As I wrote in my last blog post, at my 6 month follow-up appointment they did some psychiatric scales testing. They do this testing at every follow-up appointment to see if my depression is improving or not. In other words, to see if the surgery has been a success or not. The testing primarily consisted of three scales to determine the severity of my depression. As I wrote back when I originally did the psychiatric scales, all of the tests that I did at the time of my surgery showed that I was suffering from severe depression. The first test that we did was the Hamilton Rating Scale for Depression (HAM-D). Originally when I had my surgery, I received a score of 25 on this test. This week I received a score of 26. Scores of greater than or equal to 23 indicate a very severe depression. Thus, my depression has gotten slightly worse according to this test. The second test that I did was the Montgomery–Åsberg Depression Rating Scale (MADRS). Originally when I had my surgery, I received a score of 36 on this test. This week I received a score of 38. Scores of greater than 34 indicate severe depression. So, my depression is also getting slightly worse according to this test. Finally I did the Beck Depression Inventory (BDI). Originally when I had my surgery, I received a score of 36 on this test. This week, my score was 38 Scores of greater than or equal to 29 indicate severe depression. Thus, I am also getting slightly worse according to this test. Overall, these test scores indicate that I am getting slightly worse since I had the surgery. The brief period of improvement that I had hasn't seemed to have had any effect on my overall scores.
I forgot to mention in my last blog post something that Dr. Levitt told me about one of the other study participants that has also received Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS). She was one of the first recipients of the procedure and noticed a slight improvement about a month or two after the surgery. He said that after 11 months she had a miraculous improvement and is now back to normal. Apparently most people that they are following have HAM-D scores that are in the 20's. Hers is now apparently at 1. This is an amazing turn-around for her. She is basically cured. So, even though I haven't gotten better yet, there is still time. They always say that it can take a year or more for things to get better.
Thursday, May 16, 2019
Tuesday, May 14, 2019
MRgFUS 6 Month Follow-Up
I am coming up to 6 months since I had my Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) for my treatment resistant depression and over the last week I had two days of tests and consultations at Toronto's Sunnybrook Hospital because of that. The tests and consultations come at a good time as I am not doing very well.
As I wrote in my last blog post, a couple of months ago I had made a significant improvement and had started to feel somewhat better since we increased my dose of Fetzima to 140 mg. This may have been the result of the surgery, may have simply been the result of increasing the dose, or perhaps a result of both. However, the improvement was noticeable. Since then we have tried to increase my dose of Fetzima to 160 mg and then to 180 mg in an attempt to achieve even better results. Unfortunately, about a week after increasing to 180 mg I started to feel worse. For the past few weeks now I have been feeling as bad as I felt before the improvement. As I stated previously, my psychiatrist used the Quick Inventory of Depressive Symptomatology (QIDS) test to determine how depressed I am at each appointment. After increasing my Fetzima dose to 140 mg I scored at 13-14, which rates as Moderate Depression. At my last appointment I scored at 18 which rates as Severe Depression. In order to try and get the improvement back, we decreased my dose back to 140 mg to see if that would help. It has been close to a week now and there has been no improvement.
Thus, I was interested to have my appointments at Sunnybrook to see what they had to say about my improvement and my loss of that improvement. I started off last Tuesday with an appointment with Dr. Nir Lipsman, the neurosurgeon that performed my surgery. He said that ups and downs like that were to be expected with the surgery and that we still have lots of time to see further improvement as often it can take up to a year for improvement to appear.
Following that I had both an MRI and a PET scan to see how my brain is doing since the surgery.
Yesterday I had the second day of tests and consultations. I first met with Dr. Anthony Levitt, the psychiatrist of the study in which I took part. He had some very interesting things to say. First he said that the fact that I had a brief period of improvement would suggest that my brain is capable of getting better and that he believes the surgery played a role in that improvement. My brain got used to the increase in dose and adjusted to go back to the way that it was. He said that what we have to do now is just recreate that improvement, manage to sustain it and build upon it so that I feel completely better. I say that we "just" have to do these things, but they are difficult things to do. He had some ideas though about how we might go about doing that. He had 5 suggestions of medications that I could take while staying at a Fetzima dose of 140 mg that might work to recreate the improvement. We sent them to my psychiatrist and we will try them over the coming months.
After meeting with Dr. Levitt, I had psychiatric scales testing done to determine how depressed I was. In the past I have posted those results, but I haven't received the results yet, so I can't post them right now. I then had neuropsychological testing done to see if there was any change in my brain functioning since the surgery. These are the same tests that I had done before the surgery. These tests consisted of mostly memory games to see if the surgery had any effect on my short term memory. I had to remember lists of words that were read to me and sort cards into various groups, for example. One test that I still couldn't figure out was a computer game that played a warped betting game with me. I had to choose cards off of one of four piles and I would either win or lose money based upon the card that was drawn. I still couldn't figure out what the criteria was for deciding if I won or lost. It seemed random to me.
So, that is how things are going. My depression is back to the way that is was before the improvement I wrote about in my last blog. I am very discouraged by this. It is hard to get a taste of a bit of improvement and then have it taken away. I can't help but feel that it is somehow my fault that the improvement didn't last. Perhaps there was something I could have done to sustain it and make it even better, but I didn't and it slipped through my fingers like water. Dr. Levitt has some ideas though about how we can recreate the improvement and I look forward to trying them.
As I wrote in my last blog post, a couple of months ago I had made a significant improvement and had started to feel somewhat better since we increased my dose of Fetzima to 140 mg. This may have been the result of the surgery, may have simply been the result of increasing the dose, or perhaps a result of both. However, the improvement was noticeable. Since then we have tried to increase my dose of Fetzima to 160 mg and then to 180 mg in an attempt to achieve even better results. Unfortunately, about a week after increasing to 180 mg I started to feel worse. For the past few weeks now I have been feeling as bad as I felt before the improvement. As I stated previously, my psychiatrist used the Quick Inventory of Depressive Symptomatology (QIDS) test to determine how depressed I am at each appointment. After increasing my Fetzima dose to 140 mg I scored at 13-14, which rates as Moderate Depression. At my last appointment I scored at 18 which rates as Severe Depression. In order to try and get the improvement back, we decreased my dose back to 140 mg to see if that would help. It has been close to a week now and there has been no improvement.
Thus, I was interested to have my appointments at Sunnybrook to see what they had to say about my improvement and my loss of that improvement. I started off last Tuesday with an appointment with Dr. Nir Lipsman, the neurosurgeon that performed my surgery. He said that ups and downs like that were to be expected with the surgery and that we still have lots of time to see further improvement as often it can take up to a year for improvement to appear.
Following that I had both an MRI and a PET scan to see how my brain is doing since the surgery.
Yesterday I had the second day of tests and consultations. I first met with Dr. Anthony Levitt, the psychiatrist of the study in which I took part. He had some very interesting things to say. First he said that the fact that I had a brief period of improvement would suggest that my brain is capable of getting better and that he believes the surgery played a role in that improvement. My brain got used to the increase in dose and adjusted to go back to the way that it was. He said that what we have to do now is just recreate that improvement, manage to sustain it and build upon it so that I feel completely better. I say that we "just" have to do these things, but they are difficult things to do. He had some ideas though about how we might go about doing that. He had 5 suggestions of medications that I could take while staying at a Fetzima dose of 140 mg that might work to recreate the improvement. We sent them to my psychiatrist and we will try them over the coming months.
After meeting with Dr. Levitt, I had psychiatric scales testing done to determine how depressed I was. In the past I have posted those results, but I haven't received the results yet, so I can't post them right now. I then had neuropsychological testing done to see if there was any change in my brain functioning since the surgery. These are the same tests that I had done before the surgery. These tests consisted of mostly memory games to see if the surgery had any effect on my short term memory. I had to remember lists of words that were read to me and sort cards into various groups, for example. One test that I still couldn't figure out was a computer game that played a warped betting game with me. I had to choose cards off of one of four piles and I would either win or lose money based upon the card that was drawn. I still couldn't figure out what the criteria was for deciding if I won or lost. It seemed random to me.
So, that is how things are going. My depression is back to the way that is was before the improvement I wrote about in my last blog. I am very discouraged by this. It is hard to get a taste of a bit of improvement and then have it taken away. I can't help but feel that it is somehow my fault that the improvement didn't last. Perhaps there was something I could have done to sustain it and make it even better, but I didn't and it slipped through my fingers like water. Dr. Levitt has some ideas though about how we can recreate the improvement and I look forward to trying them.
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