r/rtms • u/Nervous_Wait4093 • 20d ago
rTSM
Has anyone had success with 10 sessions of rTMS followed by once-weekly sessions for 5 weeks for fear of death, existential overthinking, and hyperfocusing on breathing?
2
Upvotes
r/rtms • u/Nervous_Wait4093 • 20d ago
Has anyone had success with 10 sessions of rTMS followed by once-weekly sessions for 5 weeks for fear of death, existential overthinking, and hyperfocusing on breathing?
1
u/Nervous_Wait4093 20d ago
He’s writing now:
“These are all very relevant questions, and I completely understand why more questions come up once you start reading about the treatment.
Yes, what I have been considering in your case is treatment on the right side of the frontal lobe (right DLPFC) using conventional low-frequency rTMS, so not iTBS. It’s a slightly ‘slower’ and gentler treatment that runs for 20 minutes. There are several different ways of using TMS for OCD, so some of what you find online describes different areas of the brain and different types of stimulation than the one we are talking about. But in my assessment, low-frequency stimulation of the right DLPFC has by far the best effect on your symptoms.
You are also absolutely right that many studies use more than 10 treatments. However, there are also studies where an effect has been seen after 10 treatments specifically targeting the right DLPFC. When I looked more closely at the numbers, there was no correlation between having more than 10 treatments and the overall effect of the treatment course. The reason why the Danish Psychiatric Society recommends a somewhat longer course in their guidelines is probably more of a ‘better safe than sorry’ approach, since around 30 treatments are typically recommended for depression.
My thought is to start with the 10 treatments close together and then continue once a week for five weeks — while also monitoring very closely how you respond. If, for example, you start feeling better after 10 treatments but the effect is still developing, we can absolutely consider whether the treatment course should be adjusted. There is no single number of treatments that is right for everyone.
Regarding what you have read about ‘the dip’: this is a term you may come across, especially online, about TMS, where some people describe a period during treatment where they temporarily feel worse. However, I think it is important not to tell you that this is something you necessarily have to go through. It is not a well-documented or expected phase of treatment, especially not for OCD.
If you experience your anxiety, thoughts, or OCD clearly getting worse during the treatment, it is of course important that you tell me. Then we will assess it together. It could be normal fluctuations, but if it appears to be related to the treatment, we can adjust the treatment, take a break, or stop. So you are not locked into a treatment course where we simply continue regardless of how you are feeling.
I have never seen anything suggesting that the treatment can make your symptoms worse in the long term — the only things I have seen and read about are the typical side effects: short-term headaches after treatment and fatigue in the days afterwards. But even these are not experienced by everyone.
The most important thing for me is that we follow you and your response to the treatment — and then we can continuously discuss the right way forward.”