Friday, November 27, 2015

Is remission from depression possible?

The psychiatrist that I've been seeing for over two years keeps a picture in his office that looks like this:

I glance at it every time I go to see him and wonder if my brain truly resembles something like the picture on the left. It looks like the lights are turned out, as if the brain is stuck on a dimmer switch after years of enduring depressive symptoms. I can actually pin-point each little highlighted area as an avenue in my life that is relatively high-functioning despite my depression: my relationships, my work life, my creative life, and the time I spend thinking about my goals and dreams.

Not all depressed people can say that. 

I often consider what my life would be like if my brain was fully alive and on fire like the picture on the right; brightly lit up and glowing with possibilities and promises. Changes. Challenges. Growth. The stuff of personhood. The way I would live my life everyday if I could.

Then I think about how I often feel in the day-to-day: The numbness. The void of emotions. The afternoons wasted in bed. The cancelled brunches with friends. The missed meetings and appointments. The excuses that follow. The weight-gain. The constant negative monologue that has taken residence in my brain. The frustration. The "I'm not good enough's" and the "I never will be's." The debilitating guilt and shame. And the medications - so many medications!

I recently told my doctor that it feels like I experience a low-lying level of undulating depression most of the time. My medications have to be adjusted every 3 - 4 months just to keep me functioning at the level I need to fulfill my current responsibilities. If not, I'll crash and have been known to become suicidal. This can't be an optimum way to live. 

One day at my doctor's office, after complaining again that my medications just weren't cutting it, he told me about a procedure called Trans-cranial Magnetic Stimulation, or TMS. It's a relatively new procedure that has developed over the last 5 - 10 years. 

My understanding of TMS is that it is a non-invasive treatment for types of depression that do not respond well to antidepressants. It can also be used with patients who experience unbearable side effects from drug therapy. It utilizes similar technology as an MRI, hence the non-invasive classification. The patient sits in a dentist's office-type chair where a large plastic headband is placed over the head. The metal coil, which distributes magnetic pulses, is placed directly over the patient's prefrontal cortex, or the part of the brain that is thought to control one's mood along with many other things. The magnetic pulses are supposed to stimulate and eventually retrain the neurotransmitters in the brain that have forgotten how to make essential brain chemicals such as dopamine, serotonin, and norepinephrine.  The treatment is administered for about 45 minutes. As the magnetic pulses are delivered, the patient feels a repetitive tapping sensation on the head. The patient can go back to work immediately after receiving treatment. 

TMS is not ECT, or Electroconvulsive (shock) Therapy. There is no need for general anesthetic, and there is no risk of memory loss. In fact, the side effects for TMS are minimal: pain at the sight of the metal coil, headaches, and muscle twitches. Most of these are known to disappear after a week or so of treatment. Treatments have been known to last for as many as five days a week for six weeks in a row.

My doc said that about 1/3 of TMS patients experience complete remission from depression. Many are able to go off of their antidepressants entirely. Some are able to cut down to one maintenance-sized dose of medication. 

Good Lord, sign me up.

Pending my insurance's approval, there is a good chance I could begin TMS treatment in early 2016, as my doctor said I was a good candidate. Not only does medication not perform as it should for me, I've experienced several undesirable side effects along the way. It's been six long years of drug therapy. Now I'm ready for another chance. Something new, something with potential. 

TMS could be a solution for me. On the other hand, it may not. In the meantime, I will remain hopeful for the future and thankful that I have insurance that will most likely help me cover the cost of treatment.

Until then, be well, be kind, and hope on.

To our health,


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