I have tried Marplan for 12.weeks at a dose of 60.mg. That is a very high dose. The normal dose for major depression is between 20-40.mg. It is very difficult to get a psychiatrist to prescribe a irreversible MAO due to the risk of fatal rise in blood pressure if the dietary restrictions is broken. There are many psychiatrists who do not prescribe them at all for the same reason. My estimate from Denmark is that 90% of private practicing psychiatrists have not prescribed a MAOI. They have their place in the treatment of major depression and should likely be used more for people who do not respond to other antidepressants. But, I don't think that MAOI is a treatment for depersonalization. He is the only one I have heard of who have benefited from it. He could have suffered from major depression with secondary symptoms of depersonalization and not depersonalization disorder in its primary form.
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One of the antidepressants with the fewest side effects in me. It lowered the blood pressure so I became more dizzy. Then there the dietary restrictions but one gets used to them. I tried before it was known I had depersonalization. It was thought I had a form of atypical depression then.
Depersonalization in its primary form is a pharmaceutical treatment resident disorder with no formal treatment that can be replicated in a larger group of patients. There might be anecdotal stories of a drug working in some but they fail to replicate in others who try. Refractory conditions are normal in psychiatry. Many with depression do not respond to antidepressants and ECT is expensive and given reluctantly. So, it is why that focus is on the development of brain stimulation techniques is increasing to address these refractory states.
Who says I can? I read into all research into depersonalization, research in brain stimulation/rTMS as a way to come out of it.
So, when deep rTMS coil is approved in Europe or a location in Eastern Europe have rTMS equipment with neuronavigation and a deep coil I expect to try the right VLPFC or dorsal nexus a location between the medial prefrontal cortex and anterior cingulate that most brain imaging studies says are active in depersonalization. Can not be done now.
I have tried to help you but you rejected the help. You are complaining about emotional numbing, insomnia and loss of appetite. These symptoms sounds more like major depression. You have also been seen by a professor who have done research into depersonalization and written books about it and he have said that you do not suffer from depersonalization but major depression with secondary symptoms of depersonalization. So, you are suffering from major depression but identifies yourself with another condition. Major depression is a far more serious condition than depersonalization.
you wrote to me in the start of the summer and I replied to you that you should contact a rTMS clinic in italy that have the best equipment in all of Europe to get a treatment for major depression. It is a clinic that have rejected me and going into depersonalization likely due to many conflicting date pt. But, they would likely be open to major depression. I wrote to you that they had equipment to interventions into locations other clinics in Europe can not do because they use a deep coil despite it is not approved for clinical use, They could have tried locations like the medial prefrontal cortex that works in depression, PTSD and OCD. If that didn't work they could have tried the right Orbitofrontal cortex that works in depressive states with anhedonia. Other rTMS clinics in all of Europe do not have the equipment to do that . They have and use a deep coil and have neuronavigation. They use equipment you find in research facilities.You could open some doors with depression diagnosis you have from a professor and likely several German psychiatrists. But, you insisting on have depersonalization and not major depression is almost the largest obstacle for you getting help. You could have been on Sardinia for one month this summer and tried these locations. They would have given you two sessions a day at 100.euros session. So, their prices was also fair.
According to some texts the outset of depersonalization in its primary form is in 50% connected to a major depression and usually followed panic attacks. It was the case with me with depression for 6.month, 3.months into the depression depersonalization followed by panic attacks that made emotional numbing. In others it is just related to panic attacks without prior depression. Typically the depression will subside and the panic attacks replaced by emotional numbing that reflects the overregulation of emotions related to the panic attacks. Then there will be a pure state without symptoms of depression or anxiety and it will be depersonalization in its primary form without be secondary to another condition.
I don't know any with depersonalization who have tried deep tms. The reason I write about deep TMS is because the locations active in the prefrontal cortex in depersonalization and linkly makes the over regulations of emotions are too deep for a normal rTMS coil to intervene in. So, you really can't intervene properly in depersonalization as it stand. This is also the case with many with depression who do not respond to normal rTMS.
The place in Italy have rejected me, depersonalization is not on their site. They likely see the disorder and the data as to conflicting about locations. I don't know. The point is that they will not work with the disorder as it stands. So, they will reject you to. But, they use a deep coil not formally approved for clinical use yet. They linkely have because some with relations to the clinic are university researchers and do research with used rTMS and they have got the coil though those channels and not as a clinic. I hope the coil will be approved for clinical use in Europe the coming year.
The place in Italy have rejected me, depersonalization is not on their site. They likely see the disorder and the data as to conflicting about locations. I don't know. The point is that they will not work with the disorder as it stands. So, they will reject you to. But, they use a deep coil not formally approved for clinical use yet. They linkely have because some with relations to the clinic are university researchers and do research with used rTMS and they have got the coil though those channels and not as a clinic. I hope the coil will be approved for clinical use in Europe the coming year.
I am not intersted in rTMS clinics that are expensive and do not have the equipment to intervene in the locations found active in the prefrontal cortex in depersonalization . You need neuronavigation to find these locations and that rules out 95% of the clinics in Europe. Then there are the suspected locations. The right VLPFC can partially be stimulated by a normal coil, -like 20% so the risk of partial or no response is very high. There are several texts saying that a deep coil is needed to stimulate the right VLPFC properly . The location might not even be correct as most research points towards the medial prefrontal cortex and anterior cingulate as central. This locations you need a deep coil. This rules out all rTMS clinics in Europe, except the one that have rejected me. RTMS is used experimentally for depression in many public health system in Europe. The setup for their machines are only for the left and right DLPFC. They do not have neuronavigation or deep coils. So, they can technically not do it and legally not allowed to. It is only rTMS at the left and right DLPFC that have been approved for depression they are allowed to treat. When you go to other locations you are doing a experiment. In the public health system that have to be approved by a ethical board. So, it will not happen. It is only private clinics with the equipment doing it "off-label" that can do it.
One could try rTMS at the right TPJ/angular gyrus if the outset is recent, - within 5-7. years. There have been one trail at the right TPJ in 2011 and 50% had a response and it was among those who have had depersonalization the least time. The reductions was seen in symptoms related to derealisation and least related to emotional numbing. The French angular gyrus trail is just a larger replication of it. It should be published within the coming six months. That trail can be replicated without a deep coil but you likely need neuronavigation to find the location.
https://dacemirror.sci-hub.do/journal-article/cecf6c87ef47f78a30dbc4977dafe630/mantovani2011.pdf
https://dacemirror.sci-hub.do/journal-article/cecf6c87ef47f78a30dbc4977dafe630/mantovani2011.pdf
Yes, in theory. But, wait until the French trail is published as it is much larger in size and the also do a follow Up and makes some scanning in respondents and non-respondents. Much more information in that trail due to that if they follow their design. Anyway you can not get a treatment due to COVID and travel restrictions until spring. But, there ought to be a good chance for symptoms reductions. Emotional numbing should be the least affected and it might likely be related to a regulation in the prefrontal cortex that still is active. I think in those who don't respond this location might be to dominant. I have tried this location without effect. I think that the activity in the prefrontal cortex have to addressed first and this location might be more productive to try again if that happen. I don't think that the TPJ/angular gyrus is the "core location" but it plays a central role.
Yes, i would not contact them before the french trail is published. They might reject you because the current trails are too small and conflicting. The french trail will also likely bring more information about the condition. So, they will have that trial to look into too.i just found a clinic in turkey they make deep tms and have neuronavigation. there is also a professor for counseling. what you think mg? i could fly instant to turkey and its sooo fucking cheap. rtms 30 euro per session deep tms 80 euroi could make a whole experiment with those stuff hahahah![biggrin.png]()
https://npistanbul.com/eriskin-psikiyatri/manyetik-uyarim-tedavisi-ttmu
edit: they make deep tms with brainsway. but they have neuronavigation. could that be useful?
You can not come to them anyway due to COVID-19. You can likely get your MRI scan done in Turkey too for around 100.euros. In Western Europe or the us it would be around 700-1000.euros. They have a Magstim rTMS equipment and there are no deep coil. They can replicate all current trials. Also much cheaper to live there. The turkeys lire is in free fall. I think it could become very cheap.
The Brainsway deep tms is interesting too. These are h-coils and like helmets designed specific for a condition. I can not see if they have the helmet for OCD. I would like to try that. It is designed to stimulate the medial prefrontal cortex and anterior cingulate. These locations are currently seen as the most central if you take the average studies done. Depersonalization have strong OCD components with constant self monitoring and checking that are very close to obesssive compulsive disorder. It could be interesting to try that approach. Again the French trail should in their design do some follow up with fMRI scanners and they might look into regulations done in the prefrontal cortex. If there is a conformation that the medial prefrontal and anterior cingulate plays this role than I think they might be open to try to do deep tms if the have h-coil for OCD.
Deep tms is typically 4-6.weeks but it stimulates much deeper into the brain to structures that a normal rTMS coil can not access. There is a clinic in Palm Beach that is also a testing site for "Brainsway"and they have in some reports written that they have tried depersonalization but they have not written what they have used as intervention or if there was any positive response in those they treated. I might write to them.
this small video is about deep tms for OCD at the Palm Beach deep TMS Center about a woman having constant OCD systems related to her personality for 30.years.
this small video is about deep tms for OCD at the Palm Beach deep TMS Center about a woman having constant OCD systems related to her personality for 30.years.
Using a OCD coil is a experiment and you have to have read much into the disorder and brain imaging studies to see that there might be this potential relation. You can not assume they know that or will read so much into It. The reason I would wait for the French trail is because they in their design write they would do a follow up with fMRI scanners in those in the active part of the trail. They would likely look for differences in those who had a response, partial and no response. It will like point towards activity in the prefrontal cortex and likely the dorsomedial prefrontal cortex and anterior cingulate. If that is the case you would have more information to act on. The dream state is related to the right TPJ/angular gyrus but if you don't have any response from that location it will be difficult to see why today. You could try the right TPJ/angular gyrus and/or the right VLPFC now and if it not of any benefits see what the French trail will show and try "Brainsway" OCD protocol if the French trail shows the activity in the anterior cingulate and dorsomedial prefrontal cortex plays a central role in partial or non response group.
No, but if you want to have a intervention now then the basis are two locations based on two trails. The right TPJ and or the right VLPFC. The right TPJ and angular gyrus are the same location. This is based partially on neurological patients showing derealisation due to a tumor or seizure from this location and partially brain scans. The French trail uses the term angular gyrus term but their references are the same as the TPJ trail.
https://clinicaltrials.gov/ct2/show/NCT02476435
https://clinicaltrials.gov/ct2/show/NCT02476435
If one looks at "Brainsway" own site over providers your clinic that you refers to should only have a coil for major depression and not OCD. They write that another provider should have both the coil/ helmet for depression and OCD. It could be an error or he just wrote some generalizations about deep tms and only have a coil for depression. The other provider they say should have a coil for OCD is this one. https://www.kemalarikan.com/
No, there is no normal set up for neuronavigation in their pictures. It could be that they use a more primitive method that is also cheaper. That the navigation is done separately once and the location is marked with a pen and photos are taken and the mark is then refreshed every time you come.
Ok, but address it as two separate problems. Try the right TPJ/angular gyrus and or the right VLPFC at the one who have neuronavigation at first. The MRI scan will likely be burned on a disk and then you have that problem solved and it can be used other places. If it doesn't work and the French trails scanning part confirms that the medial prefrontal and anterior cingulate plays a central role then it is easier to convince a psychiatrist to try a OCD protocol later.
a resent review of brain scans in dissociative states writes about depersonalization:
3.2.1. Depersonalization/derealization disorder
Most of the studies conducted in DPD patients presented alterations in functional brain activity in frontal gyri, especially the medial prefrontal gyrus, cingulate, and insula (Ketay et al., 2014; Lemche et al., 2007, 2016; Medford et al., 2006, 2016; Weniger et al., 2013). A study by Lemche et al. (2016) tested the neural correlates of inhibitory capacity via a combined Stroop/negative priming task. They found greater activation of the dorsomedial prefrontal cortex and posterior cingulate cortex in DPD patients during the Stroop task (n = 9) as compared to healthy controls (n = 12). Medford et al. (2016) examined brain activation in response to emotive visual stimuli in DPD patients (n = 14) as compared to healthy controls (n = 25). The patient group exhibited lower activity in the secondary visual cortex as well as increased activation in dorsolateral prefrontal cortex and anterior cingulate cortex. Related research (Lemche et al., 2007) demonstrated that DPD patients (n = 9) showed decreased BOLD signals in hypothalamus and amygdala during the processing of happy and sad facial expression compared to healthy subjects (n = 12). However, DPD patients (n = 9) also exhibited a greater activation than healthy controls (n = 10) in response to viewing their own faces vs. that of a stranger in the frontal cortices (anterior cingulate cortex, bilateral medial prefrontal cortex, and left middle frontal gyri) (Ketay et al., 2014). Another study (Medford et al., 2006) indicated lower activation in bilateral frontal areas, bilateral precuneus, and cerebellum during target word recognition task in DPD patients (n = 10) than healthy controls (n = 12).
https://www.sciencedirect.com/science/article/pii/S0022395620300224?via%3Dihub#bib3
So, Brainsway OCD coil could likely affect this location.
a resent review of brain scans in dissociative states writes about depersonalization:
3.2.1. Depersonalization/derealization disorder
Most of the studies conducted in DPD patients presented alterations in functional brain activity in frontal gyri, especially the medial prefrontal gyrus, cingulate, and insula (Ketay et al., 2014; Lemche et al., 2007, 2016; Medford et al., 2006, 2016; Weniger et al., 2013). A study by Lemche et al. (2016) tested the neural correlates of inhibitory capacity via a combined Stroop/negative priming task. They found greater activation of the dorsomedial prefrontal cortex and posterior cingulate cortex in DPD patients during the Stroop task (n = 9) as compared to healthy controls (n = 12). Medford et al. (2016) examined brain activation in response to emotive visual stimuli in DPD patients (n = 14) as compared to healthy controls (n = 25). The patient group exhibited lower activity in the secondary visual cortex as well as increased activation in dorsolateral prefrontal cortex and anterior cingulate cortex. Related research (Lemche et al., 2007) demonstrated that DPD patients (n = 9) showed decreased BOLD signals in hypothalamus and amygdala during the processing of happy and sad facial expression compared to healthy subjects (n = 12). However, DPD patients (n = 9) also exhibited a greater activation than healthy controls (n = 10) in response to viewing their own faces vs. that of a stranger in the frontal cortices (anterior cingulate cortex, bilateral medial prefrontal cortex, and left middle frontal gyri) (Ketay et al., 2014). Another study (Medford et al., 2006) indicated lower activation in bilateral frontal areas, bilateral precuneus, and cerebellum during target word recognition task in DPD patients (n = 10) than healthy controls (n = 12).
https://www.sciencedirect.com/science/article/pii/S0022395620300224?via%3Dihub#bib3
So, Brainsway OCD coil could likely affect this location.
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