Has anybody here tried rTMS therapy for depression yet?

[Bo]

Hi Everyone,

My name is Bo, I'm a 28 year old male, living in Toronto, Ontario. I was diagnosed with Major Depression when I was 18, with a probability of having had depression since I was 14.

I used to be on Zoloft, but I didn't really use it reliably: I would take it if and when I remembered, and only when I could afford it. So, I made the mistake of going off it cold-turkey several times.

More recently I'm on a combination of Celexa and Wellbutrin, with moderate success. I guess you could say I'm doing "better", but I'm not exactly "fine".

I've personally observed that I seem much more likely to have dysthimia, with bouts of Major Depressive episodes interspersed throughout. Of course, this doesn't really matter as both conditions are treated using the same techniques.

Anyways, I've digressed from my original question, so let me get back to that. Recently, my employer has agreed to provide the funding for me to take part in rTMS (repetitive, trans-cranial magnetic stimulation) treatments. If you've never heard of it, you can learn more at www.mindcarecentres.com. It was recommended to me by my company's doctor, who seems very excited by the treatment.

Unfortunately, I don't have a psychiatrist at the moment (first session with him is in November), and my family physician has never even heard of rTMS, so I have very little to go on. I was searching around last night, and I found this link that basically says that rTMS isn't recognized as a treatment for depression.

Has anyone tried it yet? Observations, results? I go for my initial appointment on Wednesday (October 27, 2004), with treatment starting on the 28th.

I would absolutely love to get off of my medications someday if it's at all possible, so I'm hoping that this treatment performs a miracle.

No matter what, I'll make sure I keep everyone posted with my experieinces, observations, and progrss as time goes by, but I was hoping to hear from others who have experienced rTMS or considered it.

 

[David Baxter PhD]

I have read a little bit about it, Bo. Basically, it is still very much in the experimental stage at this point, so there is no good data to support it as a recommended treatment -- that doesn't mean it doesn't work, only that it remains to be seen whether or under what conditions it can be effective.

The other question I have from your post is are you currently seeing a therapist (i.e., for psychotherapy and/or cognitive behavior therapy)? Medication alone can be helpful but most of the available research is quite clear: If you really want to address the issue that are triggering the depression, you also need to get help in the form of psychotherapy. That's especially true if you hope one day not to need any medication...

 

[Bo]

No, I don't have access to any psychotherapy at the moment Dr. Baxter. As I mentioned, I do have an appointment with a psychiatrist in mid-November, but that's about it. And, to be honest, I'm not optimistic about this upcoming appointment, either.

This will be my fourth psychiatrist. The first two that I went to wound up saying that I was "at the point where they would refer me back to my family physician". I rejected the third one I went to, I just pretty much hated him. This fourth one is going to wind up asking about my meds, the impact that depression is having on my life, and that'll be it. He may adjust my dosage, but I truly doubt there will be any offer for cognitive behaviour therapy forthcoming. He just won't have the time available, considering that even with a referral from my GP, it took them over a month just to call me to book an appointment for a month after that!

My understanding is that unlike a psychiatrist, a general therapist would not be covered by OHIP, even with a referral. Any idea if that's correct? Like many people with long-time depression, I haven't exactly risen to the top of my profession, so money is always an issue.

I was looking through other threads, and the one about cognitive distortions was interesting. I realize that if I've had depression since I was 14, that many of my beliefs and attitudes will be unneccesarily negative. This would be learned behaviour; it would continue even if the chemical imbalances in my brain were fixed today. I know it's a word you try to avoid in psychiatry, but much of my core belief system is probably "wrong". Or, at least, distorted through experience.

I've mentioned cognitive behaviour therapy to my GP, and to at least one of the psychiatrists that I've had. Other than one session in a really bizarre therapy group, my Dr's seem to have this attitiude of fixing the chemicals in my brain through pharmacology, and that my thinking and beliefs are none of their concern. I personally believe that if a person has enough negativity, no amount of anti-depressants will be able to overcome it for long. As I said in my first post, I suspect that I have dysthymia, which would require a lot more talk therapy in my opinion.

It's funny: for most of my life since I've gotten depression, the "specialists", the psychiatrists, have pretty much treated me like I should get out of their offices and let them help somebody that has real problems. Which is, in my opinion, why so many people (especially men) don't seek help for depression. If the professional attitiude towards the illness is not enlightened, how can we be expected to beg for help?

 

[David Baxter PhD]

I notice you list your location as Scarborough, Bo... one thing you might look into is to see if either York University or the University of Toronto has a "Psychological Services" centre... universities with graduate clinical psychology programs often do and if so you might have access to upper year students who conduct therapy with clients under the supervision of clinical professors. While of course they may not have years of experience, the supervisors do, and the cost to the public is generally nominal.

The other possibility might be services through the Clarke Institute (now combined with Addiction Research Foundation and I forget the new name) -- there may be a long waiting list there, though, as there would be with hospital outpatient departments who sometimes offer such services.

Another way of finding out this information might be to contact psychologists in the area (look under Psychologists and Psychological Associates in the Yellow Pages) and ask them if they can recommend a free or low-cost service -- I do respond to such requests when I can for the Ottawa area.

 

[David Baxter PhD]

One other thing that I assumed you've already thought about but maybe not: If your employer is willing to provide funding for an experimental treatment, would they offset the costs of a psychologist or psychotherapist? Many employee extended health plans do...

If so, let me know... I do know an excellent therapist with offices in Mississuaga and Toronto...

 

[David Baxter PhD]

Bo, check your Personal Messages here... (click on the link at the top of the page).

 

[Bo]

Ok, I've pulled out my benefits package, and it doesn't say one way or the other if psychotherapy is covered. I see there is a small allowance fro Psychologists ($1500 per year), but nothing on therapists. I'll have to call my benefits provider on Monday to find out.

I hadn't thought about the local universities - thanks for the idea.

 

[David Baxter PhD]

If you're covered for Psychologists, that will work -- the person I mentioned in the private message is an M.A. level therapist but she works "under the supervision of a psychologist" for insurance claims so you would be covered. $1500 per year is actually a very generous isnurance package -- even better than the federal public service gets.

 

[Bo]

First Impressions

Hi Everybody,

I had my initial interview at the rTMS clinic today. It looks promising. The Dr. seems confident and self-assured, and was able and willing to answer all of my questions... even the ones that pointed out some of the negative aspects of the treatment.

Of course, I won't really know more until I go for my first actual treatment tomorrow, but I just wanted to share my initial impressions.

If anybody is thinking about trying this type of treatment, and is on Wellbutrin, make sure you bring that up with them as soon as possible. Depending on your dosage, they may want to reduce it before/during treatment, which can prolong your wait time.

I'm looking forward to tomorrow, when I can share more.

 

[David Baxter PhD]

Thanks, Bo. Looking forward to hearing how this goes for you.

 

[sammy]

That sounds hopeful Bo...

Pleased for you

 

[Bo]

Hi Everyone,

I didn't go to my Thursday appointment for my first treatment, I had a family emergency that needed tending to. I did go today, though.

It was... interesting. You sit in a nice, comfy chair, and they put on a relaxing cd (I think it was one of the Solitudes collection, which is always nice). They ask that you wear earplugs just to be safe. Then they take a few minutes testing different areas of your head, to find the right spot (interesting aside: depression is on the left side of the head, anxiety is on the right. Neat, huh?). They know when they've found the spot when you have involuntary thumb movements.

The treatment itself is, in a word, annoying. The only way I can explain it: hook a ball-point pen up to a sewing machine. Run it at a fairly high speed on your head for 5 seconds (It's a 5 second zap, 10 pulses per second). Rest for 25 seconds. Repeat. 50 times!!! I had expected a hum, not a series of clicking noises.

It's not exactly painful... I think. It causes some spastic movement of the muscles above your eye, which I think most people, myself included, interpret as pain. I would have sworn that there would be a bruise when it was done, but there isn't. The head isn't tender to touch or anything like that.

They actually ask your threshold level, and are completely willing to dial it down if you request it. I think that they need to turn it up as time goes on, but I truly believe that I'll get more used to it with each session. I never asked them to turn it down, I didn't want to seem like a wimp. I think on Monday I'll ask them to start just a little lower, even if they turn it up during the session. I think easing into it might be a better idea.

The biggest problem is that the "threshold level" that they measure is with your motor cortex. It really knocks you out of whack! I have a headache, but I've taken some Excedderin, so it'll go away soon. I'm a touch clumsy at the moment. My legs feel especially heavy, and I'm definitely having some feelings of eyestrain in the left eye. I'm also experiencing very small bouts of dizziness. None of it makes me worried, none of it seems long-term or life threatening, but this first session has definitley taken alot out of me. The effects are already subsiding, but it's been a few hours.

The only thing I can compare this sensation to is an endorphine rush, like after a good workout. You feel good, but also just a little ill.

I look forward to seeing how Monday's session goes!

 

[David Baxter PhD]

The only thing I can compare this sensation to is an endorphine rush, like after a good workout. You feel good, but also just a little ill.

Or like after a really scary movie. (Or, if you're Woody Allen, after falling in love or making love.)

Interesting post, Bo. Maybe you can turn this into a book some day... )

 

[^^Phoenix^^]

Hi,
Ive lifted the following passage from Yale School of Medicine
for those of us that had not heard of it before.


Transcranial magnetic stimulation (TMS) utilizes an electromagnet placed on the scalp that generates magnetic field pulses roughly the strength of an MRI scan. The magnetic pulses pass readily through the skull and stimulate the underlying cerebral cortex. Low frequency (once per second) TMS has been shown to induce sustained reductions in cortical activation in multiple studies. Currently we are conducting multiple trials of TMS. Some of these studies have been initiated to determine whether low-frequency TMS can reduce hallucinated voices. Another study uses an RI brain scan and TMS to better understand brain processes producing symptoms of borderline personality disorder. Below are descriptions of these studies and information about how to contact us

 

[Bo]

Hi Everyone,

OK, so I've had 6 treatments so far. It's very hard to say how much success I'm having.

I've always been an avid oversleeper due to my depression. I find that with the treatments, that's still the case, but now I actually enjoy sleeping. I oversleep, but I actually feel rested when I wake up. What a nice change!

I *think* I'm starting to notice small behavioural changes, such as being in a slightly better mood, and not complaining as much. I've had a few things happen in my life over the last 2 weeks that would normally bother me a lot, but I suspect I've handled them a little better than I would have in the past.

I'm still missing time at work, though. In the last 5 days, I went in on Wednesday only, and left after 3 hours. I just haven't felt up to it after the treatments. That, and the headaches are brutal. The idea of being in a room with 200 people, sitting on the telephone all day, has not exactly appealed to me. I'm actually going to approach the doctor about maybe taking a proper short-term leave, so that I don't have those absences hanging over my head each day.

Tentative opinion: I think the therapy works, or will work, but 6 treatments aren't enough. I'll let you know.

 

[David Baxter PhD]

Are you sleeping more since starting the treatments, Bo? Is your energy level any better?

Also wondering about the headaches... how long do they last after a treatment?

 

[Bo]

Sorry it took me so long to respond Dr. Baxter;

No, I'm not exactly sleeping more... I've always slept alot, but woken up feeling unrested. Lately, I've been sleeping more than "normal" people, but it feels different. Now I'm oversleeping because I like the feeling, and I'm waking up feeling more rested and relaxed than I have in years. It actually feels like I'm catching up on lost sleep, as opposed to just sleeping my life away. It's hard to explain, and it's hard to distinguish. I've never had a steady sleep pattern in my adult life, and I'm only beginning to believe that I can. It's the difference between restful sleep and mere unconciousness.

I do sometimes feel that I'm power-sleeping though. Sometimes when I lie down for a nap, if the phone rings within the first hour, I don't hear it. After an hour, though, if the phone rings or my alarm goes off, I hear it and can usually get up at that time, which is a change for me.

The headaches are pretty persistent after treatment. If you don't take anything for them, they'll last a few hours - or until you sleep it off. If you take a couple of Advil or Excederrin after the onset of the headache, then it goes away very quickly, say 10-15 minutes. One day I thought I'd outsmart myself and I took the Advil just before my treatment, but that didn't work. In my experience, you get the treatment, you get the headache, THEN you take the pills. It's really not a big deal though. In a previous post I said that the headaches are brutal - I should clarify that they are for me; they're probably nothing for other people. I've lived with stress and tension headaches for years, but since these headaches are a different type, and localized in a different area of the head, I have no tolerance built up, that's all.

I took the standard Hamilton and Beck tests again today (I took both on the first day, as well), and I think they indicated a reduction in my depression. As for myself, I keep feeling like there are small shifts under the surface of my psyche, but that the changes aren't very visible on the surface yet. It's more of feeling of... expectation, of upcoming change, than change itself.

I've also begun the process to take short-term disability leave from work, to have that issue and that guilt off my plate for a while. I need to concentrate on getting better during this great opportunity. Also, I finally put in a call to that therapist you recommended, so hopefully there's some progress there, as well.

 

[David Baxter PhD]

Thanks for the update, Bo. Interesting information indeed.

But I'm also glad to hear that you contacted the therapist -- no point in putting all your eggs in one basket and she will be able to help you take a look at other factors in your past and present life that got you to this point and may help you to avoid a relapse at a future date.

 

[Bo]

Second-last update (maybe)

Hi again everyone,

Well, today was my second-last treatment. I feel great, like I really have a chance of getting this thing licked once and for all.

I purposely never asked the clinician for my Beck and Hamilton scores while treatment was in progress. I also never looked them up on the internet or anything, because I didn't want to influence my answers. I wanted to keep it as real as possible.

Normally the clinic does the two tests one last time after the final treatment, but because I was meeting with my therapist today, I asked them if they could do the tests today, and give me my scores to share with her.

Now that the treatments and testing are basically done, I've done a little bit of research. According to Swinburne University of Technology, the scoring for the Beck Depression Inventory is like this:

Total score Levels of Depression
05 - 09 These ups and downs are considered normal
10 - 18 Mild to moderate depression
19 - 29 Moderate to severe depression
30 - 63 Severe depression
Below 4 = Possible denial of depression, faking good; this is below usual scores for normals.
Over 40 = This is significantly above even severely depressed persons, suggesting possible exaggeration of depression; possibly characteristic of histrionic or borderline personality disorders. Significant levels of depression are still possible (Groth-Marnat, 1990).

On my first day of treatment, 10/20/04, my score was 28. On 11/04/04, my score was 23. Today, 11/17/04, my score was... 5. Just 5!!! Amazing, isn't it? I never dreamed these results were possible. I get weepy just thinking about how grateful I am.

The biggest differences, for anybody that's wondering, were the physical complaints. My irritable bowel hasn't acted up at all in the last two weeks. I'm more refreshed when I wake up in the mornings that I have been since childhood. I don't worry so much about every ache and sore muscle that I have. I don't feel like I'm carrying a 40 pound rock on my back when I face the day in front of me.

The Hamilton test is a little more confusing, though: again, this is info I found on the web, from http://www.members.optusnet.com.au/bill54/depresstest.htm, but apparently the

HAM-D score level of depression is:
10 - 13 mild; 14-17 mild to moderate; >17 moderate to severe.

I scored: 10/20/04 - 9.5, 11/04/04 - 3.5, and 11/17/04 - 2. So, according to this test, I never actually had depression? Perhaps Dr. Baxter can shed some light on how this could be? I did learn that the Hamilton test is partly influenced by the tester's impressions, so that's what I'm assuming is the explanation for the discrepancy.

My rTMS treatments are basically over. On Friday I'm meeting (for the first and probably last time, too late, ha-ha!) with my psychiatrist, and I'm going to request a plan to get off my antidepressant meds. I have a therapist, who's going to help keep me on track. And I've started to take an interest in mindfulness meditation.

And I feel. Not just the negative, not the aggression, irritation, and stress. I feel the full range of emotions that "normal" people do. Today, I watched birds flying. Just because. It was so peaceful, such a beautiful feeling. Sometimes, I'm terrified of this feeling of hope that's blooming inside me, and I have to actively remember that that is one emotion I WANT to feel.

I'm going to make sure to give www.mindcarecentres.com a great patient testimonial in the next few days. I only hope that someday soon more private insurance companies, or provincial healthcare plans, accept rTMS as a valid treatment. If it works this well for everyone, a truly miraculous thing could happen.

So, this will probably be my second-last update in this thread. I'm going to make sure to come back in a month and give a final update, to let everyone know how permanent the improvement seems to be.

Thanks for listening everybody!

 

[David Baxter PhD]

That's pretty amazing, Bo. Well done.

As for the somewhat mixed scores, both of those inventories are basically quick screening measures (as is the one in David Burns Feeling Good books). The items are pretty transparent (high face value) and therefore subject to the "how do I want these results to come out?" factor so some errors are to be expected.