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More meds or TMS--the $10,000 question


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Many of you know my story, but the short version is I've been depressed for 10 years, I'm hitting the point where I'm losing the ability to function and I've tried enough meds (15+) that my docs think TMS is warranted.

my insurance company, usually amazing, is  purposely delaying coverage and admitted to me they'll probably deny it. Unfortunately, my employer is changing to a new company in September. So my insurance company is clearly delaying with no explanation in order to prevent me getting treatment while I'm covered by them.

i have, after refinancing my house, enough money to pay out of pocket but our budget is extremely tight and its $10,000 I'd rather not have to spend. 

I thought before blowing $10k on something that may not work, I'd ask once more about meds. My doc thought I should try Lamictal again at a higher dose but thinks I could still benefit from TMS too.

Im still fighting insurance and could appeal to get TMS reimbursed... But only if I get treatment while I still have their coverage, which means I need to start it NOW.

im so torn... Do TMS now, and maybe/probably be out $10,000 but with the possibility of reimbursement, or wait and see if meds work, which may or may not result in me doing TMS anyway, but this time certainly out of pocket.

any thoughts? So frustrated... I'll be so pissed if I spend $10k and it doesn't work and I had a chance to get it covered... But also would regret failing TMS and then later finding a med that works.

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I think spending $10,000 that you can't afford for TMS would be wrong. First, TMS doesn't work for everyone. It does not have the efficacy of ECT and would be a shot in the dark. Do you feel like a $10,000 gamble with the odds stacked against you? Secondly, a large part of your depression is situational. TMS will do nothing to help the situation that you would find yourself back in after the TMS treatments.

What I think makes more sense would be to try ECT which insurance probably would cover and you might get some temporary relief. However, to get real relief you have got to do something about your situation. I can't emphasize that enough. You need to restructure your life so that you are not bearing so many burdens. Until you do that, you can expect only modest help from ECT or meds.

About meds ... antidepressants never really helped me much. In my experience, there is no magic pill that is going to make everything better. I got help from a fairly aggressive cocktail. You mentioned that you never tried a tricyclic. I should mention that I have tried every tricyclic except imipramine and none helped me and I got tons of side effects. That's not everyone's experience, but it is mine. I would be more inclined to try an MAOI over a tricyclic, but maybe that's just my preference based on my past experience. However, as I said above, there is no med that is going to improve your situation. That you have to do on your own, perhaps with the help of a therapist.

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In short, ditto jt.

In slightly longer--if you can afford the $10,000, it seems much more useful to put it to some sort of lifestyle reorganization.  I don't know what that would look like, but I know that every time a suggestion was made about how to change the current situational issues, the barrier was money.  If you can pull $10,000 out of a hat (or house), that gives you more to work with.  I understand it's not a long-term solution, but it might buy you enough time in order to come up with one. 

In the interim--more med options or ECT are both better proven and usually covered, particularly given the ten year history of not doing well.  Why not try something that's actually covered before going the more experimental route?

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Well my family wouldn't support ECT right now, they're scared of the side effects and frankly so am I, I can't get around watching my kids and memory loss just doesn't work with that situation. Plus I'd have to take 6 weeks off work... I suppose I could afford that with the extra money but without my family's support it won't work :(

 

i I get the restructuring... If anyone has any ideas on how to do that, please tell. I just can't think of anything that wouldn't be very short term, even with $10,000 to work with, and that's just as much of a waste. I'm sorry :( I don't mean to shoot down ideas but I've been trying to figure out how to do that and I just can't think of any way to do that before my kids are in school, five years from now :(

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Also I should add despite being depressed for ten years, it's much, much worse now than it ever was. It got worse after my first child, and even worse after the second, but even a year ago I could function better. I'd give anything to just go back a couple years; my situation wasn't much different but I could keep my house cleaner, occasionally go out, manage work just fine and not sob uncontrollably every day. My situation is hard but I KNOW I could manage it better.

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The side effects from ECT are basically headache and memory loss from around the time the the treatments are done. It's not like you go through life with a poor memory. Once you are done with the ECT treatments, memory improves. Memory loss also depends on the type of ECT you get (unilateral vs. bilateral). So you would need support during the time of the treatments but later on you should be fine. But if your family isn't up to helping out there's not much you can do.

 

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Climber, I'm getting ECT right now. TMS didn't work for me.

What jt says is correct - the side effects for ECT are surprisingly minimal. I have a headache the day of the treatment. I lose my memory for about 24-36 hours around each treatment. That's it. It's enough that I couldn't work (I'm on short term disability), but not so much that you wouldn't be able to look after your children except for the days of the treatment (when you'll be recovering from general anesthetic). 

Your family needs to do some research on ECT. You need to educate yourselves on how ECT really works. ECT is the gold standard treatment for depression. It has come so, so far. There's a reason it's still done.

I can tell you, I've had enough treatments now (13, I think) that I can start to feel a difference in my mood. My family noticed long before I did. They said I was brighter and more engaged. I had the first several done very close together, while I was IP. Now they're up to a week apart and done OP. 

If you're really not willing to try ECT, then definitely make sure you try an MAOI. I take Parnate. The diet is annoying, but surprisingly easy to follow. I use this as a guide for what I can and can't eat. https://www.mc.vanderbilt.edu/documents/neurology/files/Tyramine Menu Book 06227101.pdf

And jt's right. You gotta meet your treatments halfway. ECT, meds, even TMS... if you don't change your situation, you're not going to get better. 

 

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IIRC (please forgive me if I am wrong) you have a very hectic schedule and you have 2 little kids.  Instead of TMS, could you spend part of that $10,000 on childcare, even if not every day?  To give you a break for time to yourself?  That might help out a lot.  You still may need something like ECT/TMS, but I would at least try the ECT first, especially if it is covered by insurance.

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Well I could spend the money on childcare, but maybe for a year or so and then what? When it runs out I'm back to being broke and in the same situation :-/

 

meanwhile, two pieces of great news yesterday... First, my insurance came through and they're going to cover TMS after all! Also, my parents are putting their house on the market and they're moving here to help out! Now I can try TMS with little risk, at least without risk of blowing money on it, and get some situational change as well :)

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