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As Colleen has pointed out, your doctor does not appear to be using an evidence-based treatment protocol.
The doctor’s anecdotal experience in the clinic is not an acceptable substitute for a rigorous scientific study.Whoever you were speaking with at Neuronetics either lacks a basic understanding of the scientific method, or is more interested in business than medicine.
The reason I mentioned contacting Neuronetics is because, in fact, they do not simply supply the machine and leave the transaction at that. The real reason rTMS is so expensive is because Neuronetics also supplies $300 single-use coils.
Unfortunately my experiences have made me incredibly cynical. I would like to believe Colleen’s suggestion, to simply ask for an evidence-based treatment protocol, would be effective. It’s possible that this approach will work, and it’s absolutely worth trying.
I have difficulty imagining that it will, and while in theory Neurostar should be financially interested in not doing business with clinics that compromise their product’s effectiveness, and while in theory the insurance company should be financially interested in making sure that the treatments they cover are being dispensed in the most effective manner, I would again be surprised if any customer-facing representative of either company would be capable of seeing it that way.But for now, please disregard my morose griping. Follow Colleen’s advice, and ask for an evidence-based protocol.
You have every right to receive effective treatment, and you shouldn’t feel ashamed or embarassed to ask for it.One thing that might be worth considering (though it is an off-label indication) is altering the frequency of the treatment waveform.
One study (although a very small one) seemed to indicate that patients who responded well to high frequency rTMS responded poorly to low-frequency, and vice versa.I don’t know if this is something your doctor is willing to consider; but I’m a bit concerned if they’re attributing your mood changes to your menstrual cycle. If you have already established with your doctor that yes, you have mood swings or anxiety associated with menstruation, then perhaps that is a valid explanation; but if not, I think your doctor is speculating instead of assessing.
P.S. Neuronetics doesn’t exactly want clinicians administering their treatments in an ineffective fashion, either. You should probably report the facility to Neuronetics if they refuse to give you a more consistent treatment schedule, too.
Hello,
I cannot answer you definitively, but I have reason to believe that insufficient treatment density will hamper your treatment’s effectiveness.
I say this primarily because of what I have both read, and personally experienced, with ECT. ECT is both most effective– and most likely to cause memory loss and cognitive deficits– when it is given at very regular intervals (at least 3 times a week).
I actually discontinued a course of ECT on the third session when the administering psychiatrist finally made it clear that she couldn’t guarantee 3x a week treatments;
the good news is that, unlike ECT, you aren’t taking on risk of brain damage.I can also tell you that the clinic at which I am about to start rTMS, their protocol starts for the first 4-5 weeks at 5 treatments a week;
so I have every reason to believe that yes, getting treatments less frequently than that will lower your odds of getting an effective treatment response.If at all possible, insist that your providers offer the treatment on a very regular schedule.
If you have other treatment providers in the area, shop around and see if someone can guarantee you more regular treatments.One last thing, and this is highly speculative so I’m not actually recommending it:
I’m buying a Fisher Wallace stimulator, which is a form of sub-seizure electrotherapy that uses AC signals.It costs $700, but you may be able to get some reimbursement through insurance. It seems to have a decent response rate, especially for PTSD and insomnia; I’m not sure if it’s as effective as rTMS, but the beauty of the device is that you own the thing, so you aren’t at anybody else’s mercy as to when you can use it.
I plan on using the unit on weekends or if I drop a treatment; though this is partially because my brain was particularly stubborn. It took me some 12 sessions of ECT, 3 times a week, to get any sort of significant response– and that response petered out within a week; so I’m taking a pretty aggressive approach.
Like I said, I’m not recommending it– but it’s something to be aware of.First and foremost, self-advocate like all hell.
I’ve dealt with so many negligent, aloof, callous, arrogant mental health workers over the years, and you can’t let somebody else’s complacency stand in between you and effective treatment. Don’t let anybody take advantage of your insecurities on this one.
Speak up– and if they don’t listen, take matters into your own hands.
