We have thought about ECT, and I think it would have been an especially good choice back in college when I was unable to function. I guess I have ruled it out over the years, unconsciously because my functioning has improved so much with CBT, I figured I wouldn’t be considered a candidate. I suppose I have until recently really been minimizing the impact of depression on my life. But if I am a candidate for TMS I’d probably be a candidate for ECT. If this doesn’t pan out, we’ll definitely be taking it under consideration. ECT has a bad rap due to its abuse in the past, but it is basically THE most effective treatment for depression, period. The memory loss sucks but it’s only around the time you receive the treatment… not like you forget who you are or anything.
Great question, as I’ve had some difficulty figuring that out myself. This site has a pretty good explanation.
I admit I really don’t know enough about neurology to understand the biological differences, but the treatment framework is straightforward enough - for ECT they put you under and induce seizures, and side-effects include memory loss. For TMS you are awake and unsedated, and the only major side effect is a headache. (It’s interesting, since receiving my first treatment I’ve had a dull ache in my head and down the left side of my face… it doesn’t really hurt, just feels funny.)
I’m going back for session #2 right now… and hoping it hurts less this time!
Has anyone explained why your head hurts post-treatment? Do the medical pros recommend or advise against taking NSAIDs or other analgesics for the pain?
It hasn’t hurt me post-treatment, only during those 4-second intervals where I’m receiving the pulses. The doc said to feel free to take any over the counter pain medication prior to the treatment in order to help with the headache. Yesterday I had an Aleve; today I went with 800mgs Ibuprofin. While I’m fine on my regular medication, I can’t take any ‘‘as needed’’ anxiety meds like Atavan because it will affect my motor threshold. Fortunately I haven’t had that much anxiety over this (other than wondering if it will work.)
The pulses are delivered through a mechanism that operates like a woodpecker on the scalp, only yesterday the pain spread all the way down the left side of my face clear to my chin. It was like that little woodpecker grew pain roots and reached out as far as it could.
Today my pain was much more localized instead of shooting down the side of my face. The TMS coordinator believes it is because the machine was hitting my orbital nerve yesterday. Striking this nerve can cause severe pain in the side of the head. She adjusted the machine (there is a tiny bit of leeway to move it to a more comfortable location… I’m talking 1 centimeter max) and it seemed to help. At first it was rattling my teeth hard and that was actually worse than yesterday. My left eye still twitches but it’s an improvement. Fortunately the lady doing this is really good about trying to make you as comfortable as possible. She has a CD player and essential oils and plants and pretty much anything she can think of to make people feel relaxed.
I also recently increased the dosage of one medication and stopped taking another. On Monday they are going to give me the motor threshold test over again, as my motor threshold is expected to change. The nurse believes the new motor threshold will be lower than the current one, thus allowing the intensity of the pulses to be decreased.
But I have had almost zero side effects post-treatment. The pain vanishes the instant the pulse stops. I was out the door and on the road the minute I stopped, clear as a bell. I have a little soreness/stiffness in the left side of my face but it’s almost too mild to mention.
Reading this, it just sounds too weird. Definitely an interesting experience, for sure.
How do you feel about contemporary treatments for depression? I know for me it has taken years of experimentation to find out what seems to work somewhat well (for me low dose lithium aspartate has been incredibly good, but I’ve used dozens of techniques and supplements over the years with varying results). I am really disappointed in how ineffective we are at treating mental illness at this point in medicine, considering how much pain and disability it causes. I hope my brothers kids never have depression, if they do I hope medicine has advanced by leaps and bounds by then. I’d rather have a physical disability than an emotional/psychological one. At least with the physical disability you can still enjoy the good things in life. Maybe I’m not looking at the right info, but right now it seems like we are only starting to figure out how to treat neurological conditions.
How do you balance the concept of depression as a result of trauma vs depression as a self defeating biological cycle? I know for me I didn’t have depression before severe traumas in my teen years (I felt blue sometimes, but never depressed), and traumas as an adult can shift my mild/moderate depressions into something more serious. At the same time, when I get properly treated for depression despite the fact that my traumas haven’t changed, they don’t seem as overwhelming anymore. ie, I know that depression makes my problems seem worse, but if I didn’t have those traumas I probably wouldn’t have depression. So I guess it is a dependent downward spiral of problems and biological depression feeding off eeach other. But since there is no effective way to ‘fix’ life trauma, I guess addressing the biological fallout of depression is the next best thing. But I know I sometimes feel like I am just treating the symptoms of trauma (depression), not the trauma itself. But the trauma itself really can’t be fixed, medicine doesn’t really know how to undo traumatic events.
Is your husband’s family helping to pay for the treatments?
Are Brodmann area 25 or the left prefrontal cortex involved in the TMS treatment? I only have an amateur knowledge of neuroscience (meaning I can read articles, but that is about it), however my understanding is those 2 areas are big factors in depression. Underactivity in the left prefrontal cortex and overactivity in the right prefrontal and Brodman area 25 are important to depression. There is work with pacemakers to stabalize area 25, but DBS is more invasive.
Does TMS work with the left prefrontal cortex or another area? I’m guessing from reading the above posts you aren’t sure. But I am under the impression that ECT, TMS, VNS (vagus nerve stimulation) and DBS (deep brain stimulation) all work on different brain areas.
Are you noticing color more? Are colors brighter or more noticeable?
I think it depends on the nature of the depression. I generally agree that we’re really only at the forefront of understanding psychological illnesses through a truly scientific paradigm. Only in the last twenty years or so have we begun to conduct randomized controlled experiments on different types of therapy, and even now, while CBT and other evidence-based methods are common, they’re still competing with treatments that haven’t been proven effective. For people who receive access to the right treatment, I think they can help - as I have said, I have been helped GREATLY by CBT, behavioral activation, prolonged exposure therapy and cognitive therapy… literally the difference between me lying motionless on the couch and me earning a Master’s degree in a very rigorous program. I have come to life because of these interventions and I think they will do a lot for many people.
That said, I have a very, very persistent case of depression. I’ve been depressed for as long as I can remember, was so bad that I required hospitalization in 2003 and have fought a long, hard battle to get where I am today. For people like me, it is a lot more trial and error, and I honestly don’t know if it’s realistic to expect that my depression can be completely cured. I generally think of myself as one of the unlucky few, however.
It’s true that meds haven’t really shown any consistent help with trauma, but it’s not true that there are no effective treatments for trauma. I used to have severe PTSD. I took one three-month course of prolonged exposure therapy, a very difficult and time-consuming process wherein one relives and re-experiences traumatic events until they no longer cause feelings of distress. Two years later I am virtually symptom free. It doesn’t mean that my traumatic experiences don’t affect my feelings - sometimes I am sad or angry or whatever, but it’s not out of control. It doesn’t interrupt my life or ruin my day or anything. I just feel it in that moment and move on. I no longer consider PTSD part of my problem. DO NOT GIVE UP in your quest to treat your traumatic experiences. There is absolutely help out there.
As for my depression, there is a strong family history to indicate it is genetic, but there is no doubt it was/can be exacerbated by trauma. Or, if not the trauma itself, thought patterns that reside as a result of trauma. I have worked so hard to purge myself of cognitive and behavior patterns that exacerbate depression, but it persists. I only very rarely have negative thoughts about myself, or just sit around doing nothing - but it persists. I exercise, I meditate, I eat healthy, I get plenty of sleep - it persists. I take meds, it persists. It absolutely sucks because it has cost an incredible amount of time and money to learn to deal with it better, but it hasn’t gone away. I have a ripping awesome life from any objective standpoint - a happy marriage, great education/career prospects, freedom from major financial concerns - and it still persists.
Indirectly. There is no way this could happen for me if it hadn’t been for their incredible generosity over the past several years.
I’m really hoping that this works for you, olives. You’ve been my go-to person to back me up when advocating for CBT for treatment of anxiety and depression - do you think you will reduce your endorsement of CBT? There are so many people fighting so hard against the idea of doing anything except taking drugs for their anxiety and depression, I hate to lose a soldier on this side.
olives, I hope this works for you. The drugs people take for depression have a wide array of side effects and what works for one person definitely doesn’t work for another. My family would be thrilled to find a non-drug solution for chronic depression. I am interested in your experience so please keep us posted.
I know for me, in the last 10 years I have had 3 bouts of pretty serious depression (on top of the melancholy I’ve had issues with) and each was precipitated by severe stress (all 3 bouts were due to financial, educational or vocational issues). So I tend to subscribe to the diathesis-stress model of depression since I know severe stress about being able to earn a living and live independently with dignity has been the trigger over the last 10 years. When I feel that is threatened, the stress puts me into a depression. When I don’t feel threatened by that, I have some melancholy but nothing too serious. The fact that I’m having problems in the worst economy since the 1930s isn’t helping either.
But I can’t always remove the source of the stress, which is a problem. I also can’t remove the original traumas I experienced when younger that likely made me more vulnerable to negative moods in my life. If I hadn’t had those traumas, maybe my brain wouldn’t be so vulnerable. At the same time had I not had those traumas my life would not have the depth or novelty it does. So it is a mixed bag. The lows are worse, and the highs are better due to trauma. You appreciate things more and you worry because you realize they are more fragile too.
I try to avoid triggers (by saving money, investing wisely, being frugal, being a good employees, being educated, etc. all designed to avoid situations where I feel I am not able to financially be self sufficient. Again, the most severe depressions I’ve had were all triggered by stress caused by vocation and financial shortcomings). But I can’t always. So my point was that a person can try to avoid the stress triggers that can put them in a depression (either immediate stress or stress due to unresolved trauma), but not always.
I know for me stress reduction doesn’t seem to help much. Meditation, exercise, guided meditation, deep breathing, PMR, etc. I don’t notice much long term benefit from those. I can’t tolerate the side effects of SSRIs, and from what I’ve read they only work a little better than placebos anyway (I have no idea how well they work on me, I couldn’t tolerate them).
What I have done is focused more on improving the resiliency of my brain to stress. I found some supplements that really help (magnesium and very low dose lithium. My recent depression got about 80% better on these), which have some studies showing them to be protective of the brain in times of stress when stress hormone levels are high, helping to prevent or reverse the brain damage that accompanies stress and can lead to depression. Luckily my MD is into alternative as well as western medicine so I can work with him on these issues.
But all in all my anti-depression toolkit tends to consist of 3 things
Making peace with myself due to the original traumas, and accepting the negatives that come from that (I think this makes me more resilient, at the very least it makes life more enjoyable and less scary)
Avoiding triggers for serious stress that can trigger a depression (for me almost always something to do with a job or income and my ability to live independently with dignity being threatened)
Making my brain more resilient in the face of stress so even when stress happens, I can cope with it w/o sinking into depression
Anyway, I hope what you are doing works for you and you get better. Depression robs people of the ability to enjoy the good things in life, and it sucks. But my point was that the depression is more a symptom/side effect of trauma and stress mixed in with genetic vulnerability, and a person can’t always remove the trauma or stress. I can’t go back in time and change the past. I can improve my reaction to it, but what happened happened. Even if I could, I don’t even know if I’d want to. It is a mixed bag of good and bad, and a huge part of my identity now.
I still strongly endorse CBT. As I said, it is the difference between me functioning or not functioning with severe depression. Even though I still have depression, CBT helped me build a life worth living. CBT is the reason I can be severely depressed and still feel that overall, my life is wonderful. It helps me put the depressive episodes into perspective and reminds me that things will eventually be okay again. It helps prevent those feelings from shifting into suicidal or self-destructive impulses. I can’t underscore enough what CBT has done for me. There was a time I couldn’t even be a student or hold down a job. CBT changed all that. If it could work miracles in a grim situation like mine, how much more could it do for others.
I can only speak from my own experience dealing with PTSD and depression. I don’t think it’s always terribly helpful to focus on WHY the symptoms are there - just on how to treat them. There is a school of thought in psychology (mostly psychodynamic/psychoanalytic) that we must uncover the roots to our dysfunctions in order to heal. I prefer the direct approach - I’m dealing with X problem in this moment and can try Y and Z to address it. I have depression. Whether it’s lingering stuff from trauma, a deeply ingrained biological vulnerability or both, it’s the same problem I have to solve.
There was a time when I felt like I was constantly engaged in a war with my past experiences - when I wasn’t reliving them directly, I was shrouded in this pervasive feeling that I was in extreme danger. Prolonged exposure therapy changed that. Honestly I barely even care about my past anymore. I feel normal feelings of sadness, grief and anger at times, but they are 100% natural responses to sad life experiences rather than this ticking time-bomb of terror and catastrophe that they used to be. I recognize how it shaped me into the person that I am today, but I’m also way more interested in what’s going on right now. So it’s true that the trauma cannot be removed, but it can be contextualized and put in its proper place.
I’ve put this whole post into my archives, because it addresses a number of issues that keep coming up in our anxiety support group that I haven’t had a good answer for before. Thanks, olives.
Today they re-did my motor threshold and changed the location of the pulse somewhat. It felt SO much better. I was relaxed and even able to talk while the machine was pulsing. It wasn’t the orbital nerve, but the trigeminal nerve - the one that controls the facial muscles - being hit repeatedly by the pulse. This was what was causing so much pain. I am really grateful for what the TMS coordinator has done to make sure I am as happy as possible. She sensed that I was having more pain than the average person and took extra time to address the problem - even insisting when I told her I could grin and bear it. They could have just slapped the thing on me and went full speed ahead, but they are always so in tune with what could make the experience more comfortable for me, and I appreciate it so much. I also appreciate being able to talk to her while I’m sitting in that chair. I brought in some music today, we turned off the lights and listened to the rain on the window. I would almost call it relaxing.
Today was Day 13 of the TMS… close to halfway through. By now it is pretty routine for me, the pain has diminished significantly and I am able to relax and converse during the treatment without interruption. I almost fell asleep yesterday.
We did our 3rd depression measurement using the Hamilton scale. There has been significant improvement from week to week.
The self-report: 17, (high moderate) to 14 (moderate) to 6 (mild.)
Clinician report: 31 (severe) to 17 (high moderate) to 7 (mild.)
I was quite surprised to score so low on the depression scale because there have been a lot of negative things going on which have made me kind of grouchy in a perfectly ordinary way (to make a long story short, we just had the moving experience from hell and life is kinda messy right now.)
It’s weird to consider the concept of the absence of depression. The absence of depression is not euphoria… I’m not running down the halls in jubilation or anything. I’m just… not depressed. I feel like it’s a little harder to knock me down lately… in fact, for the first time in my life I called to complain about bad customer service yesterday. Instead of feeling overwhelmed by the situation I took active control of it in a way I wouldn’t have done before. I haven’t lost my concentration or train of thought at all this week, which is something I have struggled with for years.
The TMS coordinator who has been administering the treatment told me that these small changes (better sleep, improved coping skills, a stronger sense of groundedness) are the first things that tend to happen around the 2nd week, and then after about 20 sessions the mood really improves.
I’ve been doing well enough that the doctor has allowed me to cut down on one of my meds (Ripserdal) which has been causing bad fatigue. I have permission to stop it altogether in one week. She doesn’t think the anxiety will return.
For me, the real celebration will come if I’m still feeling good six months post-treatment. But at the moment, it really appears to have helped.
Wow. It’s pretty remarkable that it worked so quickly. It’s very fascinating from an outsider’s perspective. Congrats as well! It’s good to remain cautiously optimistic. Keep calling customer service too! The few of us who do need more people to gripe when needed!
