Transcranial Magnetic Stimulation. Anybody have knowledge of it?

[Skeptix]

Hi there,

A good friend of mine (62 years) text me tonite saying he was considering having this procedure carried out. He asked me if I could find out about it, me being the medical - tech in our friendship!

He went through a catastrophic event in 2016 when his new wife of two years abruptly left him on their 2nd wedding anniversary. Turned out she was borderline personality disorder with a penchant for narcissism. He was utterly crushed, having thought this was his second chance at happiness (his first wife died of cancer when they where in their 40's and he hadn't been interested in a relationship til this lady came along.

Although a successful businessman, he leant on drugs all his life: alcohol and or weed.

He was sectioned (committed) twice sInce 2016 and has been on a cocktail of serious meds, Lithium et Al. He attempted suicide a handful of times and has a suicide kit stashed somewhere and ideate alot, although the intensity of that has subsided these last few years.

So: someone with long term issues (requiring self meds), trauma in his life (he had 5 young kids to raise when his wife died and her alcoholic mother came to live with them). Who then undergoes a great lift (new, exciting love) and a drop from a great height.

What would you say to the above procedure for such a man. He hasn't any joy at all in his life and looks as grey as he feels. Is it effective? Is it risky? Does it last (if effective). Any experiential info would be gratefully received.

Thanks for reading..

[drmind]

Sorry for the delay in responding but I had trouble listing a reply. I've had no personal experience with this treatment; however, I contacted a few former colleagues and they recommend that you check the Mayo Clinic website for a good discussion of this treatment. You'll see that it's a fairly safe procedure and recommended in proper cases by many reliable psychiatric professionals. However, the negatives are that it is not used on individuals who have substance abuse issues as well as those diagnosed with a bipolar disorder. It is used primarily on persons who are severely depressed only and who have not benefitted from medication and therapy and who have no other mental health issues

There are so many elements in your friends case that are tragic and being in an environment where alcohol is being used by caretaker does not help. It's been my experience that for a variety of reasons, bipolar disorders are not easily treated with "one size fits all" medication. One has to find a experienced clinician who can make the proper diagnosis as to the type and stage of the disorder and prescribe the medication that can help. Confounding the issue is the fact that this person may be self-medicating with alcohol and drugs to get relief.

However, he has to rely on his treatment team who are referring him for this treatment. It may help and hopefully it will, but he has to remember that he has other serious issues that he has to work on besides depression.

Hope this helps. Keep us posted.

[Skeptix in reply to drmind]

Thanks drmind, that does indeed help. I was pretty heavily involved in supporting this friend from the point of D-Day (she left him on the 6th June) and what struck me about it was .. drum roll .. the level of care he received.

Even though he was a private patient and so could afford the best psychiatric hospital, I was aghast at what was called 'treatment'. Now that we've all spoken of the level of care obtained by CKDers, it ought to be no surprise to me. But it was a surprise then. Who knows whether this is the best treatment for him - you would have to suppose his team a good one, wouldn't you?

[drmind in reply to Skeptix]

He needs to understand at some point that being abandoned by his second wife is not the end of tbe world. Given her mental health issues, he will understand someday it was for the best. He has to understand further that one recovers from broken hearts, so he has to get on with it because life is waiting for.him. Hopefully during any recovery time, however brief, he can get on medication for his likely bipolar disorder as well as get involved with a good therapist. He has to appreciate that theres no easy way. None. It's very hard work to change habits. Wishing him the best as he has lots of hard work ahead.

[Skeptix in reply to drmind]

It's tough. If you've had a lifetime of alcohol and weed you get to supposing you can't do it without an assist, be it pharma or this particular procedure.

My wife's a counselling psychologist (and aided him for a decent period) and would hold that, at root, a person can be assisted but no-one can can be helped out if they won't help themselves. We got him hooked up with an excellent counsellor but she eventually had to show him the door as he wasn't up for 'doing the work'

I'd be looking at this TMS as a leg up: something to perhaps kick-start things. But I fear my buddy will just want the treatment to sort him out. That he can have something haul him from the pit but not deal with the things that got him there in the first place.

But I have a degree of sympathy. When if you've smoked weed for 50 odd years I can imagine life appearing impossible without it.

[drmind in reply to Skeptix]

It is tragic, but I hope he gets the pick up from the treatment. Then, an intervention can be made to tell him what has to be done. He can use June 6th as an excuse, but after awhile it gets old. And, I know all about how hard it is to deal with substance abuse from both professional experience as well as from family. But, its up to them even though we want to help. Wish we could do it for them. He may want to start by going to AA meetings and getting a sponsor. He has to take that first step; otherwise, it'll be one quick fix after another. What I experienced from good AA meetings is that the members have been there and done that and its difficult to get away with making excuses. Yet, they are very supportive and helpful and they know all about the pitfalls. Peace and bless you and your wife for being there for him.

[drmind in reply to drmind]

You're too kind hearted. There are people who abused drugs and/or alcohol for many years and were still able to recover. He needs to meet them at AA. Listen if Brad Pitt got help from AA, they can help anyone.

Its also common for those struggling with recovery to suffer several lapses before they can celebrate any measure of sobriety. Unfortunately, it's usually something legal that puts the brakes on things I'm hoping against hope that your friend gets there before that.

Peace.

[Skeptix in reply to drmind]

Agree with you. There is an indulgent aspect to it and a personality type that tends towards needing to be needed and it's converse (wanting people to look after you). Wallowing is how we percieve it.

Ultimately its his call and folk around, family.amd us, his friends, have stopped with the deepest sympathy and concern. We're hardened to it now, given we see the wallowing element.

But still he's a pal and still there is an element of his being let down by doctors and so an element of being prepared to give a leg up. It doesn't cost us as it used to to do so.

Thanks for your wise insights which help confirm what we know!

[drmind in reply to Skeptix]

Its heart breaking, I know, and it's easy for me to sit back and psychologize. I have a PhD in Clinical Psychology and aside.from practicing, I spent 35 + years as an assistant professor training psychology interns and medical residents. So, its easy for me to pontificate. However, I've had similar situations as yours in my family and know.about how very hard it is to be on tbe sidelines. Being a special friend is way harder than being a therapist because therapists can walk away. Peace

[Skeptix in reply to drmind]

...and they can charge $130 per hour

[drmind in reply to Skeptix]

Yes, its unbelievable the fees today, but maybe it makes one think I better use this "expensive" advice. Many, many years ago, I had a wise supervisor who said to me we can teach you strategies, but we cant give you the heart to do it. You got to have the heart. You're in the wrong profession. Now, I need to get back to the CKD people. Hoping and praying TMS works. Things happen that we cannot always predict. Hoping and wishing and praying, too

[sjof]

Hi Skeptix-

I have had great success with TMS. It is my understanding that if the patient is taking some form of meds and undergoing therapy while having TMS treatments, the results are better than TMS alone. I am unable to take SSRIs and so my TMS treatments were very successful while I was in the 6 week of treatments, but the results did not hold/last for me. I had treatments spaced out to last as long as possible before insurance would pay for another round. From my personal experience (I am not a medical professional), TMS was non-invasive and the results were close to immediate. TMS is a non-pharmaceutical, approved treatment option, and covered by most insurance, including Medicare.

I hope your friend finds the care that works for him.

[Skeptix in reply to sjof]

Thanks for that sjof. So the hope is that along with medication, the results might last?

When you say "didn't last", was it a case of the treatment wearing off completely? Or what there some kind of durable boost?

I read about it being possible to get some kind of "maintenance dose"? Was that something you contemplated.

[sjof in reply to Skeptix]

Yes, the hope is that the results last, and according to the people I met who were using TMS, that is the case. The treatments take about 20 minutes and are not painful.

The maintenance dose: I am in the US and the treatment that was approved by my insurance was 36 sessions. The doctor I had generally held back five sessions to give during the period between treatments. In other words, I would go for six weeks of sessions, equaling 30 sessions (one a day). The last six sessions were generally held back in case they were needed during the interim between approved treatments as a boost. That does not have to happen. It is a decision made between the patient and psychiatrist overseeing the treatments. All 36 sessions can be given without holding any back.

For me personally, I could maintain the good results for maybe three or four days and then I would revert to my PTSD self. I expect every patient has a different response to maintaining the good outcome, but most patients I knew maintained the results quite well, and only went back for additional treatments as necessary. Depending on the coverage, insurance has a waiting period between treatments. I don't recall specifically, but I believe I had to wait five weeks between approval for the next 36 sessions.

In my case, TMS was the most successful treatment I have ever had for PTSD, it took away my fear and gave me a bit of my old life back. Unfortunately, I now live in a place where there is no TMS available.

I hope your friend experiences hope and healing very soon.

[Skeptix in reply to sjof]

That's some really good information - and encouraging at that. There is a PTSD element to my pal's condition. Although clearly dependent / habitual on self meds, he was functioning pretty well until the abrupt departure of his new wife and the cruel treatment he received from her in the aftermath. It was traumatic and that's for sure.

That's a right kick in the nuts finding something that works .. then not being able to access it. My commiserations..

Ii'll report back here in due course (assuming he goes ahead). It would be helpful for folk to have a place to read about this

Thanks

[car103 in reply to sjof]

I have Medicare. My Psychiatrist's pract.ice does both TMS and Ketamine. I was told that Medicare doesn't cover this. I am now going to investigate further.

[sjof in reply to car103]

Medicare covered my TMS several times over.

[Hidden]

I had the TMS and I don’t know if it helped. Immediately following it I had a family crisis where I had to let my sister go for good this time. It sent me into a major depression. However, since the procedure. I have also let go of my entire dysfunctional family. I don’t know if the procedure opened something up inside of me, in order for me to see clearly what was going on and the trauma I received growing up. I have to be honest the TMS was very painful for me. I had to where a mouth guard I had for my teeth grinding. This has been my experience with it. My insurance said they would pay the 17,000 USD. Then 6 mos later they want 6,500, said insurance wouldn’t pay. Be careful with that. Also, two weeks before the TMS I received two weeks of Ketamine IV therapy.

[Skeptix in reply to Hidden]

Thanks for sharing that. At this stage almost anything is worth try and it could be that the larger complications in his life overwhelm whatever benefit this procedure might give him. But hopefully even some lift to help motivate and encourage him to strive to escape. Think he's got good cover, besides you tend to get approvals from your insurance before you walk in the door here!

Ketamine. I'll ask him. What was the point of that? A prep for the TMS?

[Hidden]

No, it was just another procedure they recommended it. I was in a super bad place and I don’t remember why both had to be done. I have to stop talking about this.