Usually by 12 or 15 treatments we’re seeing some benefit that the person is beginning to improve. We have them fill out scales, self-rating depression scales, and then I also do a scale. If the people are steadily improving then it’s probably working. Sometimes the patient doesn’t feel any better and they say, you know, ‘It’s not helping me’, even though their scores are getting better, even though they are doing their own scales and the scores are getting better. And, that’s because sometimes the last thing to get better is how you feel. The depressed feeling is the last to get better, so even though they’re concentrating better, doing a few more things, and they have a little more energy and they’re enjoying food a little better, and their appetites a little better, they’re not feeling better. And, we explain this and then we continue on the way we are going.

Usually we think of about 30 treatments as being the amount most people need for their treatment. Some people get completely to a normal mood in 15 or 20 treatments, and then we may just stop there. Or, we may decide to do a few more treatments with the idea of cementing in the benefit. If there’s no benefit by 12 or 15 treatments then often we think of changing the parameters, and doing the treatment differently, for example, beginning to do treatment on both sides, or to switch from an excitatory treatment on the left to doing an inhibitory treatment on the right. And there’s a few other new parameters that have been introduced, different places and ways of treating depression. So, we have quite a few alternatives. If someone is overly stimulated by a left excitatory treatment, their [inaudible] begin to raise, and they can’t sleep, and they’re feeling kind of hyper, then they’re probably a little bipolar, and then we switch and do an inhibitory treatment here.

Over the years the treatments were mainly done left excitatory and that’s primarily because the first treatments were done that way so everybody continued to do it in the same place in the same way with some changes, like, doing more pulses per second or doing more total pulses. So, the parameters were improved over time, and there weren’t that many studies on using the right-sided inhibitory treatment, but it turns out that the right-sided inhibitory treatment works just about as well as the left excitatory.

I have treated a large number of bipolar patients, bipolar one, and then people with a mild bipolar problem called bipolar two with just the right-sided inhibitory treatment, and it’s helped their depression, and we haven’t caused anyone to cycle on them. We haven’t made anyone cycle up into a mania, or another thing that a stimulating anti depressing treatment does, whether it’s medicines or TMS, that stimulating treatment can cause people to cycle more. Maybe they don’t go into a high, but they start having more depressions and more agitation, and you’re actually making them worse over time.

In fact, you see this frequently in bipolar two people, who have had very few highs and very mild highs, so no one has really, recognise that they’re bipolar. So they’re put on an anti-depressant and the anti-depressant works really well and in a month or two they’re doing great and the psychiatrist thinks he’s a genius and-, but then in a few months the medicine poops out, and they raise the dose and it doesn’t help much, in fact the person might get worse. So then they take the patient off that medicine, they try another antidepressant, and the same thing might happen. Initially some benefit and then lose the benefit. And eventually, they’re getting no benefit at all, from any anti-depressant they had. That person is not responding because they are a little bipolar, and so they should be put on lamictal lamotrigine, which is an anti seizure medicine that has a great anti depression effect, and maybe a small amount of lithium, I always go very low, and then when you use TMS you use a right sided inhibitory treatment. We’ve had the experience that not only do we bring them out of the depression, but we stop their cycling so that people who are cycling between moderate depression and agitated depression and up and down, or cycling from depressions into mild highs, that the cycling has seized as well as bringing them out of depression. That’s quite an improvement.

What’s really important is not only to get them to normal, and the goal always has to be to get to a completely normal mood, where they feel a hundred percent. And, to maintain that you need to stay on the anti depressants usually, or some medication rather whether it’s lamictal or a tiny amount of lithium, or some combination of anti depressants. So usually the medicines that are working partially, we leave them on them, on those medicines, during the treatment, and that seems to raise the odds that they’ll come out of the depression. Now if you-, and we also use this to treat Parkinson’s disease and OCD obsessive compulsive disorder and a few other things such as migraines and chronic pain syndromes. These are off labelled treatments, but they often work extremely well.

If you have any other questions call me at 212-362-9635, 212-362-9635