You don’t need a special machine to do Saint. Almost any rtms machine can do it. The trick it’s to find the right spot in the brain and then by neuronavigation place the coil on the right place. We do it in our office. Or you can do the protocol on the dorsolateral spot and it also works. May be less effective but it works.
Thats the thing for me, it seems like most TMS machines are capable of performing the same protocol. We are in the process of opening out TMS clinic in my practice and I stressed the importance of having neuronavigation as the location is missed in 30% of cases. I would also like to see others perform RCTs attempting this protocol outside of the team that designed and is now marketing the product. Appreciate the comment
@@ShrinksInSneakers you will love your tms machine. you can do so much for patients. I did 2 certification curses. that like to recommend. The Berenson-Allen Center for Noninvasive Brain Stimulation with Alvaro pascual Leone and with Prof. Dr. Alexander T. Sack in Amsterdam. they complement. congrats for your project. I love the channel,
Not sure, but these things can take a very long time. I think it might be worth looking into clinical trials. Ive seen some that offer accelerated tms or alternate non invasive neuromodulation that targets subcortical regions where tms cant modulate directly.
@@byrgenwerth2097 The problem with clinical trials is once the clinical trial is over, the patient is SOL. They get a temporary treatment for a chronic condition.
@@martinlutherkingjr.5582 You are correct, but at least you will know if the treatment works or not if it becomes available in the future so you don't risk spending thousands for a treatment that might not work. Some people can go into remission as well. It can also give you insight into which areas of the brain being stimulated you are more responsive to which can be important for choosing neuromodulation devices that target those regions in the future. For instance, I have not responded to dlpfc stimulation at all so l won't spend money on other forms of tms that focus on that brain region and instead focus on other brain regions. Process of elimination if you will. But really it's complex stuff and not always that straightforward unfortunately.
@@byrgenwerth2097 That’s true. In your case, I’m not sure if you’ve tried it but there’s high and low frequency stimulation of the DLPFC to opposing sides that can be tried. Also, if they used a poor measurement technique like the 5 cm rule they might miss your DLPFC. Also, sufficient stimulation dosage is important. Certain medications can cause TMS to be more or less effective (like stimulants and benzos)
@@martinlutherkingjr.5582 Exactly, which I why mentioned it's not that straightforward. They could've missed the target, the stimulation parameters might not have been optimal you're absolutely correct. I did use the finger twitch method and I think they only targeted left dlpfc. So yes, I shouldn't avoid targeting this region completely in the future. If you're curious, I have tried over 20 meds, psilocybin, ketamine, tms and over 5 years of therapy. Most do absolutely nothing and 2 meds only a minor unsustained improvement.
Good video Doctor. I have been told that melancholic and psychotic depressions are subcortical and that TMS will not be effective. Is this so in your opinion. Thanks
I remember reading about this while undergoing TMS. This SAINT method probably would've worked a lot better for me bc as soon as my was TMS over, the depressive symptoms came back instantly (like as if I never had TMS).
This remains a problem even for ECT. We often have people come back for maintenance treatment ( weekly or biweekly in high risk for relapse cases) for ECT because relapse is a real issue in treatment resistant depression. The real problem here is none of these treatments are disease modifying. At the end of the day remission rates might be 80%-90% but the person can still have another depressive episode. It's all symptoms management at this point. Hope this helps and I doubt SAINT will solve this disease modifying issue
Thank you for your wonderful work.. Is there a way of improving success of the thumb approach aside from MRI or FMRI? Also, why is the placement of the coil more complicated for left-handed patients?
Thank you, this was great 😊 I currently have Theta burst TMS about every 6 months (30-40 treatments at a time) and it’s very helpful but does wear off after a couple of months hence the repeated treatments, I will have to ask about this new protocol and see when it’s available as I would love to have a more lasting treatment (I’ve done ECT in the past and am hesitant to do it again)
@ShrinksinSneakers I've had the initial consultation and am planning on starting this procedure very soon. The office uses a Magstim with StimGuide+. He mentioned that TMS would be performed on both sides of the brain, which is something I've never heard of. Are there any benefits to this method and machine?
What about the same but about CES cranial electrical stimulation often by alpha stim? Does it have Some effect? At least at That moment? For sleep or anxiety episode? And if yes how about the cheaper alternatives of 150 $?
@@yourfavoritechannel5498 FDA approved. it’s been around for 20 years. And the Saint ( it’s just a variant of rtms. More than a year. It work very well. Really recommended.
You don’t need a special machine to do Saint. Almost any rtms machine can do it. The trick it’s to find the right spot in the brain and then by neuronavigation place the coil on the right place. We do it in our office. Or you can do the protocol on the dorsolateral spot and it also works. May be less effective but it works.
Thats the thing for me, it seems like most TMS machines are capable of performing the same protocol. We are in the process of opening out TMS clinic in my practice and I stressed the importance of having neuronavigation as the location is missed in 30% of cases. I would also like to see others perform RCTs attempting this protocol outside of the team that designed and is now marketing the product. Appreciate the comment
@@ShrinksInSneakers you will love your tms machine. you can do so much for patients. I did 2 certification curses. that like to recommend. The Berenson-Allen Center for Noninvasive Brain Stimulation with Alvaro pascual Leone and with Prof. Dr. Alexander T. Sack in Amsterdam. they complement. congrats for your project. I love the channel,
My psych nurse recommended this for me.
When will insurance companies cover this in the USA? Not everyone can afford $20k-$30k per year indefinitely.
Not sure, but these things can take a very long time. I think it might be worth looking into clinical trials. Ive seen some that offer accelerated tms or alternate non invasive neuromodulation that targets subcortical regions where tms cant modulate directly.
@@byrgenwerth2097 The problem with clinical trials is once the clinical trial is over, the patient is SOL. They get a temporary treatment for a chronic condition.
@@martinlutherkingjr.5582 You are correct, but at least you will know if the treatment works or not if it becomes available in the future so you don't risk spending thousands for a treatment that might not work. Some people can go into remission as well.
It can also give you insight into which areas of the brain being stimulated you are more responsive to which can be important for choosing neuromodulation devices that target those regions in the future. For instance, I have not responded to dlpfc stimulation at all so l won't spend money on other forms of tms that focus on that brain region and instead focus on other brain regions. Process of elimination if you will. But really it's complex stuff and not always that straightforward unfortunately.
@@byrgenwerth2097 That’s true. In your case, I’m not sure if you’ve tried it but there’s high and low frequency stimulation of the DLPFC to opposing sides that can be tried. Also, if they used a poor measurement technique like the 5 cm rule they might miss your DLPFC. Also, sufficient stimulation dosage is important. Certain medications can cause TMS to be more or less effective (like stimulants and benzos)
@@martinlutherkingjr.5582 Exactly, which I why mentioned it's not that straightforward. They could've missed the target, the stimulation parameters might not have been optimal you're absolutely correct. I did use the finger twitch method and I think they only targeted left dlpfc. So yes, I shouldn't avoid targeting this region completely in the future.
If you're curious, I have tried over 20 meds, psilocybin, ketamine, tms and over 5 years of therapy. Most do absolutely nothing and 2 meds only a minor unsustained improvement.
Yes do more on TMS. It will take time to know the relapse rate and how soon to relapse. Thanks again
Love the content! Could you talk about augmentation with regards to depression medication? Would love to hear your thoughts 👍🙏
Good video Doctor. I have been told that melancholic and psychotic depressions are subcortical and that TMS will not be effective. Is this so in your opinion. Thanks
TMS works on neuronal networks. Not only in the site of application. So it depends on the site of stimulus and the network that you choose
I remember reading about this while undergoing TMS. This SAINT method probably would've worked a lot better for me bc as soon as my was TMS over, the depressive symptoms came back instantly (like as if I never had TMS).
This remains a problem even for ECT. We often have people come back for maintenance treatment ( weekly or biweekly in high risk for relapse cases) for ECT because relapse is a real issue in treatment resistant depression. The real problem here is none of these treatments are disease modifying. At the end of the day remission rates might be 80%-90% but the person can still have another depressive episode. It's all symptoms management at this point. Hope this helps and I doubt SAINT will solve this disease modifying issue
How about TMS that finally kills my constant daydreaming
Thank you for your wonderful work.. Is there a way of improving success of the thumb approach aside from MRI or FMRI? Also, why is the placement of the coil more complicated for left-handed patients?
Thank you, this was great 😊 I currently have Theta burst TMS about every 6 months (30-40 treatments at a time) and it’s very helpful but does wear off after a couple of months hence the repeated treatments, I will have to ask about this new protocol and see when it’s available as I would love to have a more lasting treatment (I’ve done ECT in the past and am hesitant to do it again)
Is there any study of TMS with unfavourable findings such as brain damage, permanent memory loss etc? I wonder if there are opposing views
No. It’s very safe. It’s been around for more than 20 years
Only anecdotal reports
Is this helpful for treatment resistant gad?
Doctor, I have a question for you. Is TMS indicated and can it help people who have depression within BPD? Thank you.
I have utmost trust in you …
What do you think of being on Xanax while being on TMS? Also , if it is caused by other issues ..
@ShrinksinSneakers
I've had the initial consultation and am planning on starting this procedure very soon. The office uses a Magstim with StimGuide+. He mentioned that TMS would be performed on both sides of the brain, which is something I've never heard of. Are there any benefits to this method and machine?
All great questions in the comments but the doctor is silent...
What about the same but about CES cranial electrical stimulation often by alpha stim? Does it have Some effect? At least at That moment? For sleep or anxiety episode? And if yes how about the cheaper alternatives of 150 $?
Cool vid, thanks
Does this use electromagnetic radio frequency?
No. The objective of the magnetic fields its to produce an electric field to stimulate the cortical neurons
@@juanbernal2976 ok. Makes sense. Did a MRI a few years back and felt more calm than I ever did afterwards.
Honestly, give us the facts about side effects. Drs. Say very few..headache, burning feeling on scalp, etc. What about long term side effects?????
The research has not produced any additional side effects, is it possible new things will be discovered sure but as of now these are the risks.
ACTUALLY TMS HAS A HIGHER SUCCESS RATE THEN MEDS,,,,,ECT...DR WHAT THE HELL !!
Doesn’t work
Fuck this treatment. It can really mess you up. Check reddit.
No truth. We use it. In our office with great success.
@@juanbernal2976 Where?
@@yourfavoritechannel5498 Sevilla España and Tijuana Mexico. We got the training in Harvard with Dr. Alvaro Pascuala Leone.
@@juanbernal2976 So how is the treatment going? Don’t think it’s been approved for public as it’s still under trial. No?
@@yourfavoritechannel5498 FDA approved. it’s been around for 20 years. And the Saint ( it’s just a variant of rtms. More than a year. It work very well. Really recommended.