<story><title>Stanford Accelerated Intelligent Neuromodulation Therapy for Depression</title><url>https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19070720</url></story><parent_chain></parent_chain><comment><author>cupcake-unicorn</author><text>Why is the media doing this with old depression treatments that have been around for ages? First it was the deep brain stimulation article, now this? rTMS technology has been around since 2008. The picture they are using is the same magnetic figure 8 coil that they used on the first devices and not even the newer technology using the Brainsway or deep TMS device.&lt;p&gt;This article is incredibly frustrating. This is NOT new technology. It is a different modality called theta burst which they didn&amp;#x27;t even mention the name of in the article. The benefit of using theta burst is that you can do TMS courses much faster. This is a major benefit but the technology is still the same. If you didn&amp;#x27;t have remission with the prolonged rTMS course theta burst is not a magic bullet. The benefit is that it&amp;#x27;s easier to do bilateral treatment and speed up the treatment quite a bit. Normally you have to come in every business day for a few months for 20 mins at a time.&lt;p&gt;It really sucks to have &amp;quot;lay people&amp;quot; in my life email me these articles like this is some new breakthrough. The articles often come out prior to FDA approval but these modalities have been around for 10+ years prior and I always knew about them  with someone with treatment resistant depression. Remember, off label treatments are a thing, and theta burst was available well before this study came out.&lt;p&gt;I&amp;#x27;m currently undergoing deep TMS treatment with the Brainsway device on my left hemisphere and they were able to boost the treatment by adding the theta burst with the figure 8 coil like in the picture to do my right hemisphere to improve chances of remission. It is a good trick and it boosts your chances of remission because it&amp;#x27;s faster and easier to do bilateral but as I said there is nothing magical about theta burst other than it&amp;#x27;s a very fast treatment. Those who didn&amp;#x27;t have remission on long courses of TMS before unilaterally probably aren&amp;#x27;t going to magically have remission on this. What we might end up seeing is some kind of threshhold that wasn&amp;#x27;t achievable in the past, say that some people could reach remission but it&amp;#x27;s not feasible to come into the office every day for 6 months.&lt;p&gt;Anyway TMS is great and should be used more but I just hate these dumb articles. Especially since it&amp;#x27;s touting this as some magical new technology. No way. And we&amp;#x27;re still a long way from TMS being prescribed in general cases - less side effects than meds but insurance wise you have to trial and fail several meds before it&amp;#x27;s covered. Even SSRIs which are given out like candy can have severe side effects like GI bleeding. TMS is very, very safe with few side effects. For me it was just discomfort during the treatment but not after.&lt;p&gt;Also just got to say this quote summed up how ridiculous the article was for me: &amp;quot;“This study is hopefully just the tip of the iceberg,” said Siddiqi. “I think we&amp;#x27;re finally on the verge of a paradigm shift in how we think about psychiatric treatment, where we&amp;#x27;ll supplement the conventional chemical imbalance and psychological conflict models with a new brain circuit model.” In other words, psychiatrists will use electricity instead of talk therapy and drugs to treat mental health disorders.&amp;quot; No reason to make rTMS sound like some Frankenstein tech and no, rTMS will not be used &amp;quot;instead of talk therapy and drugs&amp;quot;.&lt;p&gt;TBH a little disappointed at hacker news, next time link to the study! I would love to see articles on NEW treatments for depression. Spoiler alert..there really haven&amp;#x27;t been any for a long time now. Just me too drugs and this is a bit of a me too tech as well.</text></comment>
<story><title>Stanford Accelerated Intelligent Neuromodulation Therapy for Depression</title><url>https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19070720</url></story><parent_chain></parent_chain><comment><author>depressionalt</author><text>This is very interesting. TMS has always been a no go for me on account of how much time it took and how expensive it was. 5 days is very dooable compared to 30 days, every day, for a month.&lt;p&gt;The most difficult thing about depression treatments is that most medications take 2-3 weeks to kick in and it&amp;#x27;s hard to get motivated to see the treatment through.&lt;p&gt;Chemically here&amp;#x27;s what worked for me:&lt;p&gt;1. Ketamine saved my life. It&amp;#x27;s the only thing I&amp;#x27;ve encountered that provides instant relief. If you&amp;#x27;re in a particularly bad moment and buried by your thoughts, ask your psych to write you and Rx for Ketamine nose spray. It&amp;#x27;s much cheaper than intravenous Ketamine and highly effective by my experience. There&amp;#x27;s a pharma version of Ketamine on the market now (esketamine) but that require heavy doctor supervision and are also expensive. There are special pharmacies that synthesize the nose spray for you. The effect of those small, regulated doses of ketamine is like putting your brain in the sink and giving it a good wash. It helped me through some rough times. The best part about it is that it&amp;#x27;s non-addictive. Once I got through the deepest of my doldrums, I stopped filling the Rx.&lt;p&gt;2. Wellbutrin. It&amp;#x27;s the only pill that worked for me, with the fewest side effects. The only side effect is that my libido is now significantly higher (undesireable, for me).</text></comment>