day I'm still living with severe chronic depression, and I'm tired of it. The reason my psychiatrist recommended this treatment for me is because much of my depression is physical in nature (fatigue, aches and pains) even when I address the thinking and behavior components properly. I can be exercising, eating right, meditating, medicating and doing everything ''right'' and still be very depressed. Yes, I can function reasonably well, but functioning's not good enough.

Practical questions:

Quote:
Is it expensive?
God yes. The only time I've had to write a bigger check was when I bought my new car.

Quote:
Does the average insurance company cover it?
The answer is ''maybe.'' No insurance companies officially cover it, but people have had a 75% success rate with appealing for coverage of 50-100% of the cost. This is why they track your progress so carefully - insurance companies are more likely to cover it if they see evidence that it is working. The center where I am receiving the treatment has been giving me a lot of guidance regarding the appeals process.

My husband and I both decided going into this that we are treating the cost as if it won't be reimbursed, because we have no guarantee. We got a discount for paying up front. We've had to commit to a number of financial sacrifices to make this work.

Quote:
Once the course of treatment is done, how is it that it continues to work? I can see the direct stimulation affecting your mood and even lasting a while, but once you're done with your six-week treatment, how are you "cured"? Or do you need to go back periodically?
Some people never have another episode of depression again and require no follow-up. Some people require a moderate or low dose of anti-depressant for maintenance and others return for follow-up visits (of a shorter duration) every few years. As far as I know, the research on this treatment has yet to address long-term effects, but anecdotally based on this specific device in this clinic it appears to result in permanent remission in about half of all recipients.

Last edited by Spice Weasel; 07-06-2011 at 05:28 PM..
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  #15  
Old 07-06-2011, 05:30 PM
Bosda Di'Chi of Tricor Bosda Di'Chi of Tricor is offline
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Old 07-06-2011, 06:05 PM
Spice Weasel Spice Weasel is offline
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Quote:
Originally Posted by Asimovian View Post
Taking a different approach (and please disregard if this is too personal), how does your husband feel about you doing an experimental treatment? Have you shared this with family and friends? And if so, have you gotten positive responses? Do you feel any sort of stigma attached to the fact that you're dealing with an experimental treatment like this?

My best wishes for tremendous success.
This is an excellent question. My husband is a Ph.D. student in clinical psychology, so if anybody was going to give me shit about an experimental treatment for mental illness, it would be him. I expected him to be very skeptical and hard-nosed about this, and was not getting my hopes up that he would agree to it. I was hesitant myself because the evidence of efficacy here is much less robust than it is for CBT and medication - but the evidence is there. In one open-label trial, 50% of all patients experienced full remission. I happen to feel right now that my mental health is in very competent hands, so I trust both my psychiatrist and my psychologist when they tell me this could really help me. So I just had this hope - that maybe it could be an option for me.

Anyway, when Sr. Olives and I had the conversation, it was a lot shorter than I expected.
''I kind of really want to do this,'' I said.
And he replied, ''Then you have my support.'' Just like that.

When we went to the free consultation and they dropped the price bomb, I could feel my husband's brain imploding as he sat next to me (he REALLY hates spending money... which is the reason we can afford it in the first place.) I told the lady we'd talk it over and get back to her. Once in the car, I 100% expected him to resist based on the cost.

But no. The first words out of his mouth were, ''I assume we're doing this?''
''I really want to.''
''I really think it could be good for you. Okay. We'll make it work.''

I fell in love with him all over again. I know his response might have been different if I hadn't already tried so many things. As of this moment I have tried 14 different psychiatric medications, CBT, prolonged exposure therapy, cognitive therapy and ACT. I've gotten something out of each treatment, but I still suffer, and I think he's just tired of watching me suffer. My depression doesn't just affect me - it affects him too.

We have discussed it at length. I told him it might not make all my symptoms go away forever, I talked about my fears that it won't work, and the money being wasted, and everything. He's been very supportive and calm about the whole thing... just says sometimes the risks are worth the potential benefits and leaves it at that. The way he hasn't stressed about this is actually kind of shocking and contrary to his character, but it sure helps me not stress about it so much.

As for other relatives and friends, they've been very supportive and a little curious. As far as the stigma goes, I feel a stigma for dealing with mental illness, but I don't feel a stigma for trying an experimental treatment. I know people probably don't realize this, but there are plenty of treatments in routine use today that have less evidence of efficacy than this experimental treatment.

In all honesty, though, it's one of the biggest risks I've ever taken.
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  #17  
Old 07-06-2011, 06:12 PM
Antigen Antigen is offline
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Quote:
Originally Posted by olivesmarch4th View Post
When we went to the free consultation and they dropped the price bomb, I could feel my husband's brain imploding as he sat next to me (he REALLY hates spending money... which is the reason we can afford it in the first place.) I told the lady we'd talk it over and get back to her. Once in the car, I 100% expected him to resist based on the cost.
I'm curious to know the costs involved. I have been thinking about this for a while and I may go this route, but it looks like I'll need to start saving up!

Can you maybe PM me, if you're not comfortable talking about the costs here?
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  #18  
Old 07-06-2011, 06:19 PM
jsgoddess jsgoddess is offline
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I'm not surprised your husband wanted to go for it. I know that I was ready to pay out the nose for anything that seemed to offer some hope for my late husband's health struggles, even if some of them seemed goofy. We didn't end up doing much in the way of experimental treatments (the closest we came was a really neat heart treatment that showed some promise but in the end his cardiologist (one we really respected) said he believed it would be a waste of money for reasons X and Y), but we were willing to spend it even when things were pretty damned tight.

I'm glad this option was available to you. I've never heard of it. Consider my fingers crossed and my poles aligned in your general direction! Um, which sounds way kinkier than I expected. Sorry.
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  #19  
Old 07-06-2011, 06:31 PM
Spice Weasel Spice Weasel is offline
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Quote:
Originally Posted by Antigen View Post
I'm curious to know the costs involved. I have been thinking about this for a while and I may go this route, but it looks like I'll need to start saving up!

Can you maybe PM me, if you're not comfortable talking about the costs here?
Okay, I'll come out with it. It runs about $350 per session, for 30 sessions that's... $10,500.

When I think about how cost limits the ability of truly suffering people to do things like this, it gets me kinda upset. I'm grateful we're in a position to do it.

jsgoddess, thanks for the vote of support. The only person IRL I've told about the cost is my Aunt to whom I am incredibly close. I guess I'm worried that if people find out how much this costs they would judge me. But chances are they don't have to live with depression every day despite doing practically everything in their power to get better. It's so frustrating, it can feel like the biggest joke, having an amazing life but not the ability to truly enjoy it to the fullest. I think there comes a point where you'll do just about anything to stop your suffering, and I've reached mine. And I think Sr. Olives has too.

Last edited by Spice Weasel; 07-06-2011 at 06:34 PM..
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  #20  
Old 07-06-2011, 06:32 PM
Ferret Herder Ferret Herder is offline
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Just clarifying - to the best of my (study reviewer's) understanding, this treatment with this particular coil is indeed FDA approved for major (unipolar) depression in people who've failed treatment on at least one antidepressant. In this sort of patient, the "experimental" part is that they're trying to figure out how long a treatment regimen will last, and how to go about timing "reapplications."

For any other indication? Experimental as hell. It's apparently had poor results in many neurological (not psychological) trials but came up with definitive benefit in major depression studies. They're testing it on other stuff too.

(Disclaimer: IANAD/N/psychiatrist, this is just what I've gleaned from my semi-scientific readings on the topic. My reading was mostly to determine the safety of pursuing a research project at our institution, and it overwhelmingly seemed to be safe for potential study subjects.)

Last edited by Ferret Herder; 07-06-2011 at 06:33 PM..
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  #21  
Old 07-06-2011, 06:33 PM
pbbth pbbth is offline
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If you have any questions or want any advice on the insurance end of things let me know and I will help as much as I can. I work in health insurance and will be glad to try and help you get this covered if at all possible.
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  #22  
Old 07-06-2011, 06:50 PM
Spice Weasel Spice Weasel is offline
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Quote:
Originally Posted by pbbth View Post
If you have any questions or want any advice on the insurance end of things let me know and I will help as much as I can. I work in health insurance and will be glad to try and help you get this covered if at all possible.
Thank you, you're a star!

Thanks for clarifying, Ferret Herder. I've reviewed some of the literature but mostly in abstract form, and your understanding is mine too. Sorry if my thoughts are coming out fuzzy. At least I have an excuse!

Last edited by Spice Weasel; 07-06-2011 at 06:53 PM..
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  #23  
Old 07-06-2011, 07:02 PM
lisacurl lisacurl is offline
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This sounds similar to Michael Persinger's work... how much of the stimulation is hitting your frontal lobe? Has anyone seen god yet?

I hope it works well for you and the money spent is worth it!
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  #24  
Old 07-06-2011, 07:32 PM
Khadaji Khadaji is offline
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Only posting because I want to follow the thread - and to wish you the best!
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  #25  
Old 07-06-2011, 07:58 PM
lindsaybluth lindsaybluth is offline
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Woah! This thread is very cool. I hope it works out for you.

My question is where did you first hear about the treatment? From your doc? From a friend? Flyers? Your own research?
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  #26  
Old 07-06-2011, 09:28 PM
muldoonthief muldoonthief is offline
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So are you typing your answers, or are you just concentrating and watching the words appear on the monitor?

Seriously, I hope you get great results from this treatment.
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  #27  
Old 07-06-2011, 09:40 PM
Leaffan Leaffan is offline
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So, acupuncture and homeopathy didn't work out?
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Old 07-06-2011, 10:01 PM
BigT BigT is online now
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So, acupuncture and homeopathy didn't work out?
Go away.
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  #29  
Old 07-06-2011, 11:02 PM
Tess Trueheart Tess Trueheart is offline
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Cheering for you olives! You recommended a workbook that helped me feel better and I have always appreciated it. Thanks for being willing to share your experiences.

Question: if they are giving you tests as you go to see if your mood improves, is it hard to take them? I know those scale of 1 to 5 type tests and I had a good enough memory to sometimes impishly try and remember what I wrote last time (with a counselor and with a physical therapist). My mood(or pain, with the pt) that particular day/ hour was not reflective of a whole week either. Do you have problems with self reporting or questionnaires?
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Old 07-06-2011, 11:07 PM
Sunspace Sunspace is offline
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This is very interesting, olives. Dunno whether I'm a candidate, or even whether it's available in my country, but I hope there are more provable and repeatable non-drug therapies for mental illness.
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  #31  
Old 07-07-2011, 05:16 AM
Spice Weasel Spice Weasel is offline
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Quote:
Originally Posted by lindsaybluth View Post
Woah! This thread is very cool. I hope it works out for you.

My question is where did you first hear about the treatment? From your doc? From a friend? Flyers? Your own research?
From my psychiatrist. She thought I would be a good candidate due to my difficulties with medication. She showed me the machine and put me in touch with the TMS coordinator since I was interested.

Quote:
Originally Posted by Tess Trueheart View Post
Cheering for you olives! You recommended a workbook that helped me feel better and I have always appreciated it. Thanks for being willing to share your experiences.
I'm so glad that helped you! I do love that workbook and behavioral activation in general.

Quote:
Question: if they are giving you tests as you go to see if your mood improves, is it hard to take them? I know those scale of 1 to 5 type tests and I had a good enough memory to sometimes impishly try and remember what I wrote last time (with a counselor and with a physical therapist). My mood(or pain, with the pt) that particular day/ hour was not reflective of a whole week either. Do you have problems with self reporting or questionnaires?
I struggle with them sometimes because they can be very ''all or nothing.'' For example, one of the questions asked if I had any suicidal thoughts or feelings that I'd be better off dead. I consider there to be a big difference between these two things and wasn't sure how to respond because I haven't been suicidal in a long time, but I think ''better off dead'' thoughts fairly frequently. And naturally my response on these is affected by my mood at the time of administration. For this reason I tend to consistently underestimate my level of depression.

Quote:
Originally Posted by Leaffan
So, acupuncture and homeopathy didn't work out?
Quote:
Originally Posted by Psychological Medicine, 2009
Thirty double-blind sham-controlled parallel studies with 1164 patients comparing the percentage change in depression scores from baseline to endpoint of active versus sham treatment were included. A random effects meta-analysis was performed to investigate the clinical efficacy of fast-frequency rTMS over the left DLPFC in depression.

Results The test for heterogeneity was not significant (QT=30.46, p=0.39). A significant overall weighted mean effect size, d=0.39 [95% confidence interval (CI) 0.25–0.54], for active treatment was observed (z=6.52, p<0.0001). Medication resistance and intensity of rTMS did not play a role in the effect size.
Conclusions: These findings show that high-frequency rTMS over the left DLPFC is superior to sham in the treatment of depression. The effect size is robust and comparable to at least a subset of commercially available antidepressant drug agents. Current limitations and future prospects are discussed.
Cite.

Quote:
Originally Posted by Journal of Clinical Psychiatry, 2010
Studies of rTMS versus electroconvulsive treatment (ECT, 6 studies) for depression were meta-analyzed. Data extraction: Standardized mean effect sizes of rTMS versus sham were computed based on pretreatment-posttreatment comparisons. Data synthesis: The mean weighted effect size of rTMS versus sham for depression was 0.55 (P<.001). Mono-therapy with rTMS was more effective than rTMS as adjunctive to antidepressant medication. ECT was superior to rTMS in the treatment of depression (mean weighted effect size -0.47, P = .004). In the treatment of AVH, rTMS was superior to sham treatment, with a mean weighted effect size of 0.54 (P < .001). The mean weighted effect size for rTMS versus sham in the treatment of negative symptoms in schizophrenia was 0.39 (P = .11)and for OCD, 0.15 (P = .52). Side effects were mild, yet more prevalent with high-frequency rTMS at frontal locations. Conclusions: It is time to provide rTMS as a clinical treatment method for depression, for auditory verbal hallucinations, and possibly for negative symptoms. We do not recommend rTMS for the treatment of OCD.
Cite.

Let me know if you'd like more.

Last edited by Spice Weasel; 07-07-2011 at 05:18 AM..
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  #32  
Old 07-07-2011, 07:15 AM
Czarcasm Czarcasm is offline
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1. I hope it works out for the best.
2. Can you now count out 26 seconds with the accuracy of a fine Swiss watch?
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  #33  
Old 07-07-2011, 07:23 AM
levdrakon levdrakon is offline
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When you walk down the street, do street lamps flicker and go out as you walk past them?
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  #34  
Old 07-07-2011, 08:07 AM
Sigmagirl Sigmagirl is offline
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Thank you for sharing this with us. I hope that it is just what you need to help with your depression, and that you can find a way to get some or most (or all!) of the costs covered. That would be wonderful.

If it turns out that this treatment is not effective, how long would it be before they make that decision? I may have missed your saying that. Is there a "course" of treatment, and then an evaluation followed by another course? I did read your posts, but might have not caught it.

Can you drive directly afterwards? Are you dizzy?
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  #35  
Old 07-07-2011, 08:11 AM
EvilTOJ EvilTOJ is offline
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When your brainpan is comically swollen, will you make them rue the day? Will you use your brain powers to show them what REAL scientists do in University!?
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  #36  
Old 07-07-2011, 08:12 AM
Duke Duke is offline
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Is this treatment similar to that of a TENS machine? I've had TENS for muscle spasm and it's been suggested again for my recent migraines.
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  #37  
Old 07-07-2011, 08:24 AM
Spice Weasel Spice Weasel is offline
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Quote:
Originally Posted by Sigmagirl View Post
If it turns out that this treatment is not effective, how long would it be before they make that decision? I may have missed your saying that. Is there a "course" of treatment, and then an evaluation followed by another course? I did read your posts, but might have not caught it.

Can you drive directly afterwards? Are you dizzy?
It's pretty much a ''works or doesn't work'' kind of thing. I'm only doing one course. It usually takes about 4 weeks to see results, so I guess we'll know around the 4 week mark. Although they did say a lot of patients start feeling better after only a couple weeks.

As for driving, no problem. They give me a short rest period and something to drink right afterward (kind of like after you give blood), but it's totally safe to drive and resume normal activities afterward.
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  #38  
Old 07-07-2011, 09:38 AM
alice_in_wonderland alice_in_wonderland is offline
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Has ECT been considered? I know in some circles it's still considered way out there; however, all studies I've seen indicate it can be very beneficial for folks with severe, hard to treat depression.

If you have no success with your current treatment, is it under consideration at all?

Anyhow - good luck - I hope this current therapy works very well for you!
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  #39  
Old 07-07-2011, 10:05 AM
jsgoddess jsgoddess is offline
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Originally Posted by levdrakon View Post
When you walk down the street, do street lamps flicker and go out as you walk past them?
Well, hell! I've got that already! I always assumed it was the whole Prince of... well, Princess of Darkness routine.
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Old 07-07-2011, 11:23 AM
Rachellelogram Rachellelogram is offline
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The way the OP was described, it reminded me of what happens to the mom at the end of Requiem for a Dream. Which I always thought was ECT. How exactly is this different from ECT?
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  #41  
Old 07-07-2011, 11:40 AM
Spice Weasel Spice Weasel is offline
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Originally Posted by alice_in_wonderland View Post
Has ECT been considered?
We have thought about ECT, and I think it would have been an especially good choice back in college when I was unable to function. I guess I have ruled it out over the years, unconsciously because my functioning has improved so much with CBT, I figured I wouldn't be considered a candidate. I suppose I have until recently really been minimizing the impact of depression on my life. But if I am a candidate for TMS I'd probably be a candidate for ECT. If this doesn't pan out, we'll definitely be taking it under consideration. ECT has a bad rap due to its abuse in the past, but it is basically THE most effective treatment for depression, period. The memory loss sucks but it's only around the time you receive the treatment... not like you forget who you are or anything.

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Originally Posted by rachelellogram View Post
The way the OP was described, it reminded me of what happens to the mom at the end of Requiem for a Dream. Which I always thought was ECT. How exactly is this different from ECT?
Great question, as I've had some difficulty figuring that out myself. This site has a pretty good explanation.

Quote:
Clinical similarities between the 2 treatments include their apparent effectiveness in the treatment of depression, mania, and Parkinson's disease. Unlike TMS, ECT requires administration of anesthesia and induction of a seizure and usually causes some memory impairment, but its efficacy is extremely well documented in the literature. The first controlled trial of TMS was done in 1986, and there have been fewer than 10 known controlled trials since then, so its efficacy has not been as well documented.

Biologic similarities between the 2 treatments include an anticonvulsant effect for both, increased apomorphine stereotypy in animal models, and downregulation of beta-adrenergic receptors. Although both treatments precipitate early gene expression in the brain, they do so in different areas. With ECT, early gene expression occurs most often in the hippocampus, whereas with TMS, early gene expression occurs primarily in the paraventricular nucleus of the thalamus.

Recent studies have shown new growth of neurons in the brain throughout life. These authors have demonstrated that ECT causes new neuronal growth in the hippocampus, and that this new growth increases with the number of ECT treatments.... Finally, these authors speculate that TMS may be effective by resetting circadian dysthymia by the growth of new sympathetic neurons from the paraventricular nucleus to the pineal gland.
I admit I really don't know enough about neurology to understand the biological differences, but the treatment framework is straightforward enough - for ECT they put you under and induce seizures, and side-effects include memory loss. For TMS you are awake and unsedated, and the only major side effect is a headache. (It's interesting, since receiving my first treatment I've had a dull ache in my head and down the left side of my face... it doesn't really hurt, just feels funny.)

I'm going back for session #2 right now... and hoping it hurts less this time!

Last edited by Spice Weasel; 07-07-2011 at 11:42 AM..
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  #42  
Old 07-07-2011, 05:09 PM
Toucanna Toucanna is offline
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Has anyone explained why your head hurts post-treatment? Do the medical pros recommend or advise against taking NSAIDs or other analgesics for the pain?

Hope you're feeling better soon. <<hugz>>
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  #43  
Old 07-07-2011, 07:33 PM
Spice Weasel Spice Weasel is offline
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Originally Posted by Toucanna View Post
Has anyone explained why your head hurts post-treatment? Do the medical pros recommend or advise against taking NSAIDs or other analgesics for the pain?

Hope you're feeling better soon. <<hugz>>
It hasn't hurt me post-treatment, only during those 4-second intervals where I'm receiving the pulses. The doc said to feel free to take any over the counter pain medication prior to the treatment in order to help with the headache. Yesterday I had an Aleve; today I went with 800mgs Ibuprofin. While I'm fine on my regular medication, I can't take any ''as needed'' anxiety meds like Atavan because it will affect my motor threshold. Fortunately I haven't had that much anxiety over this (other than wondering if it will work.)

The pulses are delivered through a mechanism that operates like a woodpecker on the scalp, only yesterday the pain spread all the way down the left side of my face clear to my chin. It was like that little woodpecker grew pain roots and reached out as far as it could.

Today my pain was much more localized instead of shooting down the side of my face. The TMS coordinator believes it is because the machine was hitting my orbital nerve yesterday. Striking this nerve can cause severe pain in the side of the head. She adjusted the machine (there is a tiny bit of leeway to move it to a more comfortable location... I'm talking 1 centimeter max) and it seemed to help. At first it was rattling my teeth hard and that was actually worse than yesterday. My left eye still twitches but it's an improvement. Fortunately the lady doing this is really good about trying to make you as comfortable as possible. She has a CD player and essential oils and plants and pretty much anything she can think of to make people feel relaxed.

I also recently increased the dosage of one medication and stopped taking another. On Monday they are going to give me the motor threshold test over again, as my motor threshold is expected to change. The nurse believes the new motor threshold will be lower than the current one, thus allowing the intensity of the pulses to be decreased.

But I have had almost zero side effects post-treatment. The pain vanishes the instant the pulse stops. I was out the door and on the road the minute I stopped, clear as a bell. I have a little soreness/stiffness in the left side of my face but it's almost too mild to mention.

Reading this, it just sounds too weird. Definitely an interesting experience, for sure.
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  #44  
Old 07-07-2011, 07:40 PM
Wesley Clark Wesley Clark is offline
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List o' questions

1. How do you feel about contemporary treatments for depression? I know for me it has taken years of experimentation to find out what seems to work somewhat well (for me low dose lithium aspartate has been incredibly good, but I've used dozens of techniques and supplements over the years with varying results). I am really disappointed in how ineffective we are at treating mental illness at this point in medicine, considering how much pain and disability it causes. I hope my brothers kids never have depression, if they do I hope medicine has advanced by leaps and bounds by then. I'd rather have a physical disability than an emotional/psychological one. At least with the physical disability you can still enjoy the good things in life. Maybe I'm not looking at the right info, but right now it seems like we are only starting to figure out how to treat neurological conditions.

2. How do you balance the concept of depression as a result of trauma vs depression as a self defeating biological cycle? I know for me I didn't have depression before severe traumas in my teen years (I felt blue sometimes, but never depressed), and traumas as an adult can shift my mild/moderate depressions into something more serious. At the same time, when I get properly treated for depression despite the fact that my traumas haven't changed, they don't seem as overwhelming anymore. ie, I know that depression makes my problems seem worse, but if I didn't have those traumas I probably wouldn't have depression. So I guess it is a dependent downward spiral of problems and biological depression feeding off eeach other. But since there is no effective way to 'fix' life trauma, I guess addressing the biological fallout of depression is the next best thing. But I know I sometimes feel like I am just treating the symptoms of trauma (depression), not the trauma itself. But the trauma itself really can't be fixed, medicine doesn't really know how to undo traumatic events.

3. Is your husband's family helping to pay for the treatments?

4. Are Brodmann area 25 or the left prefrontal cortex involved in the TMS treatment? I only have an amateur knowledge of neuroscience (meaning I can read articles, but that is about it), however my understanding is those 2 areas are big factors in depression. Underactivity in the left prefrontal cortex and overactivity in the right prefrontal and Brodman area 25 are important to depression. There is work with pacemakers to stabalize area 25, but DBS is more invasive.

http://news.bbc.co.uk/2/hi/health/4625775.stm

Does TMS work with the left prefrontal cortex or another area? I'm guessing from reading the above posts you aren't sure. But I am under the impression that ECT, TMS, VNS (vagus nerve stimulation) and DBS (deep brain stimulation) all work on different brain areas.

5. Are you noticing color more? Are colors brighter or more noticeable?

Last edited by Wesley Clark; 07-07-2011 at 07:44 PM..
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  #45  
Old 07-07-2011, 08:21 PM
Spice Weasel Spice Weasel is offline
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Great questions, Wesley Clark.
Quote:
Originally Posted by Wesley Clark View Post
List o' questions

1. How do you feel about contemporary treatments for depression? ...Maybe I'm not looking at the right info, but right now it seems like we are only starting to figure out how to treat neurological conditions.
I think it depends on the nature of the depression. I generally agree that we're really only at the forefront of understanding psychological illnesses through a truly scientific paradigm. Only in the last twenty years or so have we begun to conduct randomized controlled experiments on different types of therapy, and even now, while CBT and other evidence-based methods are common, they're still competing with treatments that haven't been proven effective. For people who receive access to the right treatment, I think they can help - as I have said, I have been helped GREATLY by CBT, behavioral activation, prolonged exposure therapy and cognitive therapy... literally the difference between me lying motionless on the couch and me earning a Master's degree in a very rigorous program. I have come to life because of these interventions and I think they will do a lot for many people.

That said, I have a very, very persistent case of depression. I've been depressed for as long as I can remember, was so bad that I required hospitalization in 2003 and have fought a long, hard battle to get where I am today. For people like me, it is a lot more trial and error, and I honestly don't know if it's realistic to expect that my depression can be completely cured. I generally think of myself as one of the unlucky few, however.

Quote:
2. How do you balance the concept of depression as a result of trauma vs depression as a self defeating biological cycle? ...I guess addressing the biological fallout of depression is the next best thing. But I know I sometimes feel like I am just treating the symptoms of trauma (depression), not the trauma itself. But the trauma itself really can't be fixed, medicine doesn't really know how to undo traumatic events.
It's true that meds haven't really shown any consistent help with trauma, but it's not true that there are no effective treatments for trauma. I used to have severe PTSD. I took one three-month course of prolonged exposure therapy, a very difficult and time-consuming process wherein one relives and re-experiences traumatic events until they no longer cause feelings of distress. Two years later I am virtually symptom free. It doesn't mean that my traumatic experiences don't affect my feelings - sometimes I am sad or angry or whatever, but it's not out of control. It doesn't interrupt my life or ruin my day or anything. I just feel it in that moment and move on. I no longer consider PTSD part of my problem. DO NOT GIVE UP in your quest to treat your traumatic experiences. There is absolutely help out there.

As for my depression, there is a strong family history to indicate it is genetic, but there is no doubt it was/can be exacerbated by trauma. Or, if not the trauma itself, thought patterns that reside as a result of trauma. I have worked so hard to purge myself of cognitive and behavior patterns that exacerbate depression, but it persists. I only very rarely have negative thoughts about myself, or just sit around doing nothing - but it persists. I exercise, I meditate, I eat healthy, I get plenty of sleep - it persists. I take meds, it persists. It absolutely sucks because it has cost an incredible amount of time and money to learn to deal with it better, but it hasn't gone away. I have a ripping awesome life from any objective standpoint - a happy marriage, great education/career prospects, freedom from major financial concerns - and it still persists.

Quote:
3. Is your husband's family helping to pay for the treatments?
Indirectly. There is no way this could happen for me if it hadn't been for their incredible generosity over the past several years.

Quote:
4. Are Brodmann area 25 or the left prefrontal cortex involved in the TMS treatment?
TMS targets the left prefrontal cortex, indeed.

Quote:
5. Are you noticing color more? Are colors brighter or more noticeable?
Not at this time.
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  #46  
Old 07-07-2011, 08:22 PM
Cat Whisperer Cat Whisperer is offline
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I'm really hoping that this works for you, olives. You've been my go-to person to back me up when advocating for CBT for treatment of anxiety and depression - do you think you will reduce your endorsement of CBT? There are so many people fighting so hard against the idea of doing anything except taking drugs for their anxiety and depression, I hate to lose a soldier on this side.

ETA: Nice simul-post.

Last edited by Cat Whisperer; 07-07-2011 at 08:24 PM..
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  #47  
Old 07-07-2011, 08:52 PM
carnut carnut is offline
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olives, I hope this works for you. The drugs people take for depression have a wide array of side effects and what works for one person definitely doesn't work for another. My family would be thrilled to find a non-drug solution for chronic depression. I am interested in your experience so please keep us posted.
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  #48  
Old 07-07-2011, 11:25 PM
Wesley Clark Wesley Clark is offline
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Originally Posted by olivesmarch4th View Post

It's true that meds haven't really shown any consistent help with trauma, but it's not true that there are no effective treatments for trauma. I used to have severe PTSD. I took one three-month course of prolonged exposure therapy, a very difficult and time-consuming process wherein one relives and re-experiences traumatic events until they no longer cause feelings of distress. Two years later I am virtually symptom free. It doesn't mean that my traumatic experiences don't affect my feelings - sometimes I am sad or angry or whatever, but it's not out of control. It doesn't interrupt my life or ruin my day or anything. I just feel it in that moment and move on. I no longer consider PTSD part of my problem. DO NOT GIVE UP in your quest to treat your traumatic experiences. There is absolutely help out there.
I know for me, in the last 10 years I have had 3 bouts of pretty serious depression (on top of the melancholy I've had issues with) and each was precipitated by severe stress (all 3 bouts were due to financial, educational or vocational issues). So I tend to subscribe to the diathesis-stress model of depression since I know severe stress about being able to earn a living and live independently with dignity has been the trigger over the last 10 years. When I feel that is threatened, the stress puts me into a depression. When I don't feel threatened by that, I have some melancholy but nothing too serious. The fact that I'm having problems in the worst economy since the 1930s isn't helping either.

But I can't always remove the source of the stress, which is a problem. I also can't remove the original traumas I experienced when younger that likely made me more vulnerable to negative moods in my life. If I hadn't had those traumas, maybe my brain wouldn't be so vulnerable. At the same time had I not had those traumas my life would not have the depth or novelty it does. So it is a mixed bag. The lows are worse, and the highs are better due to trauma. You appreciate things more and you worry because you realize they are more fragile too.

I try to avoid triggers (by saving money, investing wisely, being frugal, being a good employees, being educated, etc. all designed to avoid situations where I feel I am not able to financially be self sufficient. Again, the most severe depressions I've had were all triggered by stress caused by vocation and financial shortcomings). But I can't always. So my point was that a person can try to avoid the stress triggers that can put them in a depression (either immediate stress or stress due to unresolved trauma), but not always.

I know for me stress reduction doesn't seem to help much. Meditation, exercise, guided meditation, deep breathing, PMR, etc. I don't notice much long term benefit from those. I can't tolerate the side effects of SSRIs, and from what I've read they only work a little better than placebos anyway (I have no idea how well they work on me, I couldn't tolerate them).

What I have done is focused more on improving the resiliency of my brain to stress. I found some supplements that really help (magnesium and very low dose lithium. My recent depression got about 80% better on these), which have some studies showing them to be protective of the brain in times of stress when stress hormone levels are high, helping to prevent or reverse the brain damage that accompanies stress and can lead to depression. Luckily my MD is into alternative as well as western medicine so I can work with him on these issues.

But all in all my anti-depression toolkit tends to consist of 3 things

1. Making peace with myself due to the original traumas, and accepting the negatives that come from that (I think this makes me more resilient, at the very least it makes life more enjoyable and less scary)

2. Avoiding triggers for serious stress that can trigger a depression (for me almost always something to do with a job or income and my ability to live independently with dignity being threatened)

3. Making my brain more resilient in the face of stress so even when stress happens, I can cope with it w/o sinking into depression

Anyway, I hope what you are doing works for you and you get better. Depression robs people of the ability to enjoy the good things in life, and it sucks. But my point was that the depression is more a symptom/side effect of trauma and stress mixed in with genetic vulnerability, and a person can't always remove the trauma or stress. I can't go back in time and change the past. I can improve my reaction to it, but what happened happened. Even if I could, I don't even know if I'd want to. It is a mixed bag of good and bad, and a huge part of my identity now.
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  #49  
Old 07-08-2011, 09:53 AM
Spice Weasel Spice Weasel is offline
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Quote:
Originally Posted by Cat Whisperer View Post
I'm really hoping that this works for you, olives. You've been my go-to person to back me up when advocating for CBT for treatment of anxiety and depression - do you think you will reduce your endorsement of CBT? There are so many people fighting so hard against the idea of doing anything except taking drugs for their anxiety and depression, I hate to lose a soldier on this side.
I still strongly endorse CBT. As I said, it is the difference between me functioning or not functioning with severe depression. Even though I still have depression, CBT helped me build a life worth living. CBT is the reason I can be severely depressed and still feel that overall, my life is wonderful. It helps me put the depressive episodes into perspective and reminds me that things will eventually be okay again. It helps prevent those feelings from shifting into suicidal or self-destructive impulses. I can't underscore enough what CBT has done for me. There was a time I couldn't even be a student or hold down a job. CBT changed all that. If it could work miracles in a grim situation like mine, how much more could it do for others.

Quote:
Originally Posted by Wesley Clark View Post
Anyway, I hope what you are doing works for you and you get better. Depression robs people of the ability to enjoy the good things in life, and it sucks. But my point was that the depression is more a symptom/side effect of trauma and stress mixed in with genetic vulnerability, and a person can't always remove the trauma or stress. I can't go back in time and change the past. I can improve my reaction to it, but what happened happened. Even if I could, I don't even know if I'd want to. It is a mixed bag of good and bad, and a huge part of my identity now.
I can only speak from my own experience dealing with PTSD and depression. I don't think it's always terribly helpful to focus on WHY the symptoms are there - just on how to treat them. There is a school of thought in psychology (mostly psychodynamic/psychoanalytic) that we must uncover the roots to our dysfunctions in order to heal. I prefer the direct approach - I'm dealing with X problem in this moment and can try Y and Z to address it. I have depression. Whether it's lingering stuff from trauma, a deeply ingrained biological vulnerability or both, it's the same problem I have to solve.

There was a time when I felt like I was constantly engaged in a war with my past experiences - when I wasn't reliving them directly, I was shrouded in this pervasive feeling that I was in extreme danger. Prolonged exposure therapy changed that. Honestly I barely even care about my past anymore. I feel normal feelings of sadness, grief and anger at times, but they are 100% natural responses to sad life experiences rather than this ticking time-bomb of terror and catastrophe that they used to be. I recognize how it shaped me into the person that I am today, but I'm also way more interested in what's going on right now. So it's true that the trauma cannot be removed, but it can be contextualized and put in its proper place.
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Old 07-08-2011, 12:11 PM
Cat Whisperer Cat Whisperer is offline
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Originally Posted by olivesmarch4th View Post
I still strongly endorse CBT. As I said, it is the difference between me functioning or not functioning with severe depression. Even though I still have depression, CBT helped me build a life worth living. CBT is the reason I can be severely depressed and still feel that overall, my life is wonderful. It helps me put the depressive episodes into perspective and reminds me that things will eventually be okay again. It helps prevent those feelings from shifting into suicidal or self-destructive impulses. I can't underscore enough what CBT has done for me. There was a time I couldn't even be a student or hold down a job. CBT changed all that. If it could work miracles in a grim situation like mine, how much more could it do for others.


I can only speak from my own experience dealing with PTSD and depression. I don't think it's always terribly helpful to focus on WHY the symptoms are there - just on how to treat them. There is a school of thought in psychology (mostly psychodynamic/psychoanalytic) that we must uncover the roots to our dysfunctions in order to heal. I prefer the direct approach - I'm dealing with X problem in this moment and can try Y and Z to address it. I have depression. Whether it's lingering stuff from trauma, a deeply ingrained biological vulnerability or both, it's the same problem I have to solve.

There was a time when I felt like I was constantly engaged in a war with my past experiences - when I wasn't reliving them directly, I was shrouded in this pervasive feeling that I was in extreme danger. Prolonged exposure therapy changed that. Honestly I barely even care about my past anymore. I feel normal feelings of sadness, grief and anger at times, but they are 100% natural responses to sad life experiences rather than this ticking time-bomb of terror and catastrophe that they used to be. I recognize how it shaped me into the person that I am today, but I'm also way more interested in what's going on right now. So it's true that the trauma cannot be removed, but it can be contextualized and put in its proper place.
I've put this whole post into my archives, because it addresses a number of issues that keep coming up in our anxiety support group that I haven't had a good answer for before. Thanks, olives.
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