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Author Topic: Ketamine Infusions / TMS therapy  (Read 127 times)
maxsterling
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« on: February 22, 2021, 10:20:20 AM »

Today W begins Ketamine infusion therapy, and tomorrow Transcranial Magnetic Stimulation (TMS) therapy.  MY understanding is that these therapies are given to patients with severe depression that does not respond to other therapies, and to those with PTSD.  My W definitely does not respond to medication for depression.  In the time I have known her, she has been on multiple antidepressants at very high doses with almost no success.  She has also seen T for years with no major change in her level of depression or mood.  As for PTSD - she was abused as a child by her mother, and had various other traumatic experiences as a teenager or adult.   But I feel most of Ws mental health issues are very classic and severe BPD.  I do feel the PTSD probably gets in the way of meaningful progress with our r/s and other therapies.  For example, the very quick onset of rage may be PTSD related, and that makes any hope of using any kind of communication tools from my end nearly impossible (for the record, she has nearly raged at her Ts - professionals with years of training)

This thread is to communicate to others what I observe regarding Ws treatment so that it may help others.  Insurance seems to be picking up the TMS therapy, but the ketamine is not covered, and is a bit pricy.    The idea for both is to "rewire" the brain.  Ketamine is supposed to help rebuild healthy neural pathways, and the TMS is supposed to stimulate underactive portions of the brain.  I have read that it does help with BPD, because pwBPD have areas of their brains that are overactive and other areas underactive compared to a non-BPD. 

I kinda view this is a last resort.  I really can't take much more of Ws current behavior without completely falling apart myself.  I don't want the kids to have to deal with it all the time either.  W seems to have anxiety over the procedures, and that brought about another rage directed at me last night again over something I had little to do with. 

The procedure today is about 2 hours.  While she is doing that, I am going to take the kids to do something fun.
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« Reply #1 on: February 22, 2021, 10:36:30 AM »

Thanks for posting this. I have been curious about the use of ketamine. I know it is for severe depression and that it can be effective- but not a permanent change like taking an antibiotic for an infection would cure that. Patients may need to come back for more treatments but I don't think it's meant to be continuous and they are I think eventually changed to a more regular depression medication.

I don't think there's studies on BPD as this is fairly new for serious depression, but I have been curious about how someone with BPD would respond. Thanks for posting about how your wife responds.

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maxsterling
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« Reply #2 on: February 22, 2021, 10:53:06 AM »

Thanks for posting this. I have been curious about the use of ketamine. I know it is for severe depression and that it can be effective- but not a permanent change like taking an antibiotic for an infection would cure that. Patients may need to come back for more treatments but I don't think it's meant to be continuous and they are I think eventually changed to a more regular depression medication.

I don't think there's studies on BPD as this is fairly new for serious depression, but I have been curious about how someone with BPD would respond. Thanks for posting about how your wife responds.



That's pretty much what I have read.  Or browsed since I don't have much time to do detailed reading these days.  W's T has experience with this, as does her P.  She has been told this may be something she will need again in a year or so.  The goal is to "right the ship" for right now so that she can actually steer it. 
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« Reply #3 on: February 23, 2021, 08:37:51 AM »

Hi Max, I'm mostly a lurker and have been following your threads.  Nearly 2 years ago my H was hospitalized (voluntarily) after almost non-stop rage episodes, which included both suicidal and homicidal ideations.  I issued an ultimatum, which I now know is useless, but I hadn't found these boards or anything about BPD at that point.  The social worker at the hospital was the one that told me about BPD, and pointed me in the direction of Stop Walking on Eggshells, which got me here.  Anyway, when he was first at the hospital they were seriously considering doing Ketamine infusions and TMS therapy.  After several days when he was in "short term care" (e.g. locked down) they decided that his diagnosis was either BPD or PTSD (they settled on PTSD, which I don't entirely agree with; his rage pre-dated the traumatic incidents that caused the PTSD).  Because of this they cancelled both therapies, saying it was pointless with those diagnoses.  The doctors and hospital were fantastic, so I do trust their opinion, but I was always curious if there would be a placebo effect or something that would have helped.  I will certainly be following along with your reports about your wife. 

I do want to add that I'm so sorry you are in this position.  I've been there (and still am many days), trying to deal with the rage and shelter the kids and supposedly take care of yourself at the same time.  Trying to make life altering decisions for multiple people and feeling frozen - always waiting to see if the "next" med or therapy will help. 
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wendydarling
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« Reply #4 on: February 23, 2021, 09:13:45 AM »

Hello maxsterling

You may find this helpful. Parents successful experience of Ketamine.
Ketamine starts Monday
And a five month follow-up mentioned in this thread.
https://bpdfamily.com/message_board/index.php?topic=333923.msg13035843#msg13035843

Excerpt
The goal is to "right the ship" for right now so that she can actually steer it.
Exactly.

WDx
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maxsterling
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« Reply #5 on: February 23, 2021, 10:53:01 AM »

Wendydarling -  thank you!!  Those threads will be a helpful resource.

W was dizzy and had a headache after the infusion yesterday.  And last night she could not sleep.  I think she could not sleep because they told her she could not use medical marijuana during treatment.  She normally uses that to knock her out (she is dependent). So she was up, online shopping, and not making much of an attempt to turn off stimulation and go to sleep.   Eventually, she DID break down and use the MM, and fell asleep for a little while.  She said the combination was not good and would not do it again.

She did make a few comments yesterday that I found interesting.  One was that she is desperate to "rewire her neural pathways" - indicating she desperately wants this to work.  Other comments were self awareness regarding her behavior - a desire to stop the cursing, negative self talk, and a recognition that she treated me poorly.  That's not new, she does that on occasion.

She did rage at me last night again after the infusion.  S4 left one of his toys at the park (honest mistake), W blamed me, did not want me to go back to get it, spent an hour raging rather than allowing the 20 minutes it would have taken to go back and retrieve the toy.  This kind of stuff drives me nuts.  She went on and on about how I need to go see a P and get back on ADHD medicine because I am forgetting stuff.  I of course (gladly) invalidated that by saying that I will trust what my last P said in that my issues in that area are from stress and lack of sleep, and that meds won't solve that.  I say I gladly invalidated that because I think W needs to hear that and process it. 

This morning she seems to be a bit more patient and positive.  I wonder how she would be if she actually got sleep.  Today is TMS therapy.  Hopefully that goes okay.
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PearlsBefore
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« Reply #6 on: February 23, 2021, 12:01:22 PM »

Was the MM contradicated by the ketamine, not by the TMS I would assume? I'm certainly interested in following your story on this front and will probably seek out some more resources on the issue myself although it's hoped I'm never in such a situation.

Do they have a prognosis for how long each therapy would likely continue?
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maxsterling
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« Reply #7 on: February 23, 2021, 12:34:52 PM »

The P that did the ketamine warned that some patients that use Marijuana while undergoing Ketamine have psychotic breaks and wind up in the hospital.  The other issue is the P not knowing the effectiveness of the ketamine.  I don't think the concern is of the MM making the Ketamine less effective, because there is little research about that.

I think we paid for 8 ketamine infusions, twice per week.   It was mentioned that this is not likely a permanent solution, and if it helps additional treatments may be necessary months/years later. 

The TMS I think is 3 times per week for about 6 weeks.   There are not the same warnings with MM and TMS.

Thinking about this more, I know certain drugs when abused can alter neuro pathways (look at some famous musicians).  I've read stories that conclude the use of Marijuana and other drugs at a young age can hinder healthy brain development and lead to mental health issues later in life.  So it makes sense that using such drugs in a more therapeutic situation could help "rewire" the brain in a healthier way.  My W was experimenting with Marijuana and Hallucinogens as young as 14, and I have sometimes wondered if that was a contributing factor in her mental health issues as an adult.
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formflier
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« Reply #8 on: February 23, 2021, 01:02:33 PM »


So...if she can say she won't do it again (MM)...why couldn't she not do it in the first place?

(I'm not after you Max....I'm putting the obvious questions out there)

If she really wants it to work...why not follow the doctors orders?


When is the next MC (if I remember right you were going every couple of weeks)?

switching gears

I'm less interested in understanding why she would want to rage for an hour, vice a 20 minute trip to the park...and I'm more interested in your participation in rage...period.

I would think the subject for next MC is "what to do about self soothing". (probably wouldn't call it rage..yet)

Either she leaves you and kids at home and she goes for a walk

Or you take kids and leave her for a period of time.

But...going forward, she may choose to rage (or not)...your choice is to not participate in any way form, shape or faction.

Best,

FF
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maxsterling
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« Reply #9 on: February 24, 2021, 10:58:24 AM »

Yesterday was her first day of TMS.  She left with a big headache.  I think the headache was partly a result of not sleeping the night before, stress, and use of the MM.  I am hoping today goes smoother. 

W did tell me this AM this she does feel better.  There have been the same stressors today with the kids as every day, but I can say W got over them much quicker.  It may be placebo affect, but from my observation W is happier today than I have seen her in months. 
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WWW
« Reply #10 on: February 24, 2021, 11:13:01 AM »


I am hopeful for you.

I personally have done

https://sadarpsych.com/home-training/baud/

A PhD level psychologist did it "to me".  As they explained it...I figured it couldn't hurt..but didn't expect much because it sounds like a bunch of hokum.

It worked for me!!!!

PTSD "memories" are no longer or much less triggering.

I still had other work to do...but it helped a bunch.

Here is to hoping your wife gets more stable from this!!!

Best,

FF
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« Reply #11 on: February 24, 2021, 01:06:15 PM »

My son has self studied (and experimented with ketamine ) he says did help and “woke him up” like a out of body looking at him moment.   Made him very sad as he realized in the moment how off he has acted and off his thinking is too.  But as positive as it was he feels he couldn’t function and it lasts a day or two Max.  Love to hear more on topic. And how to get the benefits.  What is infusion. ?  He’s terrified of needles which is why he’s said no way.

He did tms for both depression and ocd after ssri, mood stabilizers, Prozac,  did nothing.  I will say his aggression increased.  He felt pain.  Actual pain.  His mood did not improve for it. 

Everyone different of course.  We also did the genomind dna to identify drug to dna comparability
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