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Posted 14 January 2021 - 08:48 AM
Posted 14 January 2021 - 09:34 AM
Europe is currently in lockdown and you can not travel. it might last to the beginning of the summer. However you write that you have tried rTMS at the left and right DLPFC for 20.sessions. There is a subtype within depression witch is marked by anhedonia and they do not respond well to these locations.
The location for this subgroup with anhedonia is the right ventromedial/orbito prefrontal cortex. It is a locations that also comes out as active in some depersonalization studies and in the dissociative subtype of PTSD. There is only one place in Europe where they have the equipment to do rTMS at this location. They rejected me in 2019 for depersonalization properly because of very small trials, ,many confusing locations they likely thought that depersonalization is purely understood and would not work with the disorder. So, they will likely reject people with depersonalization disorder. But, you also have depression, a journal form Germany that also states it, it might be possible for you to be accepted by them as one with depression.
The price is 100.euros pr. session. two sessions a day with theta burst the first week and one session a day the second week. If it do not work they might have some alternatives for you. I will not write the address here but contact you later when there is an end to the lockdown.
Posted 14 January 2021 - 12:31 PM
Posted 14 January 2021 - 01:03 PM
The critical aspect in your case is that you have tried both imipramine and Parnate-a TCA and A MAOI. These are very old drugs that is much more effective than the newer drug. The newer anti-depressant are not so effective,- they just have fewer side-effects and can be tolerated by more people. So, you either have to be seen by one who are into more advanced psychopharmacology to look at your case or rTMS at other locations.
I would likely stay away from being a part of a rTMS trial. You might be in the placebo group or the tried a location that do not respond well to anhedonia like the dorsomedial prefrontal cortex.
The problem with rTMS is that there is likely 3.locations and networks know and the approved rTMS locations only treats on one of them. The clinic I refer to uses a coil that is not approved but widely used in research in depression. The risk are small and they likely think there is sufficient trials done to work with these two other locations. So, it is not very likely they can offer these locations in Germany unless it is a part of a trial. These locations are not formally approved yet and therefor not offered in the health systems that have rTMS. You also need some more advanced rTMS equipment to take these locations. Most rTMS clinics and in the health service is only conventional rTMS.
Posted 14 January 2021 - 01:43 PM
If you contact them do not use the term depersonalization disorder. But, major depression with anhedonia or secondary symptoms of depersonalization/derealisation.
There is no need for neuronavigation at the right orbitofrontal cortex. There are procedures to find them without. They have "localite" navigation and can likely find other locations from a "artificial brain" in a computer program in "localite". So, if you do not have a MRI scan it can be used.
Posted 14 January 2021 - 01:57 PM
Posted 14 January 2021 - 06:42 PM
Your outset seems also relatively recent within the last year.
Posted Yesterday, 11:16 AM
did you try parnate by yourself ? You had no benefit from it ? Actually i took it and i had the highest dosage of 60mg. Due to very slow blood pressure i get calm but i didnt to lost my anhedonia or i get more emotions. Now i am taking it around 8 weeks. Have i take it longer to get more benefit ? Or i have to reduce because the blocked enzymes enhance nearly all important neurotransmitters and maybe it started a down-regulation at the post-synaptic receptors ? Thanks Dieter
Posted Yesterday, 12:35 PM
Runtome. We do not suffer from the same condition. I have depersonalization disorder in its primary form while you have according to a professor who have seen you and written two books and done research into depersonalization, have major depression with secondary symptoms of depersonalization/anhedonia. You are also too old to get depersonalization with such a late outset of your state.
Major depression is far more serious condition but also much better to treat than depersonalization . So, by insisting or thinking you have depersonalization you are put you life in danger because you will try highly experimental treatments for a condition you do not have and likely have no benefits from. I tried to get you to a rTMS clinic in Italy that is the only one in Europe that have the equipment to do rTMS on a location for that is responsive for depressions with anhedonia. But, you wanted to go to Hungary for experimental rTMS for depersonalization. So, your delusion of having depersonalization is standing in the way of you getting the right treatment.
I have tried a drug, Marplan similar to Parnate approved in Denmark and I have mentioned it is a thread where you are also active and asking into it.
Very difficult to say. Parnate/tranylcypromine formal max. dose is 60.mg. You might only have been in a dose of 60.mg for 4-5.weeks as you likely have increased to dose with 10.mg pr week. There have been trials where doses as high as 200.mg a day has been used with patients being depressed for more than a decade and refractory to electro convulsive therapy. The response rate was close to 60%. If your doctor is ok with it and you can tolerate it, it can be tried to increase the dose to 90-120.mg pr. day.If you are fine with it I would try to increase the dose and see if it works. The side.effects should not increase compared to what you have. This text from 1989 says this about doses;
"More recently, several case reports have sugge- sted that higher than conventional doses of the MAO inhibitor tranylcypromine, may be a safe and effective treatment for re- fractory depression (Shopsin and Kline. 1976; Robinson. 1983; Guze and Baxter. 1987; Pearlman. 1987). Robinson (1983) described a patient with refractory depression who finally responded at 90 mg of tranylcypromine, while Guze and Baxter (\ 987) and Pearlman (\ 987) described 3 patients with resistant depression who required tranylcypromine doses ranging from 100 mg to 200 mg daily. Furthermore, side effects appeared to be uncommon in these reports, and blood pressures remained in the normotensive range even though several of the patients were receiving concomitant psychotro-
But, you could try rTMS at the right orbitofrontal cortex that is a location that many with depression with anhedonia who have failed other rTMS locations respond to. It can not be done in Germany, Hungary or elsewhere. Only one place in Italy. It is a research location in the brain and there is not yet a formal approval yet for this location. It will likely come. I tried to get you there in the summer but you did not take me or yourself serious,- you have "depersonalization" and wanted to go to Hungary.
Your friend "Didi" did this post about anhedonia.
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