What YOU can do to make TMS work better - TMS Talk 02

[@markm1783]

Great Information;
One of the main points you make in this presentation is that you should keep your routine the same while you go through TMS.
My experience was a little different. I have had Depression for over 25 years (MDD) and sought out TMS after Meds had failed several times.
I continued to take my meds throughout TMS (Lexapro, Straterra and Trazedone).
I took it upon myself to add extra activities while going through TMS that I believed help my brain heal sooner. Here's what I added to my daily routine.
1. Because I had severe rumination in morning, I would set an alarm and get up and sit under a bright light or go outside and let the sun sign on my face. This help break the Rumination loop.
2. Drink a morning protein smoothy
3. Take the following Supplements that I read help the brain; Vitamen E, Magnesium, Zinc, D, B Complex, B12 and Omega 3 Fish oil
4. Remove Negative triggers such as watching the News and Neagtive Programming.
5. Go for a walk in nature and also started exercising
6. I have Insomnia, so my MD prescribed Trazedone which I take every night before bed...I also listen to Sleep Meditation Videos on UA-cam by Jason Stephenson.
I did the above routine at the start of TMS and all the way through and have done this everyday since.
I have been in remission from Depression for 3 years +.
I believe TMS plus Proper Nutrition, Supplements, Exercise and Meditation are a great combination to keep Depression at bay.
Please feel free to reach out to me if you have any questions.

[@psycheddiscussions4661]

Yea, I would agree with that! Introducing positive habits is never a bad thing. That is why I also said that sleep medication or meditation may help if it improves sleep.
So adding in these new positive aspects can certainly improve the effect of TMS. I think what I wanted to point out is that you shouldn’t make any haphazard changes to your life style if you don't know if they will help. :)
Thanks for the comment!

[@stopbunsen]

It's interesting. I drink 1-2 cups of coffee per day, but have regular breaks from it altogether. Don't smoke, don't drink alcohol. Don't think the caffeine is interfering too much. When I have right side TMS I try to relax, just listen to relaxing sounds on my headphones. Left side TMS I usually listen to music or watch something on my phone. I'm not a morning person so I tend to do TMS in the afternoon. I usually go to the gym before I do TMS. I have 3 sessions per week to keep me going, and it's been working. My mood has been stable enough for me to work and study.
Thank you for your video!

[@psycheddiscussions4661]

I did not really touch on this, but exercise is a positive thing, particularly if it is not too straining. Some steady state cardio, or low to medium resistance exercise has shown to improve neuroplasticity. So, I love to hear that you do this before the sessions!
Indeed, the 1 or 2 cups of coffee probably make no big difference. It starts to become an issue if people drink upwards of 2-3 cups more than usual.
Thanks for listening and commenting!

[@tracyhornbaker8445]

This is so incredibly helpful I can’t thank you enough!

[@psycheddiscussions4661]

❤

[@colinferguson5432]

Thank you kindly for creating & sharing this video. It's much appreciated.
The tips there are useful for stacking the deck in favour of a positive outcome. The morning for a morning person was really interesting.
I will look for that study.

[@psycheddiscussions4661]

Thank you for watching! TMS is not guaranteed to work, but it would be great if we can make the odds as good as possible :)

[@bonniebowers3677]

This is great help. Thank you SO much for doing these talks!

[@psycheddiscussions4661]

Thank you for watching/listening. I am glad it was helpful :)

[@mohammedaljewari6399]

Thank you so much for these informations

[@psycheddiscussions4661]

You are welcome!

[@kimbaird2279]

Hi Miles! Thanks again for sharing your knowledge and information. I’m absolutely fascinated with TMS and the brain in general and grateful that I get to experience the positive effects of this treatment. One of my questions is about the movement you mentioned from stimulation of the motor cortex. Should you experience movement during the treatment? The finger twitches? I am receiving left side rTMS for MDD and I have been experiencing the movement when they increase to 120%. We have then been lowering it to 110-115% without the twitching. But it seems they really want to get me to the 120%. I understand that is the “therapeutic” dosage but I was an early responder and have been responding well to the 110%. I was at 120% but as I had mentioned in a comment on the last video, I had to put my treatment on hold due to having Covid so I may need to work back up to get my threshold back to 120%. I only have 9 sessions left and I feel they may be pushing it because they want me to get back to the 120% ASAP but, the twitching gets pretty intense. But now I know that I am also making it worse by expecting it! Should you feel any twitching or right arm muscle movement during treatment? Thanks again!

[@psycheddiscussions4661]

Hi Kim, Thank you again for listening and your great questions. About the movements. During motor mapping you will experiences finger or hand movements. But during treatment they move the TMS to another place. At that time, it is unlikely that you feel any movement in your fingers anymore.
But, what is very normal during treatment is movement of the jaw and other facial muscles, like eye brows, cheeks and nose. Those twitches come from stimulation of superficial muscles that cannot be avoided. For some it can be really annoying, such that they need to wear teeth protection.
So although that is normal, I also would say that you still should feel, more or less, comfortable. So if 120% is really too much, you should be really explicit about it and tell them that you would prefer 110%. The intensity of 120% is used as a magic number by therapists. But in reality, the science shows that there is a lot of variability and in many cases lower intensities work perfectly. So if you feel that 1) 120% is too much and 2) your depression symptoms improved after 110%, then I think that 110% is correct for you and 120% is not needed. If you can, try to friendly but insistently tell them that. :)
(Note: my opinion is based on a lot of reading and 9 years of TMS experience, but in the end it is "just" an opinion)

[@kimbaird2279]

Thanks Miles! I do experience some of the jaw movements but at the 120% I also experienced my right hand twitching during the treatment. We also did switch machines from the one I was originally mapped on, so I don’t know it that makes a difference. I really appreciate you offering up yourself for questions as I feel that the technicians aren’t fully trained on the science but the techniques. Well mine are, I’m not sure that is the case with every center. My technician is very sweet but I don’t feel she has the training on the inner workings of the brain, but does have training on the technology of the machine. So a lot of my questions are answered with guesses rather than actual facts. So it’s nice to be able to communicate with someone with so much knowledge and actual training in the field and on the machines. It’s very much appreciated! Hopefully you can help many others like me get the answers they need, and maybe the training for the centers. I’ve never even spoken to a doctor at my center. But I do have an appointment on Monday to talk to the Nurse Practitioner.

[@psycheddiscussions4661]

Good technicians are important, and I agree that maybe not all of them understand the nitty gritty of the matter. So it is nice to hear that you can trust your techs! Good luck on Monday! :)

[@adamhornbaker1163]

Thank you for this very informative video.
There have been studies showing the effectiveness of Ketamine and TMS combination therapy. I am scheduled to receive TMS and was wondering if you think that taking ketamine troches (oral ketamine) at the same time as my TMS treatments would have a synergistic effect.
Thanks again!

[@psycheddiscussions4661]

There is indeed some research, but it is limited. The best summary is this paper: doi.org/10.1016/j.heliyon.2019.e02187
Important to note is that ketamine + TMS seems to be safe. So that is truly a good thing. Also the combination seems to be positive in treatment of both unipolar and bipolar depression.
The only issue I see that it is "too much" for the brain, leading to more pronounced side effects (most likely extreme fatigue). But of course you yourself are the only person who can judge that. So, my advice would be to keep on taking ketamine while getting TMS in a small dose and then assess how you feel. If it goes well, keep going, if not, you may want to take a break from the ketamine.

[@adamhornbaker1163]

@@psycheddiscussions4661 okay great thanks for the reply. I was wondering what you think about doing the ketamine troches during the actual TMS session? For example, taking a dose of ketamine right before i sit in the chair for TMS.

[@psycheddiscussions4661]

Oral ketamine takes about 20 to 30 minutes to be taken up by the body, so if you want to try it, you should at least have that much time in between.
But I don't know how ketamine and TMS will interact. I cannot tell you whether it will amplify the effect or interfere. I am sorry, but I cannot rely answer your question.

[@jeffcole1914]

I’m learning more and more thanks

[@rubydavies3838]

Hi miles! thanks so much for these talks. What happens if you take a break from tms? say two weeks?

[@psycheddiscussions4661]

Hi Ruby. It depends a little. I would say that it is not ideal, because the effects of TMS are cummulative.
BUT, the effects also will not go away after two weeks. You may need to add an additional week at the end or so.
It will also depend on what you will be doing when you are away in those two weeks. A stressful two weeks can be detrimental. But a relaxed vacation may be even beneficial.

[@GoBananasForiPad]

Hi Miles, could you link the study associating chronotype and time of day tms is applied contributing to success? I wound like to send to my Psych

[@psycheddiscussions4661]

Of course, here it is:
Salehinejad, M.A., Wischnewski, M., Ghanavati, E. et al. Cognitive functions and underlying parameters of human brain physiology are associated with chronotype. Nat Commun 12, 4672 (2021). doi.org/10.1038/s41467-021-24885-0