TMS Therapy For Depression: Here’s What Happened
By Astrid Lucas*
Special to JenniferMargulis.net
I heard about TMS therapy for depression in early April of 2020. My mental health had been spiralling for a while., Bbut it had gotten particularly bad a few weeks into February. I suffer from severe depression and suicidal ideation. I was in my first year of college. When Covid-19 forced me to move back home in mid-March, I became more isolated than ever. After I lost the routine that had kept me afloat, I completely collapsed. Hello
Feeling too heavy to move
The vortex of bad news that surrounded me made it feel impossible to be optimistic and it was harder for me to attend class than ever, despite (read: because of) virtual learning. I felt like I’d hit a dead end. My bones felt too heavy to move. I couldn’t get out of bed in the morning, but I couldn’t fall asleep at night either. When I did nod off, my sleep was interrupted by constant nightmares. The bad dreams made me wake up more exhausted than when I’d gone to bed.
I felt like the mental health system and my college had let me down. As my mental health had gotten progressively worse, I had been reaching out over and over again. I’d been given more medications, different medications, and different pieces of advice that I couldn’t follow. My therapist told me: “Reach out to a friend when things get bad!” But how could I reach out to a friend when I was rocking back and forth in my dark room in the middle of the night, paralyzed with the irrational fear that my loved ones were dying or dead?
Told one thing, then another
My college promised we could stay on campus as long as possible, then suddenly told us we couldn’t return from Spring Break if we’d already left, and had to leave immediately if we were still on campus. So I had to pack up and get on a plane to move across the country over the span of twelve hours.
As I was lamenting this to my therapist for the umpteenth time, wishing I could just “try harder” or “find the right medication” to feel better, she told me she didn’t think I could solve my mental health problems with either willpower or more medication. Then she told me about her colleague, a psychiatrist who did trans-cranial magnetic stimulation in his office. She said TMS therapy for depression might help.
TMS therapy for depression: wanting to try it
She didn’t even have to explain to me what it was; I already wanted to try it. Honestly, I would have tried anything. So I did some research on my own and told my parents I wanted to do it. I’d been through the medication merry-go-round with limited results, which was a discouraging process. The prospect of starting TMS for depression gave me hope for the first time in a very long time. Just knowing that it was an option for me and scheduling the first week of appointments gave me energy for a few days.
Fitted with a helmet while magnets stimulate the brain
I went to the psychiatrist’s office about half an hour from my house every day and stayed for about forty-five minutes. I drove myself there in my parents’ car and called from the parking lot to be let in. A physician’s assistant named Kelly would come get me. She brought me to a small room with a big chair with a helmet for the TMS sessions and some art and plants that made the room feel cozy. A window looked out into a small garden and I could watch birds splash in a fountain during sessions.
Kelly fit a helmet over my head. She sat in the room for the duration of my 30-minute session to make sure everything was working properly and because of the small chance I could have a seizure, a very uncommon but serious side effect. But we didn’t talk. (We probably would have gotten to know each other better over the course of those eight weeks had I not had to wear earplugs or noise-canceling earbuds to soften the loud tapping noise from the machine.) Instead of chit chatting, I listened to music or audiobooks and colored virtual mandalas on the iPads the office had for us to use, which was very relaxing.
Every eight seconds or so, the machine would activate some magnets in a short burst and stimulate part of my brain. My fingers would twitch and the right side of my jaw would clench, so I had to wear a mouthguard during sessions to keep my teeth from grinding. It was surreal to watch my fingers shake. My hands were completely out of my control.
Someplace to go
It was helpful for me just to have to go somewhere five days a week, especially when I wasn’t going just about anywhere else because of Covid.
Kelly and the office’s nurse practitioner encouraged me to try meditation during sessions. Yeah no. I wasn’t into the idea of being watched while I meditated, and I’ve tried meditation before without success. It’s kind of a catch-22 when you struggle with PTSD and intrusive thoughts. Meditation is supposed to help with spiraling negative thinking, but when you’re in a really bad place psychologically and feeling suicidal you can’t control your thoughts. Instead of feeling peaceful and grounded, you end up ruminating and catastrophizing and getting caught up in the past.
When did I start to notice a difference?
My psychiatrist told me I could expect to start feeling better in 3-4 weeks, but possibly longer. I knew the stats: about half of people with treatment-resistant depression benefit from TMS therapy for depression, and about a third experience full remission.
TMS therapy for depression felt like a last resort to me. Although I knew there were other options, I was barely holding on as it was and I didn’t think I could cope with another failed treatment. When I didn’t feel any better after about three and a half weeks, my mood dropped lower than I thought was possible. I feared that I was going to have to endure this uncontrollable feeling of helplessness forever. Even a few months more felt like agony. I wanted to die. But I had reached the conclusion that I couldn’t end my life. For the sake of my family. I didn’t want to inflict that kind of suffering on them. So I felt completely trapped.
Planning my death and dreaming about an end to the pain I was experiencing gave me a sense of security and hope. When I lost that as an option, I felt completely empty. I couldn’t function at all, and as far as I could tell, I was doomed to feel that way for the rest of my painfully long life. I discovered that my rock bottom wasn’t a suicide attempt or plan or ideation, but the days and weeks I suffered knowing there was no end in sight.
Wanting to die
Every thought I had centered around wanting to commit suicide. I would burst into tears at random throughout the day wishing that it could all end, but knowing I couldn’t do it myself. I reminded myself that the TMS therapy for depression could start working, but the fact that it hadn’t after over a month destroyed me
My mom realized that I had started taking handfuls of ibuprofen every night. Even I didn’t know why. Perhaps it was some misguided attempt to make my death more gradual? Or to try to end my life without the guilt that I was doing so? I honestly don’t know
She confronted me about it. I lied and told her I was just taking the painkillers for my shoulder pain. She could tell I was lying and reminded me that what I was doing wouldn’t kill me, only injure me.
She called my therapist and told her she could tell I just “didn’t want to be here anymore.” I talked to my psychiatrist. He prescribed me a low dose of lithium to help with the suicidal ideation.
An awkward drive to the pharmacy
My dad drove me to the pharmacy. My parents couldn’t trust me to drive alone without ending my life. During that car ride he asked me why the doctor prescribed me lithium. My dad said he knew a lot of people on some of the medications I’d been on in the past, like prozac and zoloft, but lithium seemed like a “different ball game.”
“For suicidal ideation,” I muttered.
“How bad is it?” He didn’t seem surprised, but I could tell by his forced steady voice that he was upset. He asked me how often I was having suicidal thoughts.
I told him with a deep sense of shame that every minute of every day was consumed by these thoughts. Trying to hold back the tears, I admitted I wished I could disappear.
Cannabis a reprieve
I told myself I never should have been born. I felt guilty for putting my parents through all this. No parent deserves to hear that their child wants to take away the life they gave her. But I felt powerless. I forced myself to go on walks outside, but sometimes the best I could do was sitting on the porch. Being outside and exercising always helped, but I had to have the energy and motivation to get out the door, which was rarely. The one thing that gave me a reprieve was taking a THC gummy and forcing myself outside.
When I was high and outside, I could finally appreciate the things my depression didn’t let me enjoy. I would lay on logs and watch the sky, or walk the local trails until I found a good tree to climb. To my disappointment, I always returned to my normal monotonous sadness once the gummy wore off and I came home.
A turn for the better
However, things started to turn around after about six weeks of TMS therapy for depression. I finished the assignments for a class I’d taken an Incomplete in, which decreased my daily stress and guilt. The combination of the lithium and the TMS therapy for depression seemed to help. For the first time in a long time I had some respite from fantasizing about driving a car off a cliff, falling off a bridge, or just going to sleep and never waking up.
I didn’t trust it though. I’d had some good days that preceded the worst periods of my life, so I knew that I could feel comparatively okay from time to time just to end up in a pit of sadness an hour or a day later. But two weeks of feeling better gave me hope. I began to trust that I could actually get better, just a little. I still didn’t particularly want to be alive. But dying didn’t obsess me anymore. I started planning a backpacking trip. It felt good to have something to look forward to.
Helped by TMS therapy for depression
Long term, the success rate of TMS therapy for depression drops a bit. From what I’d seen online, a lot of people experience a dip in mood around six months out and require more sessions. I didn’t find that to be true. My mood started improving as soon as I got back to college. Having a community and a routine made it a lot easier to keep my head above water and even feel consistently happy.
I worried a lot that those good periods wouldn’t last, but they did. Even though I’ve had a few low days or a bad week, like my friends who haven’t been diagnosed with or medicated for mental illness, it never got worse than that. I still had the energy to do the things that kept my depression from getting worse, like hanging out with friends and exercising regularly, which made all the difference.
Was it the TMS, the lithium, or something else?
I stopped taking lithium once, but found that my baseline mood started worsening, so I talked with my psychiatrist and decided to start taking it again. Today I take 150 mg every night, a relatively low dose. When prescribed for bipolar, people usually take at least 450 mg. I attribute about half of my positive changes to TMS, and half to being on lithium.
I’m still taking bupropion, and I have trazodone on hand in case I have trouble sleeping, but I haven’t needed it in the last two months. The lithium and the TMS therapy for depression have helped me decrease the doses of the other medications, I think.
A sense of purpose
The most important things for my mental health right now are having things that give me purpose. Like working and volunteering, and maintaining relationships with the people I love.
For the first time I can remember, I feel like I can handle my mental illness. I lived in terror of getting depressed again, thinking that another depressive episode would be too much to bear. Each time I woke feeling down I panicked, sure that it was the beginning of the end. Of my happiness. And my will to live. But now I feel stronger and more hopeful. The last six months have taught me that I can live a life that I love, even after my depression told me there was nothing left.
For now, I’m doing seasonal work in a couple beautiful locations until September. I plan on returning to college and taking a reduced schedule to make time to work and take care of myself, and I’m excited for what’s to come.
About the Author:*Astrid Lucas is a pen name for a 20-year-old who has struggled with depression and suicidal thoughts. A sister, daughter, friend, and excellent student, Astrid loves the Pacific Northwest, backpacking, and mountain biking. She is taking a semester off from her sophomore year of college to work at an outdoor job in Utah. You can read her first essay about trying TMS to help her struggle with suicidal thoughts here.
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