# Going to try rTMS



## Aridity (Jun 12, 2011)

hello

I am going to try rTMS,has anyone experience with this treatment? And which side of the brain should I choosee.. My symptoms are 2d vision dp,blank mind,depression,anhedonia,loss of character. Sever DR,and sensitivity to light,floaters etc.

I am reading about vlpfc,dlpfc,tpj.. what is the best I can do.. my psych is willing to try what I want.

cheers.


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## Jackk11 (May 9, 2018)

I’m going to try this as well. VLPFC seems to be more effective for emotional numbness/anhedonia so that is what I will try.


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## Aridity (Jun 12, 2011)

Jackk11 said:


> I'm going to try this as well. VLPFC seems to be more effective for emotional numbness/anhedonia so that is what I will try.


The normal protocol is dlpfc I assume. Maybe I am going to try both at the same time.. Keep me updated on your journey please.


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## Jackk11 (May 9, 2018)

Aridity said:


> The normal protocol is dlpfc I assume. Maybe I am going to try both at the same time.. Keep me updated on your journey please.


Yes dlpfc is what they target for depression. I may start with that. Good luck to you as well I'll update here when I get it done.


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## Aridity (Jun 12, 2011)

Jackk11 said:


> Yes dlpfc is what they target for depression. I may start with that. Good luck to you as well I'll update here when I get it done.


Have you had it done,I have set my appointment for oktober 8th. I am so so scared,that it will make me worse. I can't grasp how it can get even worse than I already am. I am already totally gone. I need some reassurance,I have read the TPJ area made alot of people worse.


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## Aridity (Jun 12, 2011)

Update,I have done one session of the right and left DPLFC. No improvement yet,maybe slightly worse. But can't really tell,on the day I had it I was very fatigued and tired. I did feel good the day after but today I feel pretty bad again. DP/DR still very severly. Friday will be session 2. The procedure itself was not painfull rather unpleasant.


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## Aridity (Jun 12, 2011)

update session 2: No major side effects,it seems my cognition has declined. I did have an hour or two after the session a moment of clearity,and calmness someting I haven't felt for a long time. that gave me hope,but it did not last long. I am still pursuing this treatment. It's ony session 2 you really have to give it a shot to work.


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## Aridity (Jun 12, 2011)

I also really want to try one session,of the right VLPFC. But my practicioner has never done that before. How would he be able to locate that area of the brain? Maybe I can push him to try it one time one me.. Anyone?


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## itwasonlyjustadream (Sep 2, 2018)

Hey did you guys have success?


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## Jackk11 (May 9, 2018)

I have not had the chance to try yet. I would like to hear an update from aridity. Hopefully he has found some relief.


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## 106473 (Feb 7, 2017)

Will you keep it in this thread so I can follow it









oh and good luck


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## gaddis (Sep 18, 2005)

The doc I see once a month just got a TMS machine by Neurostar in his office. TMS is only approved in my health insurance for Major Depressive Disorder and OCD, so I don't know if it's good for Panic Disorder, dp and insomnia (my problems), but I might give it a try.

My symptoms only respond to benzos ( .75mgs of Klonopin, but 1mg. if i have to face a stressful day), so who knows if TMS will help me, but I might give it a try.

Like some others who have posted here, I'm worried that TMS might exacerbate my DP (which only bothers me if I don't get enough sleep), so this is a difficult decision.

I wonder how it went with Aridity?


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## spectator162 (Dec 26, 2017)

Hi, im trying rtms. I already did 9 sessions of 40 min on the left dlpfc. Depression is little better but the dpdr is still there. Tomorrow is my last session on the left dlpfc. Ather that the doc will try another spot. I guess the right dlpfc. One question is the right dlpfc the same like the right vlpfc?


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## Aridity (Jun 12, 2011)

spectator162 said:


> Hi, im trying rtms. I already did 9 sessions of 40 min on the left dlpfc. Depression is little better but the dpdr is still there. Tomorrow is my last session on the left dlpfc. Ather that the doc will try another spot. I guess the right dlpfc. One question is the right dlpfc the same like the right vlpfc?


Of course not... it's a different area,hence it has a different name.


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## spectator162 (Dec 26, 2017)

Sorry didnt know that.. so monday im trying vlpfc right low frequency. Cant wait..


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## Jackk11 (May 9, 2018)

Ok so I am finally going for an evaluation for TMS and I’m likely to get it covered by insurance. I will get the standard depression protocol done first then I will try to pursue other areas of the brain I am going to update in a new thread when I actually get the treatment. My main symptoms are emotional numbness, and impaired thought process. Pray for me lol.


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## gaddis (Sep 18, 2005)

My insurance turned me down for rTMS! Now I've gotta deal with rejection, on top of my other problems!









My doctor said that my health insurance company is notorious for turning people down for TMS, and he's gonna file an appeal, which he said usually gets approved.

I'll find out Thursday, at my monthly appointment.


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## Jackk11 (May 9, 2018)

I’m trying to manage my expectations of this procedure because the likelihood of it helping isn’t very high but miracles do happen lol. Honestly though we’ll never know if we don’t try. I’m also in pursuit of participating in the ongoing clinical study for ALKS 5461 so I have a few options at my feet. We’ll see.


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## Aridity (Jun 12, 2011)

Jackk11 said:


> I'm trying to manage my expectations of this procedure because the likelihood of it helping isn't very high but miracles do happen lol. Honestly though we'll never know if we don't try. I'm also in pursuit of participating in the ongoing clinical study for ALKS 5461 so I have a few options at my feet. We'll see.


Hi,Jack. There is a small change that rTMS will help you,exactly as you said if you don't try it you'll never know. Altough troughout the time I have spoken more and more people who did not benefit from this procedure at all,just like myself. From now on I won't recommend this to anyone that quick anymore,especially the normal protocol is likely to fail. I hope it does something for you.


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## Jackk11 (May 9, 2018)

Aridity said:


> Hi,Jack. There is a small change that rTMS will help you,exactly as you said if you don't try it you'll never know. Altough troughout the time I have spoken more and more people who did not benefit from this procedure at all,just like myself. From now on I won't recommend this to anyone that quick anymore,especially the normal protocol is likely to fail. I hope it does something for you.


 I don't see why you wouldn't recommend it if someone can get it covered by insurance. side effects are generally tolerable if any occur at all, and it has at least a slight possibility of helping. I'd say it's safer than most medications so if you have the means I say go for it.


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## 35467 (Dec 31, 2010)

spectator162 said:


> Hi, im trying rtms. I already did 9 sessions of 40 min on the left dlpfc. Depression is little better but the dpdr is still there. Tomorrow is my last session on the left dlpfc. Ather that the doc will try another spot. I guess the right dlpfc. One question is the right dlpfc the same like the right vlpfc?


The 9.sessions on the left DLPFC are pointless and without effect in DP. Low frequency at the right DLPFC works for some. It is an inhibitor of negative emotions/pain/trauma together with right VLPFC. There should be more response to that one. One should do both.

Depressing to read about people with depersonalisation taking rTMS sessions in areas that have no effect for DP. It ends up with trails that gives the impression the rTMS is no a cure for DP because some many have tried without effect. I only read about two who have tried rTMS to VLPFC and the both had a respons and left and never wrote anything since about their progress.The Depersonalisation research unit did a small trail on 7 and 6. had a response with 45-80% reductions in symptoms. 4. out of 9 have responded to inhibition of the right DLPFC in the Nederlands. It would have been much higher if VLPFC was included.

The reason most rTMS clinics don't take the VLPFC is because it can be difficult to locate. Most have rTMS clinics some standard locations for depression, anxiety, OCD and left and right DLPFC are among them for depression anxiety. So, they can locate those areas easily. That is why some few has been given rTMS in VLPFC that is likely to be the suppressor of emotions in depersonalisation and makes the disorder together with the right DLPFC, that is the weakest suppressor of emotions of the two. They don't have the tool for a precise location of it.


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## 35467 (Dec 31, 2010)

*Emotional numbing*

If one looks at the research into depersonalisation disorder and rTMS it has it empirical foundation in brainimaging of patients with depersonalisation. There are differences because some focus on the emotional numbing and others on the dissociate state.

In the studies for the emotional numbing several locations in the frontal lobe is active in suppression of emotions; The right ventrolateral prefrontal cortex (VLPFC), The right dorsolateral prefrontal cortex(DLPFC) and the medial prefrontal cortex(MdPFC). The right ventrolateral prefrontal cortex has been the prime suspect as it the most potent of them. The medial prefrontal cortex has never been tried. The right dorsolateral prefrontal cortex might not be effective in a primary state of depersonalisation but it might work if the symptoms are secondary to depression. In the trials at the right ventrolateral prefrontal cortex emotional numb is reduced,- but not dissociation. So, a reduction in symptoms is on avenge of 40%

In rTMS trials done at the right temporal junction (TPJ) a evolution after of the symptom clusters found the that dissociation is reduced,- but not emotional numbing. There are for the same reason speculation that two networks that are partially related is a work and working with both might give a better response. A evolution of what clusters of symptoms is reduced after rTMS at TPJ can be read here.https://www.brainstimjrnl.com/article/S1935-861X(13)00228-3/pdf

*The default mode network.*

The default mode network is the state the brain is in at rest without any trask to do. The brain is self-reflective, mind wandering about itself and its relation to others. I you feeling that the state you are in a rest is changed with DP it is related to the "Default mode network". A brief text about the network can be found here.https://en.wikipedia.org/wiki/Default_mode_network

There are several structures related to the network found to be overactive in depersonalisation. The temporal junction that has been tried rTMS is a sub hub of the default mode network but the structure very close to it, the right angular gyrus is a central hub of network . There is a trail that might be publish soon with over 100.patients that has had the right angular gyrus inhibited. As I wrote at first the medial prefrontal cortex is active in depersonalisation. It can suppress emotions, stress and anxiety as it is innovated with dynomphins and make inhibitions with use of dynomphins. When some have had reductions in depersonalisation with use drugs like naltrexone, naloxone is might be related to the medial prefrontal cortex . The medial prefrontal cortex is a hub of the default mode network and is in a relation to angular gyrus. So, to inhibit the overactivity in the angular gyrus might also work normalising in on the medial prefrontal cortex and normalise the network. Here is the abstract of a recent publication in depressed patients with depersonalisation and the Default mode network. They found a connection between depersonalisation and the the default mode network. https://www.biologicalpsychiatrycnni.org/article/S2451-9022(19)30076-X/fulltext

The trail in France with right angular gyrus might have a higher response rate than the trail with right TPJ as it is a central hub of the default mode network,- and not a sub hub as the TPJ is. If it only works on the dissociation symptoms and not the emotional numbing there is a indication that the emotional numbing and dissociation shall be adresse separately with rTMS. So, rTMS at the right ventrolateral prefrontal cortex for numbing and angular gyrus/TPJ for dissociation. The right VLPFC reduces symptoms on average 40% related to numbing but including angular gyrus or the right TPJ might reduce the state to a level that makes more soft intervention more workable like 60-90%.

To use rTMS at left and right DLPFC in primary depersonalisation is of very limited in effect with reductions in some at 15-30% in some publication. It might work better if depersonalisation is secondary to a depression. TMSEuropa with locations in the Nederlands states on their FB page that they can treat it if it related to depression on these locations.


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## forestx5 (Aug 29, 2008)

I had ECT in 2014. I assume it targeted the left side of my brain. That is the location/focal point of my history of temporal lobe seizures. I was pretty fatigued and listless when

I had the procedure. I had an induced grand mal every other day for 2 weeks. There was very little discomfort involved. A Veterans psych ward is not my favorite place to hang out,

but I needed the rest. I drove home after 2 weeks and continued to improve markedly. It has been 5 years now, and I had a brief period of depressive feelings recently, but I didn't spiral down.

I bounced right back and feel good again. ECT was a life saver for me. I wish I had done it much earlier in my illness. Medical Science doesn't understand the cause of mental illness.

Why do we take medications founded on their ignorance, when ECT has been shown to be the most effective and safest treatment available for major depression? Well, that's actually

a rhetorical question. The answer is simple. Money.


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## Aridity (Jun 12, 2011)

forestx5 said:


> I had ECT in 2014. I assume it targeted the left side of my brain. That is the location/focal point of my history of temporal lobe seizures. I was pretty fatigued and listless when
> 
> I had the procedure. I had an induced grand mal every other day for 2 weeks. There was very little discomfort involved. A Veterans psych ward is not my favorite place to hang out,
> 
> ...


ECT is very different.


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## Aridity (Jun 12, 2011)

Mayer-Gross said:


> *Emotional numbing*
> 
> If one looks at the research into depersonalisation disorder and rTMS it has it empirical foundation in brainimaging of patients with depersonalisation. There are differences because some focus on the emotional numbing and others on the dissociate state.
> 
> ...


Seems plausible what you are saying,yes I did it at that place in The Netherlands. I know about one girl who got cured with just left and right DPLFC


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