Over the past 20 years, I’ve coped relatively well with antidepressants and mood stabilizers … until this year. I’ve been on medical leave most of the year with treatment-resistant depression. I’ve had some pretty bad spells over the years, but five months ago, I entered the deepest depression I’ve ever experienced. My medications were no longer working, and I was desperate to find another solution.
Then, I heard about transcranial magnetic stimulation (TMS), and after some research, I was hopeful that this could work for me. Since TMS was FDA-approved in 2008, most insurance plans in the U.S., including Medicare/Medicaid, cover the treatment, but insurance requires proof that multiple medications have stopped working.
Going into my first treatment, the internet and my doctor provided expectations such as the procedure, treatment effectiveness, reaction times and side effects. Here’s what I learned and experienced.
How it works?
TMS is non-invasive and doesn’t requires anesthesia. The TMS device contains a magnetic coil that pulsates to stimulate neurons in the region of the brain associated with depression. At this time, TMS is approved for treatment-resistant depression and obsessive-compulsive disorder (OCD), but ongoing research explores protocols for other mood disorders, post-traumatic stress disorder (PTSD) and even chronic pain.
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Because the treatment involves magnets, you cannot wear any metal jewelry, hair clips, etc. Discuss any metal implants in your head with a doctor — they will advise if you are a candidate based on the location of the implant.
What to expect?
During the treatment, you’re in a comfortable reclining chair with an adjustable headrest and lumbar support. There is a T-shaped tape that keeps the head in position on the headrest, and you’ll wear earplugs. The magnetic pulses are administered on the left side of the head towards the front.
During the first session, the doctor performed a mapping exercise to position the magnetic pulse correctly. The machine issues a single tap while the doctor watches for a finger twitch from the right hand. Once this is complete, the position is programmed in the machine.
How does it feel? How long does it last?
The pulses feel like Woody Woodpecker tapping on your skull for five-second intervals with a rest period in between. The machine beeps before each series of pulses, so you know when the pulse interval starts. The treatment can last anywhere from 17-37 minutes, depending on the rest periods. We started out with longer rest periods, and as I got used to it, the rest periods decreased.
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Treatment protocols are four to six weeks and occur every weekday. A tapering period follows with about six treatments every other day.
What to do with your time?
You can’t wear earbuds due to the metal, and the reclining position makes it difficult to read. My center had a smart TV, so I watched videos and listened to podcasts via YouTube. I thought of the treatment as reprogramming my brain, so I chose inspirational and humorous programs for a positive mindset. Also, you can’t fall asleep. With the woodpecker tapping, you’d think it would be difficult, but fatigue means I can fall asleep anywhere, any time.
When will I see improvement? How much improvement should I expect?
Response time and improvement vary for everyone. Some people see an improvement the first week. I saw a slight improvement after four weeks and an amazing improvement at the end of the six weeks. However, it doesn’t work for everyone. Forty-five to 60 percent of patients see some improvement with 30-40 percent achieving remission. Effects can last up to 12 months, and insurance coverage for follow-up treatments varies. Luckily, my insurance will cover another course in three months.
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Are there side effects?
Headaches are the most common side effect, but as you get used to the treatment, these usually fade. Taking some Ibuprofen before the first few treatments helped, but after a few days, I tolerated the tapping.
Another common side effect, referred to as “the dip,” can occur during the first few weeks. Everyone reacts to the treatment differently, so you may not experience this at all, but it’s something to be aware of. During this dip, the initial improvement is reversed, depression recurs and it can be much worse. I experienced this about a week in, and it lasted a day or two. Others report dips up to a week. Since responses vary, I actually experienced another dip after about four weeks, but it wasn’t as bad as the first one.
Seizures and fainting are less common side effects, which is why someone will monitor you during the treatment.
I’ve just finished the six-week protocol and tapering period. I’ve seen a great improvement. I haven’t seen the hoped-for remission, but for now, I’m no longer stuck on the sofa, and my house doesn’t look trashed like I threw a huge party. I don’t know how long this will last, but I’m taking it day by day. I’m also looking for a provider that does the new ketamine nasal spray called Spravato, which is covered by insurance unlike ketamine infusions, and I’m following research advances using MDMA, LSD and magic mushrooms. Also, I have not ruled out electroconvulsive therapy (ECT). I absolutely refuse to give up the fight.