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My wife has suffered from moderate to severe MDD for most of her adult life. She responded to the standard cocktails of pharmacological treatments for years, but they stopped working for he three years ago. Over the past two years, she’s changed p-docs three times and finally found one she is happy with (for now). He first started her off on yet another course of drug therapies, but that did nothing for her either. Once this proved ineffective, he discussed other options, including ketamine infusions and TMS (he offers both through his office). He started her on ketamine immediately and began the paperwork to get insurance approval for TMS treatment. In his view, ketamine is power and effective at producing an immediate therapeutic response, but it is not likely to produce a lasting remission. TMS, on the other hand, is more likely to result in a lasting remission, but the treatment requires a huge personal commitment and the results are not immediate (and some people don’t receive any benefit at all).
Two weeks ago, my started to receive the ketamine infusions and they had a miraculous effect on her. Within 24 hours she was actually feeling good. She was smiling and was able to engage with people again. She was having happy dreams and singing along with music in the car. She was scheduled to have her 4th ketamine treatment yesterday, but her doctor called to tell her that her insurance had approved her for TMS and he wanted to start her on it immediately (which meant my wife’s 4th ketamine treatment would be cancelled). My wife agreed, but she was really anxious about starting the TMS so soon and giving up the ketamine, which she felt was really benefiting her.
This anxiety made for a miserable first treatment with TMS. It took 2 hours to complete the treatment (which was administered by an RN trained as a TMS tech). My wife described the treatment as painful and unpleasant, like a woodpecker pecking at her brain. She came home from the treatment in a full blown panic attack and crawled up in bed–reminded me of when she was in the deepest state of her depression.
I called the doctor’s office to tell them how my wife was reacting to the treatment and to ask about options. The doctor will be discussing treatment options with my wife later this week (he is going to be administering her treatment on Thursday). One option that he will discuss is using ketamine in combination with TMS. The ketamine would be administered during TMS. My wife’s doctor has provided combination therapy before, there isn’t much in the way of published research on this course of treatment. There are a number of clinicians that have published promising case studies and one small (28 patients) empirical study that suggests that there may be a synergistic effect between ketamine and TMS that could significantly increased the efficacy of both treatments. All that’s fine and good, but the research is limited
Do any of you have any experience with combination TMS/Ketamine therapy? Is this something we should be considering for my wife? I really want her to give TMS a chance and maybe this will make her more comfortable with the treatment and help avoid the “dip”–which scares her. Any advice will be greatly appreciated. Thanks!
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This topic was modified 6 years, 10 months ago by
Eric99.
Hi Eric99:
Welcome to this forum. Wow your wife and you have a lot going on – depression is so complicated. I cannot address issues regarding Ketamine. I have no experience with it. What I would say generically is that if your doctor is the one recommending treatment or treatment combinations, and she/he has the experience administering those treatments, then it probably goes without saying (and you and your wife have probably already done this) an honest conversation with your doctor is where experience with a multitude of patients can be drawn from, (from a professional perspective). As members of this forum, each person can offer their perspective and experiences as a patient. The most difficult part of these new treatments is the individualization of each response and experience. This is sometimes levied to options, risks, decisions and then blind faith. No matter what the outcome of this is, please know that there are a number of new treatments undergoing clinical trials as scientific research continues its march towards understanding depression and creating more effective treatments. I have had success with TMS and am grateful each day.
A couple of points about TMS – this treatment restores the brain closest to its natural functioning state by creating movement in the brain. Medication works such that it moves the brain’s response away from natural functioning. So if your doctor is recommending it, there is good scientific reason. I have never heard the dip is avoidable simply because there is no clear understanding yet as to why it happens. It can be mild and it can be deep – what is important to remember is it is TEMPORARY. So as a team just maintain – and use your support systems should it occur – you will both get through it. TMS is a medical treatment and you should afford yourselves every resource to assist you both in getting through it. It can have challenges but also benefits that could far out way them. And it is not bad all of the time.
Also, TMS can be administered bilaterally if your doctor feels it is advantageous. Left side of the brain for depression. Right side for anxiety. You might want to inquire.
Don’t give up this treatment unless your doctor suggests so. This can be life altering and life saving and the six weeks will be minimal compared to the outcome when successful.
Hope this is helpful. Sending support and my best.
Colleen-
This reply was modified 6 years, 10 months ago by
colleencasey.
Thanks Colleen. I am optimistic about the treatments providing a benefit, my wife’s having a hard time with it all. She was really happy with the ketamine, so switching to TMS (even with the ketamine) isn’t easy for her. I think she’s just anxious about the whole process. Even if TMS doesn’t work, she can always go back to just having ketamine. She just needs to give this a fair chance and not focus so much on the outcome. I am sure it’s easier said than done, but you’re right about there being other options out there if this isn’t as successful as we hope.
Hi Eric99:
You are welcome. It is great that you are supportive of your wife. Depression is a challenge for everyone. It truly is a family issue. Take care of yourself too.
How are things progressing? Thinking of you all. Sending my best to you all.Colleen
Thanks for the encouragement. Unfortunately, we had a set back this week. After first being told that my wife’s rTMS treatments were covered out-of-network by her carrier, they sent us a denial letter. They want us to use one of the two providers they have in network. One of those providers isn’t taking new patients and the other is a 2 hour commute (each way). We’re fighting the denial, but it’s caused an interruption in treatments. 🙁
Eric99:
How are you and your wife making out? What has happened with the course of treatments?
I am hoping things are working out. Thinking about you both.Colleen
Hey Colleen,
We’re still fighting the good fight. We’re up to treatment 21 today. Unfortunately, she had her TMS Dip last week and into early this week. It was really bad–about as bad as I have seen her. Bad enough that she was talking about how she would be better off dead and we’d be better off without her. That kind of talk–which I rarely heard her say (even if she may have had those thoughts in the past). Her doctor upped her ketamine dose considerably on Monday and she was wiped out the past couple of days. Yesterday, she seemed to be doing better–not great–but about where she was before the DIP. She’s also been complaining about headaches running across the front of her head. It’s not easy, but I’ll take it as a sign that the TMS is kicking in and she’s starting experience changes in brain function. These particular changes haven’t been pleasant, but I’ll chalk it up as part of the healing process. It’s the end result that matters and hopefully this was just one of those bumps in the road. That said, doctors and those darn TMS brochures should really give people a better heads up that many people that go through this experience the DIP–so they aren’t so shocked when it happens.
Thanks so much for checking in Colleen. It means a lot!
–Eric
Just wanted to give a quick update. As rough as last week/weekend was, this week was quite the opposite. I can’t say whether it was the higher ketamine dose or the TMS finally kicking in (or some combination of the two), but my wife had three good days in a row–starting on Friday. Her mood was upbeat, she had a lot more patience to deal with frustrating things and seemed pretty happy overall. The headaches seemed to subside and her energy was back. She wanted to go out and do stuff and not lay around the house. She also told me she was experiencing vivid, colorful dreams. Not all the dreams were good, but they were colorful at least–instead being grey or black like they usually are for her. Anyway, I “think” we might have gotten through this Dip–so fingers crossed that this continues on a positive note.
Hey Eric, I just saw your post on this string. The dream thing is interesting. That was one of the things I noticed right away with TMS, rich, full, colorful, motion picture length dreams. I wonder if that’s a common side effect of TMS or maybe it just means we’re sleeping better. Anyway interesting, so glad things are improving for you and your wife.
I’ve done the ketamine but could not afford to continue. I really had a quick and noticeable change from it. My insurance approved in-network rTMS, so that’s what I’m doing. I am at the start of my second week, and I am in the DIP. I am tired and feeling very sad. I don’t like the treatments either — I got a dental guard because I was clenching my teeth so hard that I was afraid I’d break one.
I am upset that they don’t really prepare you for what it feels like. The doctor referred to it as a “tapping” on the head. It’s more like a loud bang, particularly as they up the intensity. And the twitching on my right hand is taking some getting used to. Overall, I hope this treatment works because I find it unpleasant.
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This topic was modified 6 years, 10 months ago by
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