# Issue with rTMS for Depersonalization Disorder



## DPFighter (Apr 8, 2013)

So I did rTMS on the right TPJ and gave up after 13 sessions because I didn't notice any response. I want to try the right VLPFC but as I have been researching into this I have come across an issue with TMS (other than the expense and the hassle of finding a clinic that will do something that isn't FDA approved) and that is that the trials done on the VLPFC used nueronavigation technology to more accurately target the site of the VLPFC. This means the trials used brain scans in addition to the TMS machine to conduct the trials. Here is how it is written in the article about the VLPFC trial:

"A structural MRI was obtained for all participants prior to rTMS... Images were converted to DICOM format for use within BrainSight 2, a widely used neuronavigation software program which ensures that stimulation can only be delivered when the target site is positioned using the frameless stereotaxy."

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

When I did rTMS there were no brain scans done and the target site was located by coordinates drawn on a cap I was wearing that was the site of the right TPJ for most people. I'm concerned whether or not using the scalp coordinates for TPJ or VLPFC are good enough...? I wonder if I had access to nueronavigation when I did TPJ rTMS would I have responded?

I emailed Professor Anthony David about this (the guy who conducted the VLPFC trial) and this is what I said and what he said:

Hello professor David. I am a long term suffer of depersonalization disorder and recently received 13 sessions of rTMS over the right TPJ. I did not respond to treatment but would like to try rTMS over the VLPFC. My question is whether or not nueronavigation software and individual structural MRIs are necessary to obtain accurate coordinates for the site of stimulation for the individual? I was able to try the TPJ with coordinates sent to my doctor from the SmartTMS clinic in the UK but I haven't been able to get a straight answer from them if they have coordinates to try VLPFC. Do you suppose the coordinates can be the same for everyone or is the site of stimulation heavily reliant on what the brain scans reveal for the individual?

Thank you

Thanks for your enquiry.

The actual coordinates are the same but what neuronavigator does is put your brain into the grid so that the coordinates can be found in your brain (if that makes sense) and it needs an MRI scan of your brain to do this. Presumably the "coordinates" that were sent, were a set of measurements done on the scalp which approximate to TPJ? This is OK but not nearly as accurate.

We are hoping to do a larger study of rTMS some time in the future but first need to raise some grant funds.

Best wishes

So as I'm considering throwing out some more money for TMS I wonder how worth it it is going to be to try since I can't even get the treatment done the same exact way it was done on these trials. It was a hassle to get this all together to get the TMS clinic in my town even do the right TPJ and any regular TMS clinic in the U.S. is not going to have nueronavigation software combined with their TMS machine. I know not many of you have tried TMS, but those that have did you have any brain scans done prior to your TMS treatment in order to target the site of stimulation? Any other thoughts on this?


----------



## TDX (Jul 12, 2014)

I would say that it could still work, but neuronavigation would increase the chance and possible the effectiveness of the treatment. However another possibility is that you belong to the people who don't respond to TPJ-stimulation.


----------



## luctor et emergo (May 22, 2015)

Thanks for posting your rTMS expierence!

Too bad it didn't have a positve outcome.

"We are hoping to do a larger study of rTMS some time in the future but first need to raise some grant funds."

Pretty vague, but it's something.


----------



## forestx5 (Aug 29, 2008)

Go bareback with ECT. It will reset the compass on your neuronavigators and leave you sailing in calm seas.


----------



## dreamedm (Feb 1, 2015)

forestx5 said:


> Go bareback with ECT. It will reset the compass on your neuronavigators and leave you sailing in calm seas.


ECT is brain damage.


----------



## MichaelTheAnhedonic (Aug 31, 2016)

dreamedm said:


> ECT is brain damage.


Proofs?


----------



## forestx5 (Aug 29, 2008)

@Dreamedm

I experienced some temporary minor memory loss after ECT which consisted of 10 induced grand mal seizures. The overall outcome was

outstanding. What experience did you have that resulted in brain damage?


----------



## dreamedm (Feb 1, 2015)

forestx5 said:


> @Dreamedm
> 
> I experienced some temporary minor memory loss after ECT which consisted of 10 induced grand mal seizures. The overall outcome was
> 
> outstanding. What experience did you have that resulted in brain damage?


I can't say for sure that I incurred brain damage, but my emotions felt blunted after my 5th bilateral session, and I afterwards spiraled into a deep depression (I wasn't even depressed before ECT). Now I have the "blank mind" and accompanying depression (or damage), none of which I had prior to doing ECT.

I've also read of some folks who have incurred this "blank mind" DP (or whatever it is) as a result of ECT. Have you or anyone that you know been able to reverse "blank mind" with ECT?


----------



## dreamedm (Feb 1, 2015)

MichaelTheAnhedonic said:


> Proofs?


You can do a simple google search. There are also countless patients who report of the damage they've incurred from ECT. Easy google search.


----------



## MichaelTheAnhedonic (Aug 31, 2016)

dreamedm said:


> You can do a simple google search. There are also countless patients who report of the damage they've incurred from ECT. Easy google search.


Maybe there is some risk...

But if your blank mind was caused by it - I think I will not try it for my blank mind.


----------



## TDX (Jul 12, 2014)

> But if your blank mind was caused by it - I think I will not try it for my blank mind.


I think dreamdm's history was a bit more complicated than having ECT and directly afterwards the blank mind. I'm not sure, but I remember that it was more like that it set something in motion that ended after some time with the state he is still in. This would raise doubts it really was a direct effect of ECT or even brain damage.

But ECT is no joke. It can save life, but it can also have bad side-effects. However searching for negative outcomes won't give you a clear picture about how high the risk really is.

Concerning ECT and the blank mind I only found 3 reported attempts to treat it using ECT. In 2 it did not work and in 1 it improved symptoms, but without specifying what exactly improved. The 2 failed attempts were from the german forum depri.ch which is currently down and the success from the following paper:

https://www.ncbi.nlm.nih.gov/pubmed/2255928

By the way dreamdm: Have you finally tried the NSI-189?


----------



## dreamedm (Feb 1, 2015)

TDX said:


> I think dreamdm's history was a bit more complicated than having ECT and directly afterwards the blank mind. I'm not sure, but I remember that it was more like that it set something in motion that ended after some time with the state he is still in. This would raise doubts it really was a direct effect of ECT or even brain damage.
> 
> By the way dreamdm: Have you finally tried the NSI-189?


This is true, I spiraled into a deep depression after ECT, with blank mind occurring several months later. So I cannot say it was a direct or indirect effect from the ECT. I also experienced an "enlightenment" phase before relapsing and getting worse, so who knows...

I took the NSI-189 for about a week and developed an eye twitch, whereupon I stopped it. I may go back and try it if nothing else works. Meantime I will try and see a new psychiatrist and see if he can help in any way.

I feel like I'm in a very bad state now, perhaps worse since it began. I've been feeling pretty hopeless and defeated, honestly. Some people and doctors say this may be severe depression, but I don't know anymore if it's simply the result of blank mind DP, ECT, or what...


----------



## bintuae (Jan 17, 2017)

dreamedm said:


> This is true, I spiraled into a deep depression after ECT, with blank mind occurring several months later. So I cannot say it was a direct or indirect effect from the ECT. I also experienced an "enlightenment" phase before relapsing and getting worse, so who knows...
> 
> I took the NSI-189 for about a week and developed an eye twitch, whereupon I stopped it. I may go back and try it if nothing else works. Meantime I will try and see a new psychiatrist and see if he can help in any way.
> 
> I feel like I'm in a very bad state now, perhaps worse since it began. I've been feeling pretty hopeless and defeated, honestly. Some people and doctors say this may be severe depression, but I don't know anymore if it's simply the result of blank mind DP, ECT, or what...


I'm very sorry this happened to you. I've seen many reports of patients losing their memory after undergoing ECT. There's a reason why pdocs prefer rTMS (even though its not that effective) over ECT. Considering most of my problems were drug induced, I totally understand the feeling of realizing you did the damage by your own hands. if you know what I mean.


----------

