Ask the woman receiving transcranial magnetic stimulation for depression

A few folks asked me to start a thread regarding my experience with TMS (transcranial magnetic stimulation) for depression. I was originally going to wait until the treatment was over, but I thought some people might appreciate following my progression through the full 6 week course. Today was my very first day.

We’ll start with the basic definition:

Basically, they hook up a machine to your head and blast you with low-level electromagnetic pulses in order to alter neural activity.

Ask away.

Are there side effects afterward? Bad headache?

Interesting coincidence, I just reviewed a study on TMS for major depression today! Are you doing it daily?

What is it like, getting this treatment?

How long does a session take? How often do you go?

When are you supposed to know if it’s helping you?

Well, my first session today hurt more than I expected it to, but only during those 4-second intervals where you receive the pulse. The pain is difficult to describe… like having a monster headache with a little hammer striking you repeatedly at the source of your pain. The weird thing is, the pain vanishes the second the pulsing stops, and as of one hour post-treatment I have no headache or other symptoms.

They told me the pain goes away after the first few sessions. I guess the nerves in your scalp become desensitized with time. I admit I’m not especially excited about doing this again tomorrow.

30 sessions over 6 weeks. 5x a week for 4 weeks; then tapering off over the last two weeks.

Do metal objects stick to you now?

It’s 37 minutes a day, five days a week for the first four weeks. The first time takes longer because they have to establish a ‘‘motor threshold’’… basically they zap you until your fingers start twitching the right way and that allows them to set the pulse intensity based on your individual motor threshold.

You sit in a chair, kind of like a dentist’s chair, and they wrap tape around your head and kind of stick you into the chair nice and firm. You have to wear earplugs because the clicking is apparently loud enough to damage your ears. Then they put this sort of helmet-thing on… it looks like this and feels like your head is being squished in a vise (not painful… just pressure.) Once the coil is targeting your left prefrontal cortex, they start the machine.

chime 4 second zap 26 seconds of nothing

Repeat for 37 minutes.

You’re supposed to know it’s helping because they take both self-report and physician report measurements of your symptoms. They do this every week so ideally, the scores on these scales will improve with time.

Is this only for uni-polar (or generalized or major) depression or can it also work for the depressive phases of Bi-Polar I and Bi-Polar II?

Did you have a tendency to bang your head as a child? (This is a serious question.) Have you tried listening to recordings that try to shift your brain waves to alpha/theta states and did this work at all?

Thanks for your time! I hope you feel better.

This treatment in many ways is still in the experimental stage. In the United States, it is currently only approved for recurrent major depressive disorder in individuals who have not had success with at least one anti-depressant medication. In fact, it’s only this specific device that is approved by the FDA. While it has been identified as a promising evidence-based treatment, we are still way off from fine-tuning and exploring the practical applications of this technology.

I used to hit myself in the head with books when I was frustrated, but as a little kid I don’t think I did much head-banging.

Nope, I don’t believe I have any experience with that. Thanks!

Living Well, one thing I wanted to add is that this treatment is often recommended for patients who have difficulties with medication side-effects because TMS is virtually side-effect free. It doesn’t enter the system the same way medication does, so you don’t have to worry about fatigue and nausea and lowered libido and all that stuff that often comes with meds. The headaches tend to be mild and only last a few days.

Let’s just say I’m giving a certain Marvel super-villain a run for his money.

I am fascinated by this treatment and I’ve given it a little bit of thought for my own depression. I have it somewhat controlled with medication and CBT but it never seems to be enough. I can say that I feel better, but I can’t say that I feel good. Does that make sense?

From some of your other posts, I know you’ve been fighting depression for a long time and were having a lot of success with CBT, so I was surprised to see you starting the TMS treatments. Has something changed?

Practical questions:

Is it expensive? Does the average insurance company cover it?

Once the course of treatment is done, how is it that it continues to work? I can see the direct stimulation affecting your mood and even lasting a while, but once you’re done with your six-week treatment, how are you “cured”? Or do you need to go back periodically?

Same practical questions as Antigen.

I tried reading up on transcranial magnetic stimulation but the descriptions were too scientificamal for me to really understand. Do you know of a site/book that explains it in lay terms, or can you give explaining it a shot for the masses?

Thanks and I hope it makes yoiu feel better!

Taking a different approach (and please disregard if this is too personal), how does your husband feel about you doing an experimental treatment? Have you shared this with family and friends? And if so, have you gotten positive responses? Do you feel any sort of stigma attached to the fact that you’re dealing with an experimental treatment like this?

My best wishes for tremendous success.

Yes, that makes perfect sense, and conveniently answers your question. CBT has helped me a lot, but it wasn’t until I returned to therapy that I realized how much depression I was really willing to put up with and still call my life ‘‘good.’’ According to the scales, I’m severely depressed. ‘‘Really?’’ I thought. ‘‘But I’m doing so much better.’’ It’s great that I have learned not to catastrophize so much and that I’ve cut out all of the nasty self-talk that can perpetuate despair, but at the end of the day I’m still living with severe chronic depression, and I’m tired of it. The reason my psychiatrist recommended this treatment for me is because much of my depression is physical in nature (fatigue, aches and pains) even when I address the thinking and behavior components properly. I can be exercising, eating right, meditating, medicating and doing everything ‘‘right’’ and still be very depressed. Yes, I can function reasonably well, but functioning’s not good enough.

Practical questions:

God yes. The only time I’ve had to write a bigger check was when I bought my new car.

The answer is ‘‘maybe.’’ No insurance companies officially cover it, but people have had a 75% success rate with appealing for coverage of 50-100% of the cost. This is why they track your progress so carefully - insurance companies are more likely to cover it if they see evidence that it is working. The center where I am receiving the treatment has been giving me a lot of guidance regarding the appeals process.

My husband and I both decided going into this that we are treating the cost as if it won’t be reimbursed, because we have no guarantee. We got a discount for paying up front. We’ve had to commit to a number of financial sacrifices to make this work.

Some people never have another episode of depression again and require no follow-up. Some people require a moderate or low dose of anti-depressant for maintenance and others return for follow-up visits (of a shorter duration) every few years. As far as I know, the research on this treatment has yet to address long-term effects, but anecdotally based on this specific device in this clinic it appears to result in permanent remission in about half of all recipients.

olivesmarch4th–close your eyes, & tell me which direction North is, without lookin.

This is an excellent question. My husband is a Ph.D. student in clinical psychology, so if anybody was going to give me shit about an experimental treatment for mental illness, it would be him. I expected him to be very skeptical and hard-nosed about this, and was not getting my hopes up that he would agree to it. I was hesitant myself because the evidence of efficacy here is much less robust than it is for CBT and medication - but the evidence is there. In one open-label trial, 50% of all patients experienced full remission. I happen to feel right now that my mental health is in very competent hands, so I trust both my psychiatrist and my psychologist when they tell me this could really help me. So I just had this hope - that maybe it could be an option for me.

Anyway, when Sr. Olives and I had the conversation, it was a lot shorter than I expected.
‘‘I kind of really want to do this,’’ I said.
And he replied, ‘‘Then you have my support.’’ Just like that.

When we went to the free consultation and they dropped the price bomb, I could feel my husband’s brain imploding as he sat next to me (he REALLY hates spending money… which is the reason we can afford it in the first place.) I told the lady we’d talk it over and get back to her. Once in the car, I 100% expected him to resist based on the cost.

But no. The first words out of his mouth were, ‘‘I assume we’re doing this?’’
‘‘I really want to.’’
‘‘I really think it could be good for you. Okay. We’ll make it work.’’

I fell in love with him all over again. I know his response might have been different if I hadn’t already tried so many things. As of this moment I have tried 14 different psychiatric medications, CBT, prolonged exposure therapy, cognitive therapy and ACT. I’ve gotten something out of each treatment, but I still suffer, and I think he’s just tired of watching me suffer. My depression doesn’t just affect me - it affects him too.

We have discussed it at length. I told him it might not make all my symptoms go away forever, I talked about my fears that it won’t work, and the money being wasted, and everything. He’s been very supportive and calm about the whole thing… just says sometimes the risks are worth the potential benefits and leaves it at that. The way he hasn’t stressed about this is actually kind of shocking and contrary to his character, but it sure helps me not stress about it so much.

As for other relatives and friends, they’ve been very supportive and a little curious. As far as the stigma goes, I feel a stigma for dealing with mental illness, but I don’t feel a stigma for trying an experimental treatment. I know people probably don’t realize this, but there are plenty of treatments in routine use today that have less evidence of efficacy than this experimental treatment.

In all honesty, though, it’s one of the biggest risks I’ve ever taken.

I’m curious to know the costs involved. I have been thinking about this for a while and I may go this route, but it looks like I’ll need to start saving up!

Can you maybe PM me, if you’re not comfortable talking about the costs here?

I’m not surprised your husband wanted to go for it. I know that I was ready to pay out the nose for anything that seemed to offer some hope for my late husband’s health struggles, even if some of them seemed goofy. We didn’t end up doing much in the way of experimental treatments (the closest we came was a really neat heart treatment that showed some promise but in the end his cardiologist (one we really respected) said he believed it would be a waste of money for reasons X and Y), but we were willing to spend it even when things were pretty damned tight.

I’m glad this option was available to you. I’ve never heard of it. Consider my fingers crossed and my poles aligned in your general direction! Um, which sounds way kinkier than I expected. Sorry. :smiley:

Okay, I’ll come out with it. It runs about $350 per session, for 30 sessions that’s… $10,500.

When I think about how cost limits the ability of truly suffering people to do things like this, it gets me kinda upset. I’m grateful we’re in a position to do it.

jsgoddess, thanks for the vote of support. The only person IRL I’ve told about the cost is my Aunt to whom I am incredibly close. I guess I’m worried that if people find out how much this costs they would judge me. But chances are they don’t have to live with depression every day despite doing practically everything in their power to get better. It’s so frustrating, it can feel like the biggest joke, having an amazing life but not the ability to truly enjoy it to the fullest. I think there comes a point where you’ll do just about anything to stop your suffering, and I’ve reached mine. And I think Sr. Olives has too.

Just clarifying - to the best of my (study reviewer’s) understanding, this treatment with this particular coil is indeed FDA approved for major (unipolar) depression in people who’ve failed treatment on at least one antidepressant. In this sort of patient, the “experimental” part is that they’re trying to figure out how long a treatment regimen will last, and how to go about timing “reapplications.”

For any other indication? Experimental as hell. It’s apparently had poor results in many neurological (not psychological) trials but came up with definitive benefit in major depression studies. They’re testing it on other stuff too.

(Disclaimer: IANAD/N/psychiatrist, this is just what I’ve gleaned from my semi-scientific readings on the topic. My reading was mostly to determine the safety of pursuing a research project at our institution, and it overwhelmingly seemed to be safe for potential study subjects.)