I’ve been fairly stable since last fall, after my second round of TMS (transcranial magnetic stimulation).
But after a more recent bout of bad days, occasional panic, and a bit of suicidal ideation (not anymore, don’t worry!), my psychiatrist, Dr. Nelson, and I decided to start another round of it. Of course, I talked to CeAnne about it, but ultimately, it’s my decision.
I take my mental health care seriously; I have to. I pay attention to Dr. Nelson during our appointments (he’s both fascinating and wicked smart), I attend three or four mental health appointments every week (although I just finished DBT last week), and I do as much inner work as I can stand.
In the last four weeks alone, I’ve had eight TMS treatments, six relaxing days on the beach in North Carolina with my family, therapy, DBT, seen my case manager twice, and had three individual sessions with Dr. Nelson.
And I feel pretty damn good.
WHAT, EXACTLY, IS TMS?
That’s a fair question. It’s a newer treatment for serious depression, dating back to about 2008 here in the U.S. Not only have most people never heard of it, most medical professionals have never heard of it, either. Even a lot of the people who work in mental health don’t know what it is.
This is a great article from 2015 that explains it well. As an added bonus, you get a feel for Dr. Nelson, too. He rocks.
Here’s what it looks like:
It uses a magnetic coil within the helmet to produce changes in the part of your brain that is responsible for emotion regulation, and it sounds just like an MRI. In fact, part of the protocol is that we have to wear ear plugs (which the clinic provides).
I’m going through my third round of treatments in almost two years. I’ve noticed minimal side effects, like maybe a slight headache or feeling sleepy afterward, and that’s it. TMS is completely, 100% non-invasive.
THIS IS ESPECIALLY IMPORTANT TO UNDERSTAND: IT IS NOT THE SAME AS ECT (electroconvulsive therapy, or “shock treatments”). There is no electric current involved.
Back in 2005, I was hospitalized three times – one time, for a month – because my depression was so bad. I had ten ECT treatments over the course of three and a half weeks and felt not an ounce of relief or normalcy. It wiped out my memory from the spring and summer of that year (permanently) and has left me with continuing cognitive issues. I was *this close* to doing it again in 2015, but I wisely listened to my wife, who had researched alternatives to ECT, and tried the TMS instead.
I will never do ECT again, as long as I live. It didn’t help my depression and it’s not worth the cognitive risks involved (for me).
Because it’s still a newer treatment, the TMS clinics have a very strict protocol, involving testing motor threshholds (the lowest-strength pulse that will make your right thumb twitch), daily symptom ratings, and a more involved symptom questionnaire once a week.
Dr. Nelson met with me and CeAnne for a two-hour evaluation the first time we met him. Two hours! When is the last time you heard of a shrink spending that much time with anyone?
Anyway, he determined that I had Major Depressive Disorder (MDD). I was thinking, “Well, duh,” right? But it was way more than that. My very first shrink diagnosed me as Bipolar Type II way back in 2001, which was inaccurate. I asked about this diagnosis every time I saw her and with each subsequent shrink, and they were all like, “Yup, Bipolar Type II.” I disagreed.
So when Dr. Nelson did an actual evaluation of me in 2015, his declaration that I had MDD was nothing short of a miracle. You know what I said to him?
I said, “Thank you! I’ve been trying to tell my doctors that for fourteen years, but none of them would listen to me!”
My misdiagnosis (which, naturally, led to ineffective treatments) is a whole other story and will be the topic of several posts in the future, I’m sure. Suffice to say that before you can treat a disease effectively, you must know what you’re dealing with first.
THE TREATMENT PROCESS
A diagnosis of clinical depression is the first step in TMS treatment; thus, the evaluation. Your shrink needs to make sure you qualify for the treatments.
(TMS is not approved for treatment of bipolar depression yet; you need to be diagnosed with a depressive disorder. And no, Dr. Nelson wasn’t just repositioning me as MDD so he could make more bucks. Believe me on that.)
Step two is probably going to include a waiting list. Where I live, the Upper Midwest, there aren’t a whole lot of TMS machines. There may be more where you live or less. I’m lucky enough to be near four or five clinics that provide TMS treatments.
I think I was on the waiting list the first time around for three months, give or take. Now, normally, waiting that long for a medical appointment is enough to drive anyone crazy – especially when you’re in the throes of desperation – but I saw it differently.
I had hope.
Just knowing that relief may be possible and that it was on the way helped take some of the sting out of what I was going through. For the first time in a long time, I didn’t feel completely and utterly hopeless or helpless. Anyone with a mental illness can tell you that hope is absolutely essential to getting better.
I was able to make it through those three months (although impatiently) without another breakdown.
I guess the third step is actually receiving the treatments. The guidelines are: one treatment each weekday for four to six weeks (20-30 treatments total). Doctors have a lot of leeway in the number of treatments – some even give “maintenance” treatments once a month (good luck getting insurance to pay for that) – but 20-30 is the standard.
For instance, my first round of treatments began in November of 2015 and ended a few days before Christmas. I went to the clinic every weekday (minus holidays and a few times I didn’t feel good) at 2:45, where the sessions would last just about 25 minutes. I was home in under an hour most days. There is no sedation needed, so I just drove myself there and back. CeAnne even came with me several times.
Before I received my first treatment, and once a week thereafter, Dr. Nelson checked my motor threshhold. This is a quick and simple process; they adjust the machine a few times, you feel a few taps on the helmet, and they keep track of your reactions through the movement (or lack thereof) on your right hand.
It’s the same kind of thing as when your primary physician taps just under your kneecap and your lower leg kicks out – either there is a response (they hit the right spot), or there’s not (they missed and have to try again).
Once they’ve figured out what strength to use, they fit a snug blue cap on your head, and then smush the helmet down and to the right. They use a lot of numbers in this process, although I don’t know if they’re millimeters, centimeters, or degrees. Or they could be something else, I’ve never asked.
What I do know is that they are very precise when fitting the helmet on you. Why? Because where and how it’s situated into place determines exactly where the magnetic coil penetrates your brain and gets your neurotransmitters moving. Since we’re dealing with thought patterns and emotions, the helmet always tilts toward the right ear; in other words, it doesn’t sit straight on your head.
After the helmet-tapping thing, the strength of the pulse usually needs to be adjusted slightly, either more or less. It depends on how habituated your brain is becoming to the pulses – how much actual change has taken place in your brain.
It’s a difficult concept to grasp, I know. To some, it sounds like a bunch of scientific mumbo-jumbo. But to me, it’s a fucking miracle.
THE EFFECTS OF TMS TREATMENTS
You and I both know every person is different, so they will respond to the treatments differently. Hell, some might not even respond at all, just like me and the ECT.
For me, though, the differences were obvious after only about 10 treatments: My sleep became more regular ( a really big deal, since exhaustion is one of my major symptoms), my anxiety was noticeably less (for a few months), and I swear, my depression seemed to just *poof!* go away.
As a result of all of this, I had more energy, I became more productive, I felt better about myself, I had hope for my future, I actually felt good and positive most days – I was even able to feel joy!
The difference was like night and day, and people noticed. No longer did CeAnne and her mom feel like they had to walk on eggshells around me, afraid they might trigger my anxiety or depression or anger (anger is often a part of depression).
TMS gave me my life back, no joke.
For the first time in more than a decade, I felt like I could make some goals – because I was able to move forward on them.
Do you know what life is like when you really, truly, honestly, deeply, genuinely believe nothing is ever going to get better? You don’t make any goals, because you *know* you’ll never make any dents in them; you know that failure is all that awaits you. You have nothing to look forward to. Literally, every day is a fight for survival.
That’s no life. That’s a recipe for suicide attempts (and completions).
That’s the kind of mode that means you’re always on the verge of having a crisis, or you are in the middle of one constantly. And it just. keeps. going.
So far this time around, I’ve had 8 sessions and yes, I feel quite a bit better. My interest in growing and learning and making progress has rebounded and my creative interest in writing and photography is starting to come back.
I will be talking to Dr. Nelson at my individual appointment in a few days, where we will evaluate my progress and talk about doing the full 30-treatment course, the shortened 20-treatment course, somewhere in-between, or maybe even less.
He’s the psychiatrist, and I trust him implicitly. I will do what he suggests.
I’ll keep you in the loop.
If you have clinical depression or know someone who does, you may be interested in learning more about TMS. I have put together a short, but helpful, list of links you can visit to find out more.
(For the record, you can now buy small, personal TMS machines for use at home; however, the general consensus is that they are not very effective and may not be worth the sizeable cost. Use at your own risk, but I would talk to a knowledgeable psychiatrist first.)
**Please remember that as of July 2017, bipolar depression is not a qualified condition for TMS treatment; however, as we know, it is too easy to be misdiagnosed – especially as bipolar. So call your psychiatrist (or find one) and ask about the treatments (and your diagnosis). You may be eligible after all.**
**ALSO: There are a few other exclusions as to who can receive treatment, mostly having to do with metal fragments in your head (braces and fillings are okay). Make sure your psychiatrist knows your entire health history and be as honest as you can during your evaluation.**
**Oh, and FYI: Medicare DOES pay for TMS! (I don’t know about Medicaid, though.) I’ve been through it three times (I have Medicare plus a supplemental policy) and have never received a bill :). Most other insurance companies also cover it now, but not all. Make sure to ask your insuance company if they cover it before you start treatments.**
Okay, here are a few links to get you started: