Would you have tried rTMS if it was free? [Poll]
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Let's hear it from you. If rTMS was available at your local hospital, free of charge, would you have tried it? If yes, then why, if no, then why not.
I would not. rTMS is a treatment option here in Denmark for refractory depression and it is free in those hospitals who use it. rTMS is only approved for depression at the left and right DLPFC in Europe and the US. Many american patients are covered by their insurance company to get rTMS but only for depression at these locations. These locations are also very easy to find without neuronavigation. So, it is a cheaper setup. But, the left and right DLPFC are not locations that have any effect on depersonalisation. Most have no effect from it and some even see that their depersonalisation symptoms get worse at these locations. So, no i will not try these areas for free. Because the locations for depersonalisation are difficult to locate without additional equipment for location and the often the cost a a MRI scan this makes it very limited who can offer it. The rTMS equipment used for free in Denmark for refractory depression do not have neuronavigation so they can find locations that works for depersonalisation like the right VLPFC, TPJ or angular gyrus. The trials done at these locations are also very small and not replicated in large sizes so there is no approval as a treatment. I know about a canadian women with depersonalisation that has been a patient in one of the largest rTMS research facially in the world. They have neuronavigation. They have tried the right and left DLPFC. Then she tried the medial prefrontal cortex that is the area that the research unit is doing research into. No, effect. I said to her she should ask for the right VLPFC. This was rejected because it is a location that the research facility have no approval to work with. They have set of a experimental trial that is approved to work at that location.
So, free treatment or treatment that is covered by insurance companies at these locations will not be an option for the next 10-15.years unless it is a trail. Either you find a private rTMS clinic that have this equipment, have read into depersonalisation and you pay the cost yourself. That is no free treatment.
So, free treatment or treatment that is covered by insurance companies at these locations will not be an option for the next 10-15.years unless it is a trail. Either you find a private rTMS clinic that have this equipment, have read into depersonalisation and you pay the cost yourself. That is no free treatment.
Oh, we're talking past each other.
You and me both would have accepted treatment at a location of choice, I guess. So the other members, I am curious to know what the other members think. If they are yea-sayers or nay-sayers. So I am not discussing the feasibility of getting any of these.
• rTMS at the right VLPFC
• rTMS at the TPJ
• rTMS at the angular gyrus
What I am asking is leaving money aside, given what we know of rTMS and DPDR today, would you or wouldn't you want to get such rTMS treatment. So think of it as a hypothetical question, like «Would you go to the World Cup if you got a free ticket».
You and me both would have accepted treatment at a location of choice, I guess. So the other members, I am curious to know what the other members think. If they are yea-sayers or nay-sayers. So I am not discussing the feasibility of getting any of these.
• rTMS at the right VLPFC
• rTMS at the TPJ
• rTMS at the angular gyrus
What I am asking is leaving money aside, given what we know of rTMS and DPDR today, would you or wouldn't you want to get such rTMS treatment. So think of it as a hypothetical question, like «Would you go to the World Cup if you got a free ticket».
I added bolds to the crux of the matter. The trials are small, the trials are non-replicated, but they are promising indeed. I see pros and cons of getting such treatment, and now I wonder what the general opinion of the forum is. What they think about it, leaving costs aside.
Well, you can compere it with lamotrigin combination trails. There are publications on the subject that are very small but there are indications that 50% might have some benefit from it. 50% ought to have some reduction in symptoms on that combination. Yet, very few have given it a try and with a try i mean doses of lamotrigine that is known to be productive in DP like 200-300.mg or as high as 500.mg with a antidepressant or two that works. To give that trial alone a "fair" chance might take 6-8.months to try. Most have not tried it. with rTMS it could be the same.
It is my impression that there is very little interest on the subject. One have two months ago posted some videos on youtube about his rTMS trial on the right VLPFC and its effects on his emotional numbing.It worked on that aspect of the disorder on him. I have reposted his videos here. Very few have seen them. Prior to my posting his video had been shown 200.times and it is still very low. It might be to complicated and techical for most to relate to.
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If they targeted the rVLPC + TPJ + AG free of charge then why not. There's a high chance it works, and even if it doesn't then nothing was lost.
Good points! I'll make a poll on lamotrigin later! There are similarities, and there are differences. One big difference is the time aspect.
Time. We have 6 to 8 months on a drug, versus getting in a chair and getting treated with a fancy magnet for half an hour. Like they write, after one session, 5 out of 7 patients showed a 'partial response'. So it can be pretty quick, finding out if it works!
Side effects. Drugs usually have side effects, and such magnet treatment usually has less side effects.
Potential. With lamotrigin we could take a higher dose and make it a more lengthy treatment, but that's pretty much it. I doubt it can be curative for most. But with rTMS, we could, like you've pointed out get like 44 % improvement with the magnet treatment pointed towards the part of the frontal lobe, and then proceed to other parts of the brain.
Theory and practice fits. Sometime we find out a drug works by chance, and have no idea why! But with the magnet treatment theory and practice fits perfectly well. The part of the frontal lobe they've treated with magnets is indeed highly involved in processing emotions (you know a heck of a lot more about this than me, but I am writing to everyone here). Gee, looking at that link I posted, there was some aspect of social exclusion when I first got ill. Could very well be that my right VLPFC shut down emotions.
I'll see if I can find that later. My health is poor and I've only got energy to visit the forums occasionally. I think I remember something about a YouTube channel and something about a person not getting properly neuronavigated rTMS. Yeah, I guess it's too technical for most. But the way I see it, it's the most promising field we have!
No, the factor is that people here don't try whatever it is because it is not offered to them. The combination of lamotrigin with a antideressent has been known for 15.years. Very few have tried it despite it might benefit 50% to a degree.A central aspect is that depersonalisation is still highly unknown and under diagnosed. So, all treatment initiatives is on the side of the patients in many cases. Very few will ever see a psychtrist who says that;" now we will try the lamotrigin combo with two different antidepressant and see if it might benefit you" because they don't know about the disorder or its treatment. The same with rTMS: I have come across many with depersonalisation from US and Canada who have tried rTMS without any effect. So, they thinking they have tried rTMS but when asked about locations tried it shows that they have never tried rTMS for depersonalisation with the locations tried. Because the disorder and treatment is highly unknown you really have to be very aware, active and systematic to work with this disorder: We are offered nothing by the mental health system.
I am still speaking hypothetically. Like «Would you go to the World Cup if you got a free ticket». Comparing «would you want a lamotrigin combo» versus «would you want a good magnet treatment».
But sure, I agree with your points. People don't take the bull by the horns, but rather just try whatever is offered to them. And it's a shame the mental health system doesn't offer these rather harmless treatments to patients, patients who are losing pretty much everything they have when nothing is done.
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