12 ms·

Stanford Accelerated Intelligent Neuromodulation Therapy for Depression

Maursault 5y ago
I was depressed from age 20 to age 45. 10 years of meds and therapy, then therapy therapy therapy. Then I moved back to S. Florida after about 30 years, and I nearly went out of my mind, persistent mania. I self-treated mania successfully with decent herb. But the experience taught me something, and I investigated and learned more. Sunlight regulates mood. Too much sunlight causes mania (which neatly explains the Florida Man phenomenon). I have cured my 25 year long depression with Sunlight and, when needed, sleep-deprivation (basically, I'd skip a night every once in while if I wasn't getting enough sun in my eyes), and I haven't felt clinical depression in over 7 years, and even through a few family tragedies during this period, my mood has not slipped once in just over 7 years. The things done to the depressed by "modern" medicine is sometimes medieval. Electro-Convulsive Therapy should be illegal. It is the same thing as the scientist with the frog, cuts off one leg, still jumps, cuts off the other leg, frog is deaf. ECT isn't a valid treatment for anything at all. ECT fries the neurological system, obliterating neuronal myelin (which may take 20 years to return, and risks psychosis when it does for the return of a now unfamiliar internal monolog, racing thoughts and hearing voices. In all cases where a patient receives ECT, all cases with no exceptions, the patient will subsequently develop a pain disorder and are no longer able to recognize sarcasm, pinpointing some of the brain-damage ECT causes. Someone close to me was forced into ECT treatments by a quack psychiatrist. It murdered her, her body was still alive, but the person she was... was gone. 20 years later, when her wonderful personality only just started to return, she could no longer sleep because of being unaccustomed to the returning rush of internal thoughts, throwing her into a persistent depression due to going weeks and months without a decent night's sleep, until she took her own life. I'd like to offer some advice to the depressed: stay away from psychiatrists, their only form of treatment is some pill that makes you feel worse. If you need prescriptions, see a Psychiatric Mental Health - Practical Nurse (PMH-NP). Psychologists also help, and they are harmless. Never ever submit to ECT, it won't help you, it just makes you more manageable to other people. If you can get off prescriptions, try getting more sunlight in your eyes every day it is possible, and if you don't get enough, skip a night's sleep, but never more than two in a row. If you experience mania, be very careful. Lithium, for all it's side-effects, rapidly brings stability, but it's effects wear off once levels drop too low. I'm not going to recommend anyone smoke pot, but it worked well enough for me as a stabilizer. But of all the antidepressants tried over 25 years, nothing worked remotely as well as religiously getting as much bright sun in my eyes as I could.
jl2718 5y ago
Regarding magnetic brain stimulation, does anybody else always fall asleep with intense dreams every time they get into an MRI machine?
- gattilorenz 5y ago
  Never tried either of them, but MRI shouldn't really stimulate your brain, or interfere with electrical activity. Surely not to the level of TMS.
  - undefinedzero 5y ago
    Having to lie completely still for hours with a constant plain and repeating sound in the background definitely stimulates some part of your brain.
- quickthrower2 5y ago
  No but i “felt” the effects of it but its hard to describe. it was pretty mild though but enough to dispel the idea i had that those 20 minutes would be meditation time! Of course anecdotal and the effect might have been from the noise or vibration
  - j4hdufd8 5y ago
    Do you consider these effects you felt to be good? I didn't catch if it is a good or bad experience
    - quickthrower2 5y ago
      Slightly bad, but we are talking slightly uncomfortable. Much less than a headache.
nightchalk16 5y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044191/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044191/ I have benefited a lot from acetylcysteine.
- scottcodie 5y ago
  Honestly, I can't speak more highly of N-acetylcysteine. It helped me reduce my caffeine consumption to near zero and helped me battle my attention deficit issues. I bought out the entire stock of my local grocery store after trying it for a few days. I'm afraid of sounding like one of those supplement nuts but it really worked for me.
  - causi 5y ago
    What dosage did you find effective?
    - scottcodie 5y ago
      The recommended dosage on the label was enough for me to see full benefits, 600mg. The effect is within an hour. As other people in the thread said, it may not be without side effects. The FDA has not approved it as a dietary supplement. Please do your due diligence.
  - TekMol 5y ago
    How did it help you to reduce caffeine consumption? And why is caffeine consumption bad?
    - scottcodie 5y ago
      I tend to drink caffeine with I need to recruit mental energy. I find I don't get compulsive cravings to drink coffee and I can drink a single cup of coffee and be fine for the entire day. If anyone knows why this is, I'm all ears, I'm honestly shocked.
    - alex_duf 5y ago
TekMol 5y ago
I find depression very interesting. Maybe because I am sometimes on the brink of depression myself. Maybe because I am interested in the other side of the spectrum: How to live a happy life. One thing I often wonder: What happens when a depressed person forces themselves to do things that are associated with not being depressed? Workout, dopamine fasting, social interaction. When I observe myself in depressed phases and people who suffer from worse forms of depression, usually they do not work out, do not spend empathic time with others and constantly dopamine binge (via eating or other forms of quick pleasure). Would a change of behavior/lifestyle change the depression?
- alex_duf 5y ago
  The point of depression is that you do not want to do things that you'd normally do. You don't want to exercise, see people nor wake up in the morning, and you feel terrible.
  - notRobot 5y ago
    And often, even if you want to, you can't. Like, no matter how much you want to, you can't force yourself to get out of bed or go for a run or socialise of whatever.
  - drekipus 5y ago
    It's not a case of "doing what you normally do" either. What you normally do got you to this point. It's about recognising the situation and pushing through it, as though you were a robot, and taking a walk around the block, let's say. Winston Churchill used to paint while he's depressed. Its not a case of "they are hopeless" - they need to move and do something. And in the process, recognising what the triggers are and how to overcome it.
    - deleted 5y ago
      [deleted]
    - scollet 5y ago
      > What you normally do got you to this point. This is destructive rhetoric.
causi 5y ago
Then for 10 hours a day for five consecutive days, Emma sat in a chair while a magnetic field stimulated her brain. I wonder what the cost will be. A friend of mine had regular TMS 30 minutes a day, five days a week for a month and the cost even with excellent insurance was well north of a thousand dollars. This is five times as much time in the machine.
- jackdh 5y ago
  If it works as advertised I don't think people would blink an eye at paying 5 figures for it.
  - actually_a_dog 5y ago
    Sure they would, considering a very large number of people (most people, if you believe those surveys that say most Americans would borrow money to pay for an unexpected $400 expense) don't even have 5 figures.
    - diordiderot 5y ago
      This is hackernews, huge class bubble
      - throwawaylinux 5y ago
        Who also happen to be the champions of the working class and saviors of the poor and oppressed.
    - kortilla 5y ago
      Yet people buy 5 figure cars all of the time for much dumber reasons than crippling depression. > most people, if you believe those surveys that say most Americans would borrow money to pay for an unexpected $400 expense This is idiotic. I would technically “borrow money” as well because I would likely put it on my credit card since that is by far the most convenient way to pay for things (and gives you the most protection as a consumer). I would just pay it off at the end of the month though.
depressionalt 5y ago
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. The most difficult thing about depression treatments is that most medications take 2-3 weeks to kick in and it's hard to get motivated to see the treatment through. Chemically here's what worked for me: 1. Ketamine saved my life. It's the only thing I've encountered that provides instant relief. If you're in a particularly bad moment and buried by your thoughts, ask your psych to write you and Rx for Ketamine nose spray. It's much cheaper than intravenous Ketamine and highly effective by my experience. There'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's non-addictive. Once I got through the deepest of my doldrums, I stopped filling the Rx. 2. Wellbutrin. It'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).
- diordiderot 5y ago
  Wellbutrin was a god send for me. It gave my the energy to get therapy, exercise, etc. Highly recommend if you're anxious about SSRIs
  - depressionalt 5y ago
    I also recommend that those experiencing SSRI-resistant depression try it. SSRIs didn't do much for me other than hit me like a rubber mallet to the brain. Wellbutrin's subtle stimulation has been so effective for the type of depression where you want to stay in bed and have no motivation to do even the basic things, which is how I felt before. If you're reading this and depressed, you're not alone. It will get better, and you too will eagerly look forward to your days ahead.
- filmgirlcw 5y ago
  My doctor wants to get me on esketamine and insurance will cover it -- the issue we're having is my doctor is 2200 miles away and I have to take it under supervision (we're looking at who we might be able to partner with to try this). I'm hopeful I'll be able to try it in the new year. I'm really glad Wellbutrin worked for you. When I tried it ~20 years ago (as a young teenager), it worked well for me for a few weeks and then absolutely did not work anymore. But that's the beauty/pain of SSRIs. There are a million of them and they impact each person differently.
codeulike 5y ago
Tldr: MRI to check out the territory then targeted magnetic fields for a week or so. Why not describe the treatment in the headline? Clicks, that's why.
cupcake-unicorn 5y ago
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. This article is incredibly frustrating. This is NOT new technology. It is a different modality called theta burst which they didn'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't have remission with the prolonged rTMS course theta burst is not a magic bullet. The benefit is that it'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. It really sucks to have "lay people" 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. I'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's faster and easier to do bilateral but as I said there is nothing magical about theta burst other than it's a very fast treatment. Those who didn't have remission on long courses of TMS before unilaterally probably aren't going to magically have remission on this. What we might end up seeing is some kind of threshhold that wasn't achievable in the past, say that some people could reach remission but it's not feasible to come into the office every day for 6 months. Anyway TMS is great and should be used more but I just hate these dumb articles. Especially since it's touting this as some magical new technology. No way. And we'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'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. Also just got to say this quote summed up how ridiculous the article was for me: "“This study is hopefully just the tip of the iceberg,” said Siddiqi. “I think we're finally on the verge of a paradigm shift in how we think about psychiatric treatment, where we'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." No reason to make rTMS sound like some Frankenstein tech and no, rTMS will not be used "instead of talk therapy and drugs". 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't been any for a long time now. Just me too drugs and this is a bit of a me too tech as well.
etaioinshrdlu 5y ago
I wonder why she didn't try Ketamine first. It's barely mentioned in the article.
- jokoon 5y ago
  > The maintenance therapy with ketamine (from twice a week to once in two weeks) appears to be a promising option, although the evidence to firmly recommend it is insufficient https://en.wikipedia.org/wiki/Ketamine#Depression https://en.wikipedia.org/wiki/Ketamine#Depression > The approval of esketamine for TRD by the FDA was controversial due to limited and mixed evidence of efficacy and safety. > In January 2020, esketamine was rejected by the National Health Service (NHS) of Great Britain.[41] The NHS questioned the benefits of the medication for depression and claimed that it was too expensive. https://en.wikipedia.org/wiki/Esketamine#Depression https://en.wikipedia.org/wiki/Esketamine#Depression It's too early, and it's for treatment resistant depression. So yeah, unless you're a doctor/neurologist and know the protocol for validating drugs, it's not really worth listening to the pseudo science advocated by drug users who also encourage taking psilocybin/LSD/MDMA as a silver bullet, and constantly talk about pharma conspiracies. "Listen to the professionals" is a better advice.
  - Tenoke 5y ago
    I don't know about Wikipedia's editors but decent meta-analyses were already showing solid results in 2014[0] and this meta-analysis of 24 RCTs this year also shows decent results. The NHS reasoning is that it's too expensive, not ineffective and even that seems odd to me as it's produced pretty cheaply to use for variety of purposes. I'd guess the expense is due to the patents of esketamine used to approve it for depression while being able to profit, but that seems to be the less effective type at any rate. 0. https://link.springer.com/article/10.1007/s00213-014-3664-5 https://link.springer.com/article/10.1007/s00213-014-3664-5 1. https://www.sciencedirect.com/science/article/abs/pii/S016503272032766X https://www.sciencedirect.com/science/article/abs/pii/S01650...
jerrygoyal 5y ago
shrooms can potentially do it in a day.
- kfarr 5y ago
  Yeah I thought this was going to be an article about LSD therapy that’s all the rage again.
aspaviento 5y ago
> “I’m usually hysterical,” she said > She says it felt like a woodpecker tapped on her skull every 15 seconds > Then for 10 hours a day for five consecutive days, Emma sat in a chair while a magnetic field stimulated her brain. All this sounds counterintuitive to me. For someone on the brink of a crisis daily, something that sounds like torture (a tap on your skill every 15 secs during 10 hours) helped her to feel relaxed at the end of the day.
- armchairhacker 5y ago
  My depression-like symptoms are caused by boredom. It would be really interesting if this would somehow make me not bored sitting in a chair for 10 hours.
sparsely 5y ago
> Stanford’s neuromodulation therapy could be widely available by the end of next year — that’s when scientists are hoping FDA clearance comes through What's taking a year? It doesn't sound like there is an additional study the FDA is waiting for results on.
- danuker 5y ago
  Bureaucracy.
- anotherboffin 5y ago
  Just to give some context. It’s not directly my line of work, but my employer filled out a New Drug Application (NDA) with the FDA recently and we were told the whole thing exceeds 200’000 pages. Given the size and amount of data in there, one year seems reasonable for FDA review.
ggm 5y ago
I'd be delighted if even only a small cohort get benefit. Better we know, better we know how to tell who will benefit.
julesdocx 5y ago
This is sad to see such pseudo science at the top of hacker news.
- tomhoward 5y ago
  From reading the linked paper on the study that was conducted by the Stanford School of Medicine, what aspects of the study did you deem to be unscientific?

I was depressed from age 20 to age 45. 10 years of meds and therapy, then therapy therapy therapy. Then I moved back to S. Florida after about 30 years, and I nearly went out of my mind, persistent mania. I self-treated mania successfully with decent herb. But the experience taught me something, and I investigated and learned more. Sunlight regulates mood. Too much sunlight causes mania (which neatly explains the Florida Man phenomenon). I have cured my 25 year long depression with Sunlight and, when needed, sleep-deprivation (basically, I'd skip a night every once in while if I wasn't getting enough sun in my eyes), and I haven't felt clinical depression in over 7 years, and even through a few family tragedies during this period, my mood has not slipped once in just over 7 years. The things done to the depressed by "modern" medicine is sometimes medieval. Electro-Convulsive Therapy should be illegal. It is the same thing as the scientist with the frog, cuts off one leg, still jumps, cuts off the other leg, frog is deaf. ECT isn't a valid treatment for anything at all. ECT fries the neurological system, obliterating neuronal myelin (which may take 20 years to return, and risks psychosis when it does for the return of a now unfamiliar internal monolog, racing thoughts and hearing voices. In all cases where a patient receives ECT, all cases with no exceptions, the patient will subsequently develop a pain disorder and are no longer able to recognize sarcasm, pinpointing some of the brain-damage ECT causes. Someone close to me was forced into ECT treatments by a quack psychiatrist. It murdered her, her body was still alive, but the person she was... was gone. 20 years later, when her wonderful personality only just started to return, she could no longer sleep because of being unaccustomed to the returning rush of internal thoughts, throwing her into a persistent depression due to going weeks and months without a decent night's sleep, until she took her own life. I'd like to offer some advice to the depressed: stay away from psychiatrists, their only form of treatment is some pill that makes you feel worse. If you need prescriptions, see a Psychiatric Mental Health - Practical Nurse (PMH-NP). Psychologists also help, and they are harmless. Never ever submit to ECT, it won't help you, it just makes you more manageable to other people. If you can get off prescriptions, try getting more sunlight in your eyes every day it is possible, and if you don't get enough, skip a night's sleep, but never more than two in a row. If you experience mania, be very careful. Lithium, for all it's side-effects, rapidly brings stability, but it's effects wear off once levels drop too low. I'm not going to recommend anyone smoke pot, but it worked well enough for me as a stabilizer. But of all the antidepressants tried over 25 years, nothing worked remotely as well as religiously getting as much bright sun in my eyes as I could.

jl2718 5y ago

Regarding magnetic brain stimulation, does anybody else always fall asleep with intense dreams every time they get into an MRI machine?

gattilorenz 5y ago
Never tried either of them, but MRI shouldn't really stimulate your brain, or interfere with electrical activity. Surely not to the level of TMS.
- undefinedzero 5y ago
  Having to lie completely still for hours with a constant plain and repeating sound in the background definitely stimulates some part of your brain.
quickthrower2 5y ago
No but i “felt” the effects of it but its hard to describe. it was pretty mild though but enough to dispel the idea i had that those 20 minutes would be meditation time! Of course anecdotal and the effect might have been from the noise or vibration
- j4hdufd8 5y ago
  Do you consider these effects you felt to be good? I didn't catch if it is a good or bad experience
  - quickthrower2 5y ago
    Slightly bad, but we are talking slightly uncomfortable. Much less than a headache.

nightchalk16 5y ago

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044191/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044191/ I have benefited a lot from acetylcysteine.

scottcodie 5y ago
Honestly, I can't speak more highly of N-acetylcysteine. It helped me reduce my caffeine consumption to near zero and helped me battle my attention deficit issues. I bought out the entire stock of my local grocery store after trying it for a few days. I'm afraid of sounding like one of those supplement nuts but it really worked for me.
- causi 5y ago
  What dosage did you find effective?
  - scottcodie 5y ago
    The recommended dosage on the label was enough for me to see full benefits, 600mg. The effect is within an hour. As other people in the thread said, it may not be without side effects. The FDA has not approved it as a dietary supplement. Please do your due diligence.
- TekMol 5y ago
  How did it help you to reduce caffeine consumption? And why is caffeine consumption bad?
  - scottcodie 5y ago
    I tend to drink caffeine with I need to recruit mental energy. I find I don't get compulsive cravings to drink coffee and I can drink a single cup of coffee and be fine for the entire day. If anyone knows why this is, I'm all ears, I'm honestly shocked.
  - alex_duf 5y ago

TekMol 5y ago

I find depression very interesting. Maybe because I am sometimes on the brink of depression myself. Maybe because I am interested in the other side of the spectrum: How to live a happy life. One thing I often wonder: What happens when a depressed person forces themselves to do things that are associated with not being depressed? Workout, dopamine fasting, social interaction. When I observe myself in depressed phases and people who suffer from worse forms of depression, usually they do not work out, do not spend empathic time with others and constantly dopamine binge (via eating or other forms of quick pleasure). Would a change of behavior/lifestyle change the depression?

alex_duf 5y ago
The point of depression is that you do not want to do things that you'd normally do. You don't want to exercise, see people nor wake up in the morning, and you feel terrible.
- notRobot 5y ago
  And often, even if you want to, you can't. Like, no matter how much you want to, you can't force yourself to get out of bed or go for a run or socialise of whatever.
- drekipus 5y ago
  It's not a case of "doing what you normally do" either. What you normally do got you to this point. It's about recognising the situation and pushing through it, as though you were a robot, and taking a walk around the block, let's say. Winston Churchill used to paint while he's depressed. Its not a case of "they are hopeless" - they need to move and do something. And in the process, recognising what the triggers are and how to overcome it.
  - deleted 5y ago
    [deleted]
  - scollet 5y ago
    > What you normally do got you to this point. This is destructive rhetoric.

causi 5y ago

Then for 10 hours a day for five consecutive days, Emma sat in a chair while a magnetic field stimulated her brain. I wonder what the cost will be. A friend of mine had regular TMS 30 minutes a day, five days a week for a month and the cost even with excellent insurance was well north of a thousand dollars. This is five times as much time in the machine.

jackdh 5y ago
If it works as advertised I don't think people would blink an eye at paying 5 figures for it.
- actually_a_dog 5y ago
  Sure they would, considering a very large number of people (most people, if you believe those surveys that say most Americans would borrow money to pay for an unexpected $400 expense) don't even have 5 figures.
  - diordiderot 5y ago
    This is hackernews, huge class bubble
    - throwawaylinux 5y ago
      Who also happen to be the champions of the working class and saviors of the poor and oppressed.
  - kortilla 5y ago
    Yet people buy 5 figure cars all of the time for much dumber reasons than crippling depression. > most people, if you believe those surveys that say most Americans would borrow money to pay for an unexpected $400 expense This is idiotic. I would technically “borrow money” as well because I would likely put it on my credit card since that is by far the most convenient way to pay for things (and gives you the most protection as a consumer). I would just pay it off at the end of the month though.

depressionalt 5y ago

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. The most difficult thing about depression treatments is that most medications take 2-3 weeks to kick in and it's hard to get motivated to see the treatment through. Chemically here's what worked for me: 1. Ketamine saved my life. It's the only thing I've encountered that provides instant relief. If you're in a particularly bad moment and buried by your thoughts, ask your psych to write you and Rx for Ketamine nose spray. It's much cheaper than intravenous Ketamine and highly effective by my experience. There'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's non-addictive. Once I got through the deepest of my doldrums, I stopped filling the Rx. 2. Wellbutrin. It'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).

diordiderot 5y ago
Wellbutrin was a god send for me. It gave my the energy to get therapy, exercise, etc. Highly recommend if you're anxious about SSRIs
- depressionalt 5y ago
  I also recommend that those experiencing SSRI-resistant depression try it. SSRIs didn't do much for me other than hit me like a rubber mallet to the brain. Wellbutrin's subtle stimulation has been so effective for the type of depression where you want to stay in bed and have no motivation to do even the basic things, which is how I felt before. If you're reading this and depressed, you're not alone. It will get better, and you too will eagerly look forward to your days ahead.
filmgirlcw 5y ago
My doctor wants to get me on esketamine and insurance will cover it -- the issue we're having is my doctor is 2200 miles away and I have to take it under supervision (we're looking at who we might be able to partner with to try this). I'm hopeful I'll be able to try it in the new year. I'm really glad Wellbutrin worked for you. When I tried it ~20 years ago (as a young teenager), it worked well for me for a few weeks and then absolutely did not work anymore. But that's the beauty/pain of SSRIs. There are a million of them and they impact each person differently.

codeulike 5y ago

Tldr: MRI to check out the territory then targeted magnetic fields for a week or so. Why not describe the treatment in the headline? Clicks, that's why.

cupcake-unicorn 5y ago

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. This article is incredibly frustrating. This is NOT new technology. It is a different modality called theta burst which they didn'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't have remission with the prolonged rTMS course theta burst is not a magic bullet. The benefit is that it'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. It really sucks to have "lay people" 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. I'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's faster and easier to do bilateral but as I said there is nothing magical about theta burst other than it's a very fast treatment. Those who didn't have remission on long courses of TMS before unilaterally probably aren't going to magically have remission on this. What we might end up seeing is some kind of threshhold that wasn't achievable in the past, say that some people could reach remission but it's not feasible to come into the office every day for 6 months. Anyway TMS is great and should be used more but I just hate these dumb articles. Especially since it's touting this as some magical new technology. No way. And we'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'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. Also just got to say this quote summed up how ridiculous the article was for me: "“This study is hopefully just the tip of the iceberg,” said Siddiqi. “I think we're finally on the verge of a paradigm shift in how we think about psychiatric treatment, where we'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." No reason to make rTMS sound like some Frankenstein tech and no, rTMS will not be used "instead of talk therapy and drugs". 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't been any for a long time now. Just me too drugs and this is a bit of a me too tech as well.

etaioinshrdlu 5y ago

I wonder why she didn't try Ketamine first. It's barely mentioned in the article.

jokoon 5y ago
> The maintenance therapy with ketamine (from twice a week to once in two weeks) appears to be a promising option, although the evidence to firmly recommend it is insufficient https://en.wikipedia.org/wiki/Ketamine#Depression https://en.wikipedia.org/wiki/Ketamine#Depression > The approval of esketamine for TRD by the FDA was controversial due to limited and mixed evidence of efficacy and safety. > In January 2020, esketamine was rejected by the National Health Service (NHS) of Great Britain.[41] The NHS questioned the benefits of the medication for depression and claimed that it was too expensive. https://en.wikipedia.org/wiki/Esketamine#Depression https://en.wikipedia.org/wiki/Esketamine#Depression It's too early, and it's for treatment resistant depression. So yeah, unless you're a doctor/neurologist and know the protocol for validating drugs, it's not really worth listening to the pseudo science advocated by drug users who also encourage taking psilocybin/LSD/MDMA as a silver bullet, and constantly talk about pharma conspiracies. "Listen to the professionals" is a better advice.
- Tenoke 5y ago
  I don't know about Wikipedia's editors but decent meta-analyses were already showing solid results in 2014[0] and this meta-analysis of 24 RCTs this year also shows decent results. The NHS reasoning is that it's too expensive, not ineffective and even that seems odd to me as it's produced pretty cheaply to use for variety of purposes. I'd guess the expense is due to the patents of esketamine used to approve it for depression while being able to profit, but that seems to be the less effective type at any rate. 0. https://link.springer.com/article/10.1007/s00213-014-3664-5 https://link.springer.com/article/10.1007/s00213-014-3664-5 1. https://www.sciencedirect.com/science/article/abs/pii/S016503272032766X https://www.sciencedirect.com/science/article/abs/pii/S01650...

jerrygoyal 5y ago

shrooms can potentially do it in a day.

kfarr 5y ago
Yeah I thought this was going to be an article about LSD therapy that’s all the rage again.

aspaviento 5y ago

> “I’m usually hysterical,” she said > She says it felt like a woodpecker tapped on her skull every 15 seconds > Then for 10 hours a day for five consecutive days, Emma sat in a chair while a magnetic field stimulated her brain. All this sounds counterintuitive to me. For someone on the brink of a crisis daily, something that sounds like torture (a tap on your skill every 15 secs during 10 hours) helped her to feel relaxed at the end of the day.

armchairhacker 5y ago
My depression-like symptoms are caused by boredom. It would be really interesting if this would somehow make me not bored sitting in a chair for 10 hours.

sparsely 5y ago

> Stanford’s neuromodulation therapy could be widely available by the end of next year — that’s when scientists are hoping FDA clearance comes through What's taking a year? It doesn't sound like there is an additional study the FDA is waiting for results on.

danuker 5y ago
Bureaucracy.
anotherboffin 5y ago
Just to give some context. It’s not directly my line of work, but my employer filled out a New Drug Application (NDA) with the FDA recently and we were told the whole thing exceeds 200’000 pages. Given the size and amount of data in there, one year seems reasonable for FDA review.

ggm 5y ago

I'd be delighted if even only a small cohort get benefit. Better we know, better we know how to tell who will benefit.

julesdocx 5y ago

This is sad to see such pseudo science at the top of hacker news.

tomhoward 5y ago
From reading the linked paper on the study that was conducted by the Stanford School of Medicine, what aspects of the study did you deem to be unscientific?