Bipolar blog

More on rTMS and VNS and MRI

→ January 18, 2009 - Comments off

I frequent poster, Herb, has introduced more information on the rTMS with VNS topic. Some doctors are saying it is possible. Additionally, if you read the whole thread, someone corrects me and notes that MRIs are possible with a VNS implant. This is, actually, true. Cyberonics has put together some physician information on this, copied below.

So it goes back to exactly what I said, no one really knows in the implications. Proceed at your own risk.

Additionally, if you read the whole thread, someone corrects me and notes that MRIs are possible with a VNS implant. This is, actually, true. Cyberonics has put together some physician information on this, copied below (no, I don’t know what this stuff means, sorry):

MAGNETIC RESONANCE IMAGING (MRI) ______

Caution: Magnetic resonance imaging (MRI) should not be performed with a magnetic resonance body coil in the transmit mode. The heat induced in the Lead by an MRI body scan can cause injury.

If an MRI should be done, use only a transmit and receive type of head coil. Magnetic and RF fields produced by MRI may change the Pulse Generator settings (change to reset parameters) or activate the device. Stimulation has been shown to cause the adverse events reported in the “Adverse Events” section in the indication-specific parts of the multi-part physician manuals. MRI compatibility was demonstrated using a 1.5T General Electric Signa Imager with a Model 100 only. The Model 102 and Model 102R are functionally equivalent to the Model 100. Testing on this imager as performed on a phantom1 indicated that the following Pulse Generator and MRI
procedures can be used safely without adverse events:

Pulse Generator output programmed to 0 mA for the MRI procedure, and afterward, retested by performing the System Diagnostics (Lead Test) and reprogrammed to the original settings

Head coil type: transmit and receive only

Static magnetic field strength: ≤2.0 tesla

Specific absorption rate (SAR): <1.3 W/kg for a 154.5-lb (70-kg) patient Time-varying intensity: <10 tesla/sec Use caution when other MRI systems are used, since adverse events may occur because of different magnetic field distributions. Consider other imaging modalities when appropriate. Caution: Procedures in which the RF is transmitted by a body coil should not be done on a patient who has the VNS Therapy™ System. Thus, protocols must not be used that utilize local coils that are RF-receive only, with RF-transmit performed by the body coil. Note that some RF head coils are receive-only, and that most other local coils, such as knee and spinal coils, are also RF receive-only. These coils must not be used in patients with the VNS Therapy System.

I can’t find the source on their annoying site, but for more info, contact Cyberonics.

Mood Charting Depression, Anxiety, Mania, Irritation

→ August 16, 2008 - 4 Comments

I’m a geek. If you know me, I deny this, but it’s actually true. Not the Star Wars-watching, video-game drenched, mother-basement living, socially awkward,virgin type, but a geek nonetheless. I do, after all, make software for a living, understand math, and make logical arguments.

A Mood Chart

So, in the vein supportive numbers, I have been charting my mood for a while. I chart depression (obviously) along with mania, anxiety, and irritation. I’ve also added trend lines for anxiety and depression (the dotted ones):


The headline is the depression is dropping while the anxiety is increasing. Looking a bit closer, you can see that Jul. 16 when I added the Zyprexa/Celexa combo, the depression dropped substantially. It’s probably the best I have felt for over a year. I don’t have the numbers to prove it, but trust me, it’s true. (I’m scared to even write that because I feel like it will be taken away from me. I feel like a higher power will reach down into my life and destroy it. I suppose a higher power will reach into my brain and start squishing it like squishing whole tomatoes for a marinara sauce. Brain sauce. Yum.)

Mood charting has two main benefits.

One, you have objective record for what is happening to you. Your doctor is going to ask you “how are you feeling?” (which is the dumbest question ever) and you have to be able to answer it. It’s harder than it sounds. Are you more anxious, or less? What side effects have you noticed? How long have they been happening? What kind of pain? How depressed are you compared to last time? Irritation? Mania? Energy level? And it would be handy if you could answer all of that in 2 minutes or less.

Seriously? Yes, seriously. You only have a few minutes with your doctor. You don’t have time to “think about it”. Mood charting can help you maintain an objective view of what is really going on. Generally, I can remember all these things because I have been doing this forever, but you may not be so “experienced”.

Two, you’ll have historic record so when you switch doctors, you know what to tell the new guy. Think your new doc will sift through the records of the old one? Well, maybe, but maybe not. It’s so much better if YOU can answer their questions and be the record for them. Then you know it’s actually accurate and right. And trust me, you won’t remember 17 drugs from now what happened with THIS antidepressant and THIS mood stabilizer combination. You just won’t. At this point, all the goddamned drugs sound the same to me. Alprozylepin. Meh. Whatever.

Try charting the numbers with drug names, dosages, side-effects, and “other pertinent info”. If every time you eat an ice cream sundae you feel super, maybe note that. Or your menstrual cycle, or whatever makes sense for you. Generally I haven’t bothered doing this because I’m so depressingly constant. I know how I am, I’m depressed. Screw off already. It just so happens that something has changed. Unbelievably. Miraculously.

See, I have the numbers to prove it.

(Child says to God, “how do I know you’re God? Show me a miracle.” God points to a tree. The child says, “that’s not a miracle, that’s a tree!”, to which God says, “let’s see you make one”.

God should have pointed to me. Let’s see you fix her.)

Marijuana Makes Depression Better and Worse?

→ April 30, 2008 - 1 Comment

‘Roud these parts lots of people are smoking lots of stuff that might not entirely be legal. Very common. Good climate for that sort of thing.

I though, have always been of the opinion that marijuana makes depression worse and so stay away from the stuff. Really, if you’re crazy and on psychotropic drugs, adding extra, less predictable, street psychotropic drugs doesn’t seem like a good idea. Anecdotally, do stoners strike you as obscenely happy people? They strike me as just slow, tired, munchie-craving people. That’s not going to help me feel better. (More logically, THC from the marijuana coats the outside of your brain cells, further impeding neurotransmitters, which is bad if you already have a serotonin deficiency.)

But the nice folks at McGill university weren’t about to answer the question with conjecture, which is why I like science so much. And I was surprised. Turns out that small amount of marijuana might actually help you, but large amounts can actually increase depression and maybe cause psychosis. I copied the article below for your convenience.

MONTREAL, Oct. 24 (UPI) — A synthetic form of the active ingredient of marijuana acts as an antidepressant in low doses but in higher doses can worsen depression, a Canadian study said.

First author Dr. Gabriella Gobbi of McGill University said it has been long known that depletion of the neurotransmitter serotonin in the brain leads to depression, so antidepressants like Prozac and Celexa work by enhancing the available concentration of serotonin in the brain.

This study offers the first evidence that marijuana can also increase serotonin, at least at lower doses, but at higher doses the serotonin in the rats’ brains dropped below the level of those in the control group.

The study, published in The Journal of Neuroscience, finds excessive marijuana use in people with depression poses high risk of psychosis.

The antidepressant and intoxicating effects of marijuana are due to its chemical similarity to natural substances in the brain known as “endo-cannabinoids,” which are released under conditions of high stress or pain, Gobbi said.

Don’t rush to dial-a-dealer just yet though, because amounts are unclear, and the study was on rats. Unless you’re a rat. Then, go for it.

Mederma for Scars?

→ February 25, 2008 - 9 Comments

Has anyone used Mederma?

Mederma, for those of you who don’t know, is a relatively new gel that’s supposed to help lessen the appearance of scars. Apparently it contains some “proprietary” botanical extract. I don’t know what that means because I highly doubt Merk invented a plant, or discovered a super-secret one deep in the hills of Borneo and hid it from everyone else, or anything, but it’s a pharmaceutical company, so I suppose anything is possible.

It’s an odd gel that feels silicone-like, (although doesn’t seem to contain any silicone) has a light, fairly pleasant smell, and doesn’t really dry or soak into your skin like a skin cream does. You’re supposed to use it 3-4 time a day so it basically forms a layer over your skin that tends to flake or rub off when rubbed. (It’s like a thin layer of rubber comes off. Weird.)

It’s expensive, over the counter, and while there is actually a money-back guarantee on the thing, there is no guarantee that it will work. It might, it might not. With all the different people, with all the different types of skin, and all the different types of scars, there is really no way to know if it will work for any given person.

The thing is, it makes me ITCHY. Like, seriously. Which really negates the whole point. Now, instead of my neck looking awful because of an incision scar it looks even worse because of all the scratching. It’s driving me crazy! You’d think after all the crazy side effects I’ve had over the years that I could get over a little itching. Nope. It’s a 24 / 7, every single minute of the day problem. Itching should not be underestimated.

Other people seem to like the stuff, and only my neck really seems to itch, not so much the scar on my chest, (Why? Who the hell knows. I have no idea why my brother turns red after taking niacin either.) so I might continue to try it there. And hey, if you’re like me and a pile of scars anyway, there are places all over to try it. (Yes, it’s supposed to work on even old scars, but be prepared to use it 4 times a day for months.) I have totally found a new market for these people. They should hand out samples to cutters and they’ll have clients for life.

Oh, I forgot, they’re a pharmaceutical company. They’ve already got people on that.

How Much Does VNS Implant Surgery Cost?

→ February 9, 2008 - 4 Comments

I just got my hospital bill, and it isn’t the $30,000 I was quoted beforehand. Here’s how it really breaks down:

Pre-surgery tests:

Professional fee $135
Laboratory $58
Chemistry $46
Hematology $36
Urology $34
Clinic $643
EKG/ECG $102
————
$919

Surgery:

Pharmacy $1,103.47
Med-surg supplies $636.00
Supply/Implant $35,828.00
OR Services $3,977.00
Anesthesia $643.00
Drugs/Detail code $40.63
Drugs/Self admin $1.81
Recovery room $681.00
——————
$42,901.00

Grand Total $43,820.91

Note that there was not even an overnight stay in the hospital. These numbers do not include turning the device on, or all the follow up care required even to get to a therapeutic dose. Costs also vary widely depending on where you get it done.

This is a far cry from the $30,000 I was quoted and as you can see, the implant itself is a fair chunk beyond that. Why that is, I do not know. There are multiple versions of the implant, and the costs might be slightly different. Also, it seems that insurance companies here pay less than the full cost. It’s infinately frustrating that insurance companies pay less but that some poor person who walks in off the street has to actually pay more. But let’s not get started about that.

Just in case you were wondering, I do have the best insurance ever, and this all cost me absolutely nothing.

L-methylfolate as Antidepressant Enhancing Agent

→ January 6, 2008 - Comments off

I do a lot of psychopharmacology research reading. Like, a lot. I try to post things that I find interesting and not bore you with everything else. Similarly, I try to post things that are decently easy to read and understand. Today though, you have not gotten off so lucky, but the article is interesting.

What is L-Methylfolate?

L-methylfolate (MTHF) is a compound your body makes from folate (and the help of a few other things). Folic acid is the synthetic version of folate, available to take in supplemental form. Pregnant mothers generally take folic acid. As you would assume, taking more folic acid, will up the level of MTHF found in the brain.

The problem comes with an MTHF deficiency. This deficiency cannot necessarily be corrected by taking folic acid as some people genetically do not synthesize enough MTHF from folate from the diet or through supplements, moreover, there is some evidence to suggests that MTHF can “turn up” the efficacy of antidepressants even when no deficiency is present. It can also take many, many times the amount of folic acid to synthesize the amount of MTHF needed than would be found in the diet or available supplements. Anticonvulsants (mood stabilizers, like Lamictal and others) can also create a depletion in MTHF.

What Does This L-Methylfolate Stuff Mean?

The long story short is this, there is some evidence to suggest that taking MTHF supplements is warranted when antidepressants have either stopped working, or are not working at all. MTHF supplements are considered neither a drug, nor a food by the FDA (funny huh) but are still regulated and require a prescription.

This is really preliminary data there are all kinds of studies needed to bear out these findings, and my explanation above has been really simplified. But the really great thing about knowing about it is that it can help you, without causing the kind of side effects you typically see with pharmacological drugs. My doctor, who is seriously a no-nonsense woman made me aware of this, really respects the author of the article, and has given me a prescription for the stuff, whatever that’s worth. When you think about it, this actually makes a lot of sense. After being on anticonvulsants for years (like, eight of them) it’s not surprising that I’m deficient in a nutrient or two. This would explain why antidepressants just don’t seem to work in some people, and also seem to stop working after some time.

The article itself is good, but it’s extremely complicated and has so many chemical names in it it makes my brain hurt. There are pictures though. Kind of funny ones, I think. So, try to wade through the article, or just print out a copy and take it into your doctor and see what the say.

Article found here. Enjoy. (At least look at the diagrams. Steve there has a sense of humor.)

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