Depersonalization Support Forum banner
1 - 11 of 11 Posts

·
Registered
Joined
·
95 Posts
What lies behind the negative symptoms in schizophrenia and DPDR is likely different. Nonetheless it's encouraging to see people with schizophrenia benefit from the rather novel treatment TMS.

Delayed effect of repetitive transcranial magnetic stimulation (rTMS) on negative symptoms of schizophrenia: Findings from a randomized controlled trial.
Z Li, M Yin, XL Lyu, LL Zhang, XD Du and GC Hung, Psychiatry research, 30 2016 06

Evidence is inconsistent regarding the effect of repetitive transcranial magnetic stimulation (rTMS) on negative symptoms of schizophrenia. In this study, 47 patients were randomized to receive either active rTMS over left dorsolateral prefrontal cortex (n=25) or sham stimulation (n=22). Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms (SANS) at baseline, 4 weeks and 8 weeks. At 4 weeks, there was no difference in SANS scores between 2 groups. By 8 weeks, patients with active rTMS had significantly reduced SANS score than controls. Our findings suggest a delayed effect of rTMS on negative symptoms.


Now what's SANS score? It measures things like alogia, avolition, apathy, anhedonia, asociality, attentional impairment.
 

·
Registered
Joined
·
733 Posts
High frequency stimulation at the left DLPFC (10-20 Hz) is a normal procedure to treat a hypo-dopaminic state in the motivational system for addictions. That is the procedure here. The problem is that in depersonalisation the lack of emotions comes from a overactive frontal cortex that inhibit emotions -particularly from the right VLPFC . Many in with depersonalisation has tried the procedure in a rTMS clinic in the Nederlands with inhibition of right DLPFC and stimulation of the left DLPFC. 4 out of 10 had a response, likely because they had depression with symptoms of depersonalisation and not depersonalisation as a disorder.
 

·
Registered
Joined
·
733 Posts
"We concluded that TMS is a potential therapeutic option for DPD and that modulation of VLPFC is a plausible mechanism. Most recently the occurrence of depersonalization symptoms has been reported following high frequency (HF), i.e. stimulatory rTMS to the dorsolateral PFC in a woman with treatment-resistant depression (Geerts et al., 2015) which is consistent with the model."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906152/

So, rTMS introduced depersonalisation has been reported when stimulation of the left DLPFC is done. Some in the Nedherlands felt their depersonalisation became worse after rTMS at these locations .Ask Aridity https://www.dpselfhelp.com/forum/index.php?/user/38045-aridity/
 

·
Registered
Joined
·
95 Posts
Discussion Starter · #4 ·
It's encouraging to see that this new treatment, TMS, which isn't taken seriously enough where I live, has the potential to treat the most untreatable of all, the negative symptoms of schizophrenia.

And your comments to this are much appreciated.

According to this paper they have access to neuronavigated rTMS in Moscow. If you'd bracket your skepticism on whether or not they'd treat DPDR and foreigners, would you consider neuronavigated rTMS against DPDR at such a clinic subpar to what's done in Western countries?
 

·
Registered
Joined
·
393 Posts
High frequency stimulation at the left DLPFC (10-20 Hz) is a normal procedure to treat a hypo-dopaminic state in the motivational system for addictions. That is the procedure here. The problem is that in depersonalisation the lack of emotions comes from a overactive frontal cortex that inhibit emotions -particularly from the right VLPFC . Many in with depersonalisation has tried the procedure in a rTMS clinic in the Nederlands with inhibition of right DLPFC and stimulation of the left DLPFC. 4 out of 10 had a response, likely because they had depression with symptoms of depersonalisation and not depersonalisation as a disorder.
I was one of them who did no respond, and had to quit after 5 sessions. It made my dp/dr so much worse. That I was to afraid to continue. But I really want to give it another chance.
 

·
Registered
Joined
·
733 Posts
According to this paper they have access to neuronavigated rTMS in Moscow. If you'd bracket your skepticism on whether or not they'd treat DPDR and foreigners, would you consider neuronavigated rTMS against DPDR at such a clinic subpar to what's done in Western countries?
That is a neurological research facilily in Moscow. I have never said that there wasn't neuronavigation. I think neuronavigation is the norm research facilities at universities. Almost all trials done at universities are with the use of neuronavigation because of accuracy and they also try areas that can be specific for one patient after a brain damage ect. . One hours drive from where I live is there at a psychology lab rTMS equipment with neuronavigation. There are also other universities in Denmark with it. But, that is not a treatment that is offered. I seems to me that you invent possibilities that are not there;" If they have it there they can treat me"

We only have one option nbecause rTMS is a experimental treatment. Here is Denmark it is offered to a limited numbers of patients refractory depression. They don't use neuronavigation on these patients because you can locate the areas -the right and left DLPFC,- without the use of neuronavigation with a more simple and less expensive method. When you have to go to other and smaller parts of the brain like the right VLPFC you have to use it to find it. Almost all private rTMS clinics rejects doing rTMS on the right VLPFC because they can't locate it. Almost all private rTMS clinics in Europe and the USA treat disorders like depression, addiction and OCD on locations that can be found with a more simple method and because these areas are much larger. So, neuronavigation is almost absent on the private rTMS market.

But, the problem is not neuronavigation alone but people understand of the disorder. You have to be in hands of people who have read much on the subject than just a free abstract from pubmed, -and those who have tried rTMS have likely only been in the hands of people that only have read the abstracts. . From the perspective of rTMS it is a complexs disorder. There are abstract that says the right DLPFC have shown a 30% reduction in some, others the 50% respond to the right TPJ,-50% do not. They also only see reduction in dissociation at TPJ but not numbing , then there is the right VLPFC that is the most potent for numbing but not dissociation. Then comes the angular gyrus that is close to TPJ but in a larger network. So, you have a lot of locations from there and you cannot take them all in one trail. You can work with one or two and most places they chose those areas they are use to be able to locate -the left and right DLPFC.

As a paying patient with depersonalisation you are on a private market with rTMS clinics that only have equipment to locate some locations for depression and OCD. They can not locate those relevant for depersonalisation and they have not read much about the disorder.
 

·
Registered
Joined
·
733 Posts
If one looks at fMRI functional studies done in depersonalisation the suppression of emotions in done by a overactive DLPFC, medial prefrontal cortex and the right VLPFC. At Kings College they did a rTMS trail on the VLPFC as they thought is was the most active. But, research since then point to the the right VLPFC is not a filter of emotions by itself. It is more likely to be a kind of mobiliser of the rest of the structures in the prefrontal cortex to start to regulate emotions or as in depersonalisation to shut them down. So, by inhibition of the right VLPFC you stop this overactive instruction of the prefrontal cortex to regulate.

The angular gyrus are a part of the networks involved in the cognitive regulation of emotions. So, it will be affected in that proces. It could be intersting to start a inhibition of the right VLPFC until numbing goes away and then take the angular gyrus for the dissociation.

This text is about how the brains cognitive systems can regulate emotions. Depersonalisation is a disorder related to emotional regulation.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801480/

The clinic that i wrote to have neuronavigation but also people who are researchers and done research with the use of rTMS. So, in theory there will potentially people who read more into the disorder and knows how to address it better. They can also work with two locations unlike they can in trails.
 

·
Registered
Joined
·
733 Posts
I hope, if this is an effective treatment, they make more treatment centers so people can make it five days a week like what is required. This is especially true in the US where public transportation and parking options near the treatment centers can be pretty sub par.
There are protocol for that. There has been trails with highly depressed and suicidal patients who was given rTMS 5.times a day. It is most normal to do 2.times a day for the first week, then once a day for the next weeks. People might need maintenance treatment with fewer treatments, like 10, than the first time every 9-12.months. In some depressed people who live close to a rTMS facility maintenance is given as one session once a month.
 

·
Registered
Joined
·
95 Posts
That is a neurological research facilily in Moscow. I have never said that there wasn't neuronavigation.
I never said that it was easy.

I have got a green light before, at another Russian research facility, to try a more invasive treatment than rTMS. The drugs alone costing 21,000 USD, plus compensation to the researchers, entailing an extra "language barrier fee" that I myself proposed. You're a bright guy, so you know what's true in the West needn't be true in the East. Where RECs bar the road in West, there are fewer hurdles in the East. But that doesn't mean it's easy.

Research staff usually have a more intellectually curious mind than others, and are more apt to wanting to learn about novel treatments and diseases, so if a research facility is on board with it, it needn't be a disadvantage-compared to a regular clinic which hasn't treated DPDR before. Given that they take time to read up on it.

I am new to DPDR, and truly appreciate your posts, Mayer-Gross. They're gold. But don't put words in my mouth. My attitude is that's hard, but certainly not impossible.
 

·
Registered
Joined
·
95 Posts
"We concluded that TMS is a potential therapeutic option for DPD and that modulation of VLPFC is a plausible mechanism. Most recently the occurrence of depersonalization symptoms has been reported following high frequency (HF), i.e. stimulatory rTMS to the dorsolateral PFC in a woman with treatment-resistant depression (Geerts et al., 2015) which is consistent with the model."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906152/

So, rTMS introduced depersonalisation has been reported when stimulation of the left DLPFC is done. Some in the Nedherlands felt their depersonalisation became worse after rTMS at these locations .Ask Aridity https://www.dpselfhelp.com/forum/index.php?/user/38045-aridity/
I added bolds to the quote.

@Aridity. May I ask you, have you done rTMS at other locations than the DLPFC? Such as the locations that SMART TMS currently target well (or okayish, if I got it right), such as the TPJ?
 
1 - 11 of 11 Posts
Top