Olives, do you care if i send a link to this thread to my Mom? She is a clinical psychologist, and may be intrested in this subject.
Olives, that is great news!
What you describe happened to me after we took my hormonal imbalance out of the picture. After a couple of weeks, I realized that I was doing okay. I remember standing in the bathroom and taking an internal measure of myself. I wasn’t jumping for joy but I wasn’t carrying around a big package of depression on my shoulders. It was such a relief. Again, not joy, but suddenly I felt I could breathe a little deeper and stand a little more firmly on the ground.
Congratulations to you.
Good to hear it’s working for you. I have a friend who also got good results from this therapy. Good luck with your continued treatment.
I am honestly curious - how do you know you’re not answering the questions differently because you feel like it should be working? Are you tricking yourself or possibly feeling a placebo effect? I ask, not to be nasty or to doubt you that it’s working, but because I have an extremely hard time dealing with these sorts of self-assessments and I’m always worried I’m not doing them properly. Like squinting on an eye exam, you know?
I’m encouraged that it’s working so well for you, and you’ve inspired me to start saving up and possibly go for a consultation.
Og forbid I should interrupt this love-fest for TMS with a suggestion that it’s all in your head (heh). Just because this isn’t General Questions doesn’t mean we (SDMB) should hold claims to a different standard – Fighting Ignorance, y’know.
So…Scholarly searching shows that this treatment is far from accepted by the medical community at this time. If you don’t want to read all the brief extracts below, just skip to the bolded part.
From the Blue Cross Technology Evaluation Center comes this:
(bolding mine).
I’d say that the evidence of efficacy at this time is dubious at best, and the placebo effect might be the strongest effect present. And it’s a very expensive placebo.
It’s worth keeping in mind that the analysis was done by a major health insurance company, so cost is the primary (or near-primary) concern. The analysis itself does note that 4 out of the 5 meta-analyses that they analyzed found significant improvements over placebo, and the major criticisms seem to be that one inclusion criteria was failure on one (or more!) antidepressant medications, when they would have preferred more medications tried first, and that this is a recently-approved therapy that needs more research. I heartily agree with the latter, and in olives’ case, she appears to have been through a number of different antidepressant medications already.
Furthermore, research has suggested that some antidepressant medications work on a near-placebo effect, and may have other real health effects to boot.
So in a case where a patient has failed on a number of antidepressants, this may be a more expensive placebo, but may also be a safer placebo than what she’s been going through already.
I don’t know, self-reports are always kinda wonky for me because I tend to be influenced by how I’m feeling in that moment. I try to be as honest as possible for them. I can say that I really didn’t expect to feel much better, or really notice that I was feeling much better (research shows that the patient herself is the last to notice she is feeling better.) The Hamilton scale doesn’t focus as much on negative cognitions and mood as it does on more concrete indicators like sleep, appetite, etc. If the placebo effect worked for me you’d think it would have kicked in on one of the 20 different medications and therapies I’ve tried. I tend not to sugarcoat what’s going on with therapists and psychiatrists. But I can’t definitively say it’s not the placebo effect. The only true test of this treatment will be time.
Thanks for your input, it is all too appropriate in a thread started by one of the staunchest supporters of evidence-based treatments on this board. I read a number of studies before I decided to do this. They weren’t all positive reviews, as yours above indicates, but the majority showed some evidence of efficacy. Even when it did work better than placebo, the overall success rate is lower than I’d have liked (but actually comparable to other treatments.) But as Ferret Herder points out, there are several studies indicating efficacy, including a handful of true RCTs.
I don’t claim it’s the most proven and rigorously tested treatment. It’s not junk science either. It’s classified as ‘‘promising’’ - some evidence that it works. What I do know is I’ve tried many different classes and variation of medication as well as prolonged exposure therapy, cognitive behavioral therapy, cognitive therapy, and currently ACT. I’ve committed crazy amounts of time, energy and money to my mental health over the last decade, and I still become severely depressed. When I last checked in with my therapist two weeks ago I wasn’t doing so hot, and he said, ‘‘Wow, I would really think you would be feeling better by now considering you’re doing everything right for ACT. That indicates me to me that there is a very strong biological component to your depression and I am very glad I referred to you the psychiatric clinic.’’
Something’s wrong with my brain. I’m hoping TMS can fix it. It’s not like I haven’t tried everything else. Maybe it won’t work, and I’ll be out $10k and that will suck. And if that happens, my last hope will probably be ECT. But maybe it will work, as it has worked for some people. Maybe it will reduce my symptoms by 20%, maybe by 80%. I don’t know what else to say. Life’s a gamble. This is what happens when you start running out of options.
Olive, IANADoctor, but one thing that pops out at me about this treatment is the rationale behind it. If it works, how does it work?
It reminds me a lot of claims, now known to be 100% bogus, of beneficial effects from permanent magnets. The claims are/were all over the fantasy spectrum (google for them sometime). Some claimed that magnetic fields were good, some bad, all depending on what they were selling them for. It was at least safe to claim no harm, because, AFAIK, weak magnetic fields of that type have no demonstrable effects on human biological conditions at all.
I will grant you that TMS might be different, perhaps in significant ways, but I’d like to see some expert in biophysics tell us just how. How do we know that pulsed fields are good? What strength? What pulse rate? Does it matter where the energy is directed, or are all electrical fields in the brain good? Bad?
Yes, I have seen some mention of these items in the various reports, but it seems like we are operating at the ragged edge of science, if indeed it is science.
Why is the treatment effective only for depression? Does it have any other psychological effects, what kind, how much? How come it doesn’t make depression worse (with so little evidence, that is a possibility that must be considered).
Can any related or proposed processes be reproduced in the lab? In a petri dish? If not, we are totally relying on subjective opinions, and that presents a severe problem in clinical trials when sham treatments are hard to disguise from the patient, and impossible to hide from the practitioner.
Although you mention some studies that suggest a strong placebo effect, I wonder if they controlled for no treatment at all, not just substitutes. And it is possible that the Hawthorne or Experimenter effect is also a factor (someone wearing a white coat works on you with fancy instruments, you feel obligated to report positive results).
This article, published in The Journal of Neuroscience, suggests that it can impact the hippocampus as well. There are also imaging studies indicating increased levels of seratonin, norepinephrin and dopamine as a result of TMS. There are a few theories about why it works, but the general consensus is that it stimulates blood flow and increases neurotransmitter activity in the left prefrontal cortex.
These questions are still under exploration. Here’s one study that explores coil-to-cortex distance as well as pulse frequency.
It is important to note that these aren’t pulses being shot randomly into the brain. They are targeted at a very specific area only about 2-3 centimeters deep.
Brain Effects of TMS Delivered Over Prefrontal Cortex in Depressed Adults.
It’s not only effective for depression. Variations of TMS have been found to diminish negative symptoms of schizophrenia, symptoms of Parkinson’s disease, and more recently (in a yet unpublished small study) with autistic children. (These appear to work by targeting different areas of the brain affected by these disorders, not just the prefrontal cortex.) However, those applications are in the earliest stages of exploration, and AFAIK have not yet been approved by the FDA. It also appears to increase the pain tolerance of post-operative patients. The research is happening. It’s not going to happen overnight. The University of Pennsylvania, one of the foremost mental health research facilities in the world, currently has a research center working on TMS. It takes years to build a solid research base to support such a treatment, but the evidence is sufficient for the FDA to approve it and me to try it in the hope that it will help me.
The long-term effects are not known. I found one article that indicates that, at least in the short term, it impairs working memory.
It has less evidence than CBT or ECT, but far more than standard psychodynamic therapy, for example. I would be much more skeptical of someone receiving standard outpatient therapy than doing something like this.
These are good points. It’s pretty hard to do sham treatment for TMS since having an elctromagnetic pulse shot through your skull has a pretty distinctive feeling. I can’t really change what’s out there, though. I considered the evidence, I considered my circumstances, and I made a choice based on the information I had. Hopefully I will benefit from that choice.
I do appreciate you bringing up your concerns. As annoying as it is to defend a personal choice you have made, these are important questions to ask, always.
Another point I wanted to make - yes, it’s expensive, but it’s not really any more expensive than my treatment has been in the past. My prolonged exposure therapy was about $175/session IIRC. A visit with a psychiatrist is $350 for the consult and $250 for every session thereafter. I think I’ve spent at least $10k in the past decade trying to get better. Before I had good insurance I paid hundreds of dollars a month for medication. Then there’s the cost of hospitalization. Those are just the sacrifices you have to make when you have a chronic illness.
I saw that, but I wonder what happens if you target an area slightly to one side, deeper or shallower (blinded, of course) and can these results be readily duplicated? These are not frivolous questions.
It’s a pretty broad stroke used to treat a narrow situation, with too many variables, IMHO.
Examination of that link raises quoite few red flags. Small sample size (22), no mention (in the abstract) of the statistical significance or even raw data for how much change was shown, etc.
Thanks for understanding. I really don’t intend to attack you personally, but I know a lot about we can fool ourselves; I hate to see people waste their time and money on worthless treatments or worse, and history has millions of examples of that.
Hope you get better!
Too late to edit & fix…
The link I was referencing was this one,Changes in Prefrontal Cortex and Paralimbic Activity in Depression Following Two Weeks of Daily Left Prefrontal TMS
Also no mention of follow-up. Some phenomena, seemingly effective during the treatment period may show no advantage over placebos or no treatment at all some time later.
I know, and in the past I’ve been burned by so-called experts who didn’t know what the hell they were doing. At the time I just blindly trusted. This time I am at least going in without the blind trust and unrealistic expectations that I did in the past. Whatever happens, I take responsibility for the choice I’m making.
But honestly, I’m wondering - where could I really go from here, other than toward more experimental treatments? I have literally tried about 13 different psychiatric medications - atypical antipsychotics, mood stabilizers, SSRIs, the works. I have been in and out of therapy for a decade, and I don’t just show up - I work HARD. I do my homework. I put in my time. I exercise, I meditate, I eat right, and still I suffer. What’s left?
I certainly don’t fault you for trying anything and everything, and if you think this has the best chance of working, go for it. But I constantly remind myself when something appears to be “working” that I am probably the poorest and most biased observer (because I am also the patient), at least if knowledge and truth are paramount.
My doc recently gave me a nasal spray as a treatment for a chronic sinus condition. Unlike some other medications, this seems to have a slight positive effect, and that’s what clinical trials suggest (this one is approved by the FDA). But I am observing it knowing full well that I am subject to a multitude of biases, and the fact that it seems to work may be more mind than chemistry.
So I guess I’ll keep using it (it’s cheap and not a problem to self-medicate) unless I run across a study that suggests that it is not effective after all.
Don’t you wish things could be more black and white instead of multiple shades of gray?
Today I completed Day 20 of TMS. The procedure is old hat by now. I’ve nearly fallen asleep twice in the process.
This is actually a milestone for the treatment because it marks the beginning of the end. As of today I will be tapering off for the next four weeks. Next week I only have 3 sessions, then 2, then 1.
My mood has remained stable. The only significant symptom of depression I am having currently is fatigue and difficulty staying asleep. I have completely stopped taking the anxiety medication. Bizarrely enough, my anxiety has gone way down. I’ve had a touch of the night tremors but that’s about it. My body used to be completely wired with adrenaline at all times; even when I was doing relatively okay, I could feel the stress of it in my body. That’s just gone.
(On the other hand, this week I had a resurgence of PTSD symptoms which I haven’t seen in ages. I was able to get some emotional distance pretty early on though so it was no major disruption, just some temporary unpleasantness for a few days.)
My doctor says even though TMS isn’t indicated for anxiety, it does appear to help with it. So maybe.
I feel, quite frankly, very strange. I’m normally very in touch with my current state of being but lately I’ve been feeling a way I can’t easily describe. The best way I can describe it is blunted. I don’t feel particularly depressed or particularly happy. Life’s stressors abound but for some reason I’m incapable of getting too worked up over them. It’s almost as if I am detached. I start to get worried or upset and then some part of me just steps in and says, ‘‘Oh, look, thoughts. Nice, let’s move along.’’
The flip side of this, which is not particularly wonderful, is that I don’t feel much motivation to do anything. I guess the truth is a lot of my activities and productivity are typically driven by fear and anxiety. I would be productive specifically to avoid all the trauma of failure. Without anxiety, I’m sort of like, ‘‘What’s the point?’’
I don’t know if that’s a short-term effect or unrelated or what, but it’s something I’m going to have to work on. A big part of it could just be the fact that I’ve been unemployed for a few months while doing the treatment and really anxious to get on with my life.
I’ve also been doing ACT therapy which focuses on defusing from thoughts/emotions and sort of stepping back objectively, so that might have something to do with it as well.
Anyway, that’s the update. Can’t believe I only have seven sessions left.
I’m glad you feel it is working, depression is hell. I don’t know if this question has been asked aleady (I don’t want to go through all 80 posts to see if it has) but what happens after you finish the TMS series? Do you go back periodically to get new bouts of TMS? How long do the results last after this is done? Can you do it on a sporadic basis for life if it does work?
Thanks for posting about this. It has been really fascinating.
I was wondering about this. I wondered how much of a role anxiety plays in getting motivated.
I’ll be interested to hear more about how this changes over time.
Congratulations on feeling better.
If you have actually made changes in your brain, this might be your new normal and you will eventually get used to it. Even when the changes are things you want and have worked towards, they don’t always feel right and normal right away (like losing weight - you have to get used to your new body, etc.). Does that make any sense? 
The long-term effects of the treatment are unknown. Anecdotally, the outcome depends on the person. Some people just continue on a maintenance anti-depressant, some people have follow-up visits every few years, some people require no medication or no follow-up treatment at all.
My doctor has said that about three months post-treatment we will review whether or not to take me off the anti-depressant I am currently on. Part of the idea of TMS is to reduce the amount of medication one has to take, which is particularly helpful to those of us who are very sensitive. In the last month I have gone from three medications to just one.
Yes, it makes perfect sense. I know I can get used to this - it’s just different.
Oh, cool. I was just wondering about you the other day. Glad to hear it’s working!
I wonder if the bluntness isn’t caused by the TMS by itself, but also the effects of the antidepressant combined with it. You might be running on too much now.
There is another possibility that I’ve avoided talking to you about in the past: were you on benzos? How quickly did you taper off? And how long have you been off? There are sometimes withdrawal effects.
Oh, and one reply to Musicat’s last response: What’s the difference between thinking you are no longer depressed, and actually no longer being depressed? Think about it.