Excellent review- thank you.

@floridatmsclinic1239

Жыл бұрын

Thanks for watching!

My concern is the Xanax I am on. I was up to 1 mg a day and my psychiatrist wants me to decrease it to .5mg. However, with my recent divorce and my being almost bankrupt, plus work stress I have found my benzo use went up !! I do not know what to do !!

From my own personal experience, after 5 sessions, I tend to think less of taking my medication. Eventually I do because I know they will help my symptoms. Usually come noon I end up taking them. But it is interesting.

9:40 When do your unresponsive anhedonic patients take the low dose stimulant? Do you time the dosage so that the patient only consumes the stimulant immediately before their rTMS appointment or is an extended release formulation prescribed for coverage throughout the entire day like a patient with ADHD typically has?

@floridatmsclinic1239

2 жыл бұрын

The paper that showed higher response with patients taking a stimulant while going through TMS didn't investigate timing. When we decide that a concurrent stimulant could be beneficial for a patient, we prescribe it in a similar manner to ADD/ADHD treatment. Once a day for extended-release or more frequent for immediate release.

Personally i think that it would be a waste of money to use ssri while doing tms. The benefit that you get from tms might be nullified by the horrible withdrawal symptoms that one most likely will get, when one quit the ssri. Even if you tapper slowly, its very likely one will feel very bad. I tappered slowly before tms, and even so the withdrawal symptoms influenced negatively on the results from tms. SSRI:s are potent drugs, with many posible side effect. I would not recommend it to anyone except for people with severe ocd or anxiety. Even in that cases i would recommend, thinking twice before taking SSRI. TMS is a much better alternative. To bad it has a high cost

Medication does nothing for me, hoping TMS helps

What about quntapine?

Is there any evidence that stimulants were correlated with improved response for inhibitory stimulation like 1hz right DLPFC or has this only been studied in high frequency rTMS? Intuitively it seems like a stimulant would do the opposite of what an inhibitory stimulation is trying to do.

@floridatmsclinic1239

Жыл бұрын

Excellent question! Stimulants were correlated with better outcome regardless of left high frequency vs right low frequency. Watch the video on laterality of treatment to understand the balance between the two sides of the brain, if we inhibit the right sided we are technically simulating the left.

So would a patient taking their stimulant medication shortly before TMS increase the likelihood of long term effectiveness of TMS even if they didn’t continue stimulants long term? By taking it shortly before TMS it would likely be in the highest concentration in the blood stream.

@floridatmsclinic1239

2 жыл бұрын

We know that patients who are taking stimulants during TMS have better outcomes. We don't have data looking at stopping a stimulant right after TMS and comparing that with continuing a stimulant. Generally speaking, we would favor continuing what works.

@martinlutherkingjr.5582

2 жыл бұрын

@@floridatmsclinic1239 Thanks for clarifying that and the fast response!