Transcranial magnetic stimulation (TMS) and MAOIs

[Tinker69]

Has anyone had transcranial magnetic stimulation? My psychiatrist wants me to try this treatment as nothing else seems to be working. I have googled about TMS but there does not seem to be many personal accounts from people undertaking this treatment. From my reading it takes between 4 to 6 weeks and treatments are about 30 minutes to an hour each day. It appears to be very safe with no anaesthetic required. I would really like to find out from a real person what it was like, if it worked and whether you relapsed after about 6 months etc. Also do you continue to take ADs while undergoing the treatment. I  am currently on MAOIs. This requires a strict diet. I am increasing the dosage of the MAOIs over the next couple of weeks. Has anyone else taken MAOIs? How did you feel about the diet? I do not seem to have any adverse effects from the Medication which I have been on for about 3 months. They do not seem to actually do anything for me which is why the Psych wants me to try TMS. Over the years I have been on so many different ADs and they don't seem to work for me.  Would appreciate hearing about anyone else's experience with TMS or MAOIs.

[MarkieMark]

Just a little more information about accessing TMS...

I received free treatment of 20 "applications" over two weeks. I attended up to four 'applications' a day spread over two weeks as an outpatient. There was no problem driving home after my sessions and after a few treatments I improved dramatically. As I described above, this was life-changing with zero side-effects.

Disconcertingly, there is no availability for me to receive further treatment from the same facility. The trial protocols do not allow for the provision of any follow-up treatment.

The best option I have managed to track down requires me to fly to Melbourne. I would be required to spend five days in a clinic because the treatment isn't available on an outpatient basis. (subsequent follow-up visit at the same clinic would be over three days). My understanding of the reason why I have to be admitted to a clinic to access the treatment is all about funding. Receiving TMS as an outpatient is not covered by Medicare or private health insurance. I think it's extraordinary that I have to occupy a bed for this reason, just so the clinic can access sufficient funding to provide the treatment.

I also understand from my psychiatrist that the reason why the therapy is not funded by Medicare is that policy dictates that ECT (Electroconvulsive Therapy) is the preferred alternative. This is despite the success rate of extensive TCM trials over the years. ECT is also far more expensive, more invasive, requires anesthesia and can have some side-effects (some memory loss).

I have corresponded with my local Federal MP. Her response included the statement that "there have been two applications to the Medical Services Advisory Committee (MSAC) in the last decade seeking to have TMS listed as a publicly funded service. Both of these applications have been unsuccessful on the grounds of uncertain effectiveness and cost effectiveness due to insufficient patient data."

My psychiatrist assures me that there is now more than sufficient evidence to prove the effectiveness of TMS.

How ironic that the "system" results in so much needless funding being spent by Medicare and my health insurance company for stays in a clinic to receive treatment as an inpatient, not to mention the cost of my flights interstate.

[MrsNesbitt]

I have just finished a course of treatment in Sydney city and the results have been fantastic. I went from 29 on the DAAS scale to 5 in just 10 sessions. I did a lot of research before starting the treatment and went with a company that combines TMS with psychotherapy. The process involved an initial meeting with a psychiatrist who went through medical issues. I had to wear a special watch for a week that measured sleep and light and then had a QEEG scan. After that they mapped out a personalised treatment plan for me. I then went twice a week to receive treatment. Whilst receiving the TMS treatment there is a mental health professional doing counselling (CBT for me) at the same time. I saw a psychologist for 4 sessions then a psychiatrist every 5th time. They recorded the DAAS score every 5 sessions.

This group, which combines TMS and psychotherapy claims efficacy of around 80% in treating depression. I believe them and my own case certainly supports it. This compares to studies which show efficacy for TMS on its own of around 45%.

I am a now a big advocate of this combined TMS and therapy approach as.

- Better Efficacy - 80% compared to the current “industry gold standard” of drugs and psychotherapy which is around 65% (as best that I can determine).
Quicker Treatment – Treatment is usually finished in 2-4 months compared to what often takes from 6 months to years with other treatments
- NO DRUGS – No Side Effects. Some people report mild headaches. I did not experience any side effects. I have been on drugs before and whilst they helped I just hated how they made me feel (or not feel in my case)

I will caution that the program is not cheap. I received some rebates from medicare with a mental health plan but until TMS receives health fund rebates (which it does in the US and many European countries) this treatment will unfortunately be out of reach for many people.

[Dr_Kim]

Hi everyone,

It seems to me that the whole area of rTMS ( regular transcranial magnetic stimulation ) is still a bit unresolved in Australia and more research is still needed but as things stand this is what I could find on this topic :

In my reading of the current state of TMS in Australia , I understand a few salient points.

1. Most studies show it to be really helpful for about half of the people that try it . ( Researchers at Monash University reviewed data for 1000 patents over 10 years and found 50% had a great response, 15-20% had some benefit and about 30 % had no benefit whatsoever. )

2. The people that it is appropriate for are those where other treatments have failed. ( Most in the Monash study had tried 5-6 medications AND counselling) 

3. The protocol for administering it at this stage requires an initial consult with a psychiatrist and then visits for treatment daily , 5 times a week for 4 weeks. Treatments take about an hour or so.

4. Many people also need maintenance treatment.

5. The side effects are low and it is well tolerated.

6. The way it works is not 100% understood, but it may have something to do with stimulating parts of the brain that have been noted to be “quiet” in depressed people.

The machines that deliver this treatment are not readily available around Australia and at present it is extremely hard to get the therapy even if you decide that you want to give it a whirl.

The costs to the patient at this point are a major issue. There have been a number of submissions to the government to provide a Medicare rebate for the service so that it will be more affordable, however these submissions have failed. So at present there seems to be only a couple ways to get this treatment:

- as an inpatient at a public hospital on the advice of the treating psychiatrist
- as an inpatient at a private psychiatric hospital that has access to this machine and under the referral of your treating psychiatrist ( you would need private health cover to cover the cost of your hospital stay)
- as an outpatient . This is a possibility as it is safe to drive to and from your appointments daily . However, you would need to “self fund” this option even if you have private health cover ! My sources tell me it is currently about $6000 for a course of rTMS via the outpatients option.

There was a great podcast about TMS recently that you may be interested in .. just remember that the doctors interviewed here work in the area so are particularly UPBEAT about its success etc but it does contain an account from someone who has the procedure and explains what it feels like .. so that might be helpful to those thinking about it. 

All In The Mind - Brain Stimulation for Depression

In my view, nothing in the area of depression treatment is the miracle cure for everyone but I am happy that there is another form of treatment to offer some people as we need as many things as possible in our fight against this very difficult illness. 

[ALLee]

Hi Chris80. Is the treatment covered by DVA? Glad it has helped.

[Daisy2]

Great thread Tinker69. Exactly the information I was looking for. I have only recently heard of this therapy and was wondering if this is something I can try for my daughter. She is 15 yrs old suffering from depression, social anxiety and panics attacks. Medications are not working for her, she is under the care of a phycologist and a psychiatrist. She has also been in hospital due to suicidal thoughts and self harm. Nothing seems to be working for her.

This thread has been really informative. Now I'm thinking that this treatment is currently only available in major city centres and needs massive follow up sessions which I'm not sure would be possible for us. It is great to hear that for some people the treatment and follow up sessions have been helpful and I feel sorry for those who have had no reprieve from their symptoms.

I look forward to reading the results on those currently going through the therapy and hope it is successful for you all. Perhaps one day my daughter will be access this treatment also, worth a try!!

[MaryMary89]

1. Most studies show it to be really helpful for about half of the people that try it . ( Researchers at Monash University reviewed data for 1000 patents over 10 years and found 50% had a great response, 15-20% had some benefit and about 30 % had no benefit whatsoever. )

6. The way it works is not 100% understood, but it may have something to do with stimulating parts of the brain that have been noted to be “quiet” in depressed people.

It seems there have been mixed messages among the medical community and i'm sure drug companies would be happy to keep it this way.

See this study that came out just recently that shows benefits of TMS when combined with Psychotherapy.

Donse, L., Padberg, F., Sack, A. T., Rush, A. J., & Arns, M. (2017). Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study. Brain Stimulation. https://doi.org/10.1016/j.brs.2017.11.004

They did TMS at the same time as having your regular Psychotherapy session with a Psychologist or Psychiatrist, they found that 66% of patients responded well to treatment, and 56 % of the sample achieved complete remission after 6 month follow up. So that's to say that the effects are longer lasting when combined with talk-therapy, and also more chance of response in teh first place. Combining TMS with talk therapy makes sense when you think about it. If depression is linked to disrupted communication in a specific network of brain structures (DLPFC and the deeper anterior cingulate), TMS is designed to ignite those pathways, but when you are doing Psychotherapy, it is understood to also activate the deeper anterior cingulate. So it is therefore seen that doing psychotherapy at the same time as TMS activates these networks from both ends. As this study shows, there's a better chance of recovery.

Not only should TMS be reimbursed like they do in Netherlands but when they make the policies here in australia they should consider this to be available to Psychologists and outpatient practices. This idea of going to a hospital as an inpatient, and it's administerd by a nurse - then the effects aren't going to be as good and then more confusion if it works or not.

Someone on here already mentioned the Neurocare clinic in Sydney before who do this TMS with psychotherapy. I'm sure it's more expensive, but if it's a better chance?

[ShanC]

Just a brief history for perspective of my experience with TMS and MAOIS - I have suffered for 6 years with MDD major depressive disorder and anxiety. I have had many experiences and trials with medications, until I was was put onto a drug trial which worked very well for the last 3 years

However 3 months ago since a move to Melbourne 12months ago the “black dog” appeared with a vengeance, I run a large company and have been unable to socialise, work or leave my house.

I reluctantly but with optimism was admitted to a Clinic on advise from medical friends and my partner.

The TMS was prescribed as 20 - 30 sessions with a change to MAOIS (medically more effective with TMS according to my psychiatrist)

I can truly say TMS has saved my life, I saw results after about 8-10 sessions, and stayed for the full 20 sessions and was discharged.

TMS requires what is called “maintenance” and you will be required to attend again 4 weeks later for another session of 5-10 treatments. I had a second admission of 10 TMS sessions due to a change of mediations increase (when you change any medication TMS “mapping” needs to be redone) this proved extremely successful.

The anxiety is still an ongoing issue for me, but with psychotherapy and TMS and MAOIS the anxiety is very slowly alleviating.

It’s not an easy journey we are all on, and I hope you all find peace and a suitable method. I feel that TMS needs far more credit in the Medicare system to be more available. The cost can be quite extraordinary if you don’t have private health, but it is something that I feel will continue to help many people.

The TMS process is not to be scared of it feels like “woody the wood pecker” on your head and there were no side affects for me, just a minor headache on the first session but this soon passed and the uncomfortable nature was alleviated.

I am very grateful to the clinic and the doctors and nurses here to help with my care and wouldn’t hesitate to be a strong TMS and MAOIS advocate given the very minor side affects. My MAOIS which is non-reversible meaning no diet restrictions! As many MAOIS have, so was very happy with my choice and my doctors kind assistance.

Hope this is somewhat helpful - each day at a time friends

[Andy_Mack]

Hello everyone - I have just joined the Beyond Blue group and have been researching TMS topics. TMS is interesting to me in that it requires a minimum of 3 half hour treatments each week over an initial 4 - 6 week period with the suggestion that further treatments may be required after six to twelve months. I am told these treatments may cost around $150 per session, but there may be "substantial discounts" available after preliminary assessment by the supervising psychiatrist. My observation would be that, for many of us who suffer chronic medication resistant depression, the very fact that we were able, or obliged to, leave home for that period every day would have a positive health benefit in itself - particularly the interaction with a supportive therapist - and that this aspect of the treatment would in itself tend to cloud the assessment of any positive benefit of the treatment. In other words, the incentive to leave the house and attend for treatment (that social experience) will in itself have real health benefits for the patient. I have suffered chronic depression for the past 18 months, following a protracted but not full blown manic episode (which did not end in hospitalisation) and have begun to think that ECT or TMS might be the only option for me. I would appreciate hearing from those of you who posted on this subject 3 years ago with any updates on your treatment experiences you may be able to share.

[Al67WA]

Hi, I am 51 have had MD and Anxiety for 4 years or so. I have had around 90 ETCs, and am on a range of medication. I was doing pretty well with last ECT in late 2017, but have had a recent relapse that I am not yet coming out of. ECT has affected my memory, so now looking at the possibility of TMS if my current situation does not improve shortly. Some of the posts on this were a little while ago, prior to undertaking TMS. I would appreciate any updates on how it has worked or not for them. My specialist has told me that current figures suggest that it is beneficial for around 30% of those who have it - with those people generally being those who are treatment resistant (to other approaches). Any info much appreciated.

[Kelster]

Hi Tinker69, 

I have had TMS for bipolar 2 depression episodes. I’ve tried so many different medications and they don’t work for me but TMS has been life saving in it works for me and apart from very low meds I have been using TMS as treatment for 3 years. My problem is it effects me so well I can get pushed into a mania which leads to bad anxiety and bad headaches however that passes after a few weeks. I recommend seeing a psych that knows a lot about it, my doctor has his own clinic now so is very involved in research. The people I have met either say it’s amazing ( and met heaps)or doesn’t work but I suppose that’s the same as different medications.

Good luck and any questions don’t hesitate to contact me.