“A woodpecker on steroids” – My experience, so far, with Transcranial Magnetic Stimulation

So, for the first time in my multi-decade battle with depression, I’m trying a new type of therapy (other than talking and taking pills). It’s Transcranial Magnetic Stimulation (TMS), and I’ve written about it before.

Here’s the basic gist of how it works:

Transcranial magnetic stimulation (TMS) is a method whereby an electromagnet placed on a scalp transmits magnetic pulses or waves to a small portion of the brain. Repetitive transcranial magnetic stimulation (rTMS) delivered at a low frequency (once per second) has been shown to reduce the reactivity or excitability of the part of the brain stimulated and other brain regions functionally connected to the region stimulated.

I started it Monday, and it is time intensive – not so much in how long you have to sit there (my sessions are only twenty minutes), but in terms of how long you have to do it – for me, it’s six weeks, five days a week. I had to wait until vacation was over and for a break in my calendar to make it happen.

As for how it works: Honestly, it’s not hard. You sit there. You get yourself into a nice and comfy chair and they adjust a couple of things by your head. The right side of your head is lined up with a pad to keep your head still. The left side of your head is where the action is at – a magnet, enclosed in some equipment, is aligned in the right spot. It’s desired location is your frontal cortex, which is the area of your brain where depression apparently can be adjusted. They send one magnetic pulse into your head, and if your hand twitches, they have the right spot.

Once they have the right spot, they save the settings and that’s where you sit. If it’s aligned right, you may feel a little discomfort or pressure during the actual treatment. The actual treatment consists of your head being tapped with a magnet (not directly, but through padding) for four seconds, followed by a rest of twelve seconds. That continues for twenty minutes.

Is it painful? No. The first alignment can be – if it’s misaligned, it hits a nerve and OUCH. It just stings for a few seconds. They readjust, and then it’s fine. Now, is it comfortable? Nah. But you do build a resistance to it. I had a headache and took Tylenol the first three days. By days four and five I barely noticed. They also give you earplugs. Those are optional, but if a Doctor gives you ear plugs, use them, okay?

It’s a strange experience, described to me by the nurse as being hit by a woodpecker on steroids. I love that description, and it’s accurate. I mean, you’re basically getting tapped by a magnet or roughly 30 times over four seconds. It’s weird, but not painful. I’ll putz on my phone, close my eyes and chill, whatever. Honestly, its not that bad. The session ends and you go back to work. There are no after effects, except for maybe a slight headache that Tylenol can bop right out. You can drive, think, function, etc. I’ve left therapy sessions where I’ve been more disoriented.

When am I supposed to see results? The literature I read said week four. They said they thought they had seen some people get more depressed as the placebo effect wore away in week two. I’m hoping I don’t go through that, because I have no illusions that this will work until at least week four.

So, one week down, five to go. Here’s to hoping.

As always, I’d love to hear your thoughts and experiences, and as the process goes on I’ll share more, including some pics. Let us know about your TMS experiences below!

SIDE NOTE: First, again, I’m not a doctor or medical professional – I’m a damn politician and writer. I’m certainly doing my best to write an accurate description, but if you have any questions or concerns, please contact a medical professional. Second, this probably goes without saying, but I’m going through this treatment like any other normal person and paying with my insurance. I am not receiving any compensation or consideration whatsoever for sharing my experiences.

The incredibly sweet tribute to a mental health hero in Zelda: Breath of the Wild

I’ve written about video games before, but never quite like this.

Yesterday, I was watching this video on Zelda: Breath of the Wild (awesome game, by the way). In the course of watching, I came across this:

For those of you who don’t watch the video, here’s the basic gist: Link, the game’s hero, walks to the edge of a Proxim Bridge in the game. He is confronted by a character named Brigo, who stops you from jumping off of the bridge and says things to get you to stay put. He even offers to stay with you to keep you company.

Okay, kind of random, right? Brigo is likely inspired by Kevin Briggs:

Kevin Briggs.jpg

Briggs is a fascinating man: He spent decades working for the California Highway Patrol, which he retired from in 2013. During much of that time, he patrolled the Golden Gate Bridge, and by his estimates, stopped over 200 people from jumping to their death.

This is a truly kind tribute to a man who clearly deserves it.

If you want to watch the entire scene, it’s below:

What does peace feel like to you?

I’ve written before about my relatively desperate attempts to meditate. I phrase it that way because it seems like, no matter what happens, my efforts fade away. Then I’m reminded of how important meditation can be for depression at a later date. I start again, I start again, and the cycle continues.

The good news – well, at least for me – is that I am in a cycle now where I am actually meditating. While I haven’t noticed a change in thinking yet, I will say that I always feel better and more peaceful in the immediate aftermath of a meditation session. And, that sense of peace is what I want to discuss in this entry, because I had a genuinely interesting realization while meditating the other day.

The meditation I practice – which, from what I’ve read, is the best kind for a depressed or anxious person to engage in – is mindfulness meditation. It’s a little complicated to explain – mainly because I don’t understand it and I kinda suck at – but the basics is focusing on nothing – and, in so doing, improving your focus.

Like I said, I’m terrible at it. My mind moves at a million miles an hour and I can’t shut it off. That’s one of the many reasons I am meditating: To try to relax and improve my focus.

So, the other day, I’m meditating. I have been sticking with five minute sessions – YouTube videos – and doing so because if I do longer I fall asleep. Anyway, I’m almost done. That realization is met with a degree of happiness and sadness. Happiness because I can get back to work. Sadness because I am at peace. And then I realize something: I’m at peace. Meditating is nice, and when I can actually concentrate enough to do it right, it fills me with peace.

That, then, triggers a question: What does peace feel like to me? There’s an easy answer, too: A fullness. A fullness in my chest which crowds out any negative feelings.

So, here’s my suggestion: Find what peace feels like to you. Because if you do, you can recognize the feeling when you actually experience it. And maybe, from there, learn how to keep it with you, even if it’s only just an extra moment or two.

Anyway, that’s something to think about: What does peace feel like to you? Let us know in the comments below!

How vacation can make you depressed, and what to do about it

One of the issues I have had with my depression is traveling. I go to Harrisburg very frequently as part of my job, and many of those are overnight – I’m probably away from home something like 40-50 nights a year (easily the worst part of my job, and that has nothing to do with depression!). It was hard to get used to. That being said, at this point, I’ve spent so much time in Harrisburg, it’s almost like a second home. I have the same hotel (and usually the same few rooms), same basic routine, and it’s made life relatively easy.
Now, traveling to a new place, particularly when I am alone, remains a struggle. A new routine, a new city, make life very hard. For me, that happens from time to time, usually as part of a convention or hearing. I have found that it’s best for me to keep the same basic routine. I try to be back in my hotel room by 8-9, putz around for a bit, go to sleep by 11 and wake up early enough to get to the gym. Having a standard routine no matter where I go is really helpful, as it gives me a sense of comfort and normalcy, no matter where I am.
While I know I’m not the only one with travel anxiety, the idea that others could share my periodic troubles on family vacations were new to me. But, to my surprise, when I googled “vacation depression,” I found a ton!
Anyway, after doing some research, here are the best tips that I could find, along with some of my own thoughts.
  • First, and this is just me stalking, stick to your routine. Get up around the same time. Keep a normal bedtimes. Try to keep at least one meal you eat similar to what you’d eat at home. A sense of routine can avoid a shock to your body.
  • Go easy on yourself. Remember that vacations aren’t about expectations or THINGS I HAVE TO MUST DO RIGHT NOW NOW NOW – they are about relaxing, unwinding and a break from the stresses of normal life. If you suffer from depression, this may mean that you still suffer – and that’s okay. That’s who you are. Give yourself permission to be in pain and don’t berate yourself for it.
  • Choose a vacation that matches your personality. Placing pressure on yourself to go on a vacation you think you’re “supposed” to go on will only add to the depression you’re feeling. Instead, select a destination that will allow you to get what you want out of the vacation. Going somewhere you can’t fully enjoy or a place that makes you feel inadequate will only make your depression worse (via WikiHow)
  • Avoid comparing yourself to others. Many people with depression fall into the trap of comparing others’ vacations to theirs. You may look at the vacationers around you and wonder why you’re not enjoying yourself as much as they are. Placing pressure on yourself to enjoy what you think you should can make you feel worse. Instead, realize you probably aren’t seeing the bigger picture (via WikiHow)

There’s more out there, and if you have any tips, I’d love to hear them. Leave them in the comments below!

Public spaces and depression may be related!?!?!

So this article popped up in my newsfeed and it blew me away:

In what is perhaps the first scientific study of the effects of public spaces on mental health, a non-profit group in Philadelphia cleaned up trash-filled vacant lots and “greened up” others, primarily in low-income areas, and found that residents reported feeling happier.

The results of the study?

They found that residents of areas that had either the greening or trash removal projects reported a decrease in feelings of depression by about 40 percent. In neighborhoods below the poverty line, the drop was 70 percent. Researchers also found reductions in feelings of worthlessness, hopelessness and overall poor mental health.

What? What?

That being said, the outcomes of this study are very much inline with a perspective I developed after reading Lost Connections by Johanna Hari. I wrote about my feelings on the book here, and while I did have some major concerns with portions of the book, it really opened my eyes to an often unexplored dimension of depression: The social and community one. If everything around us is falling apart, too stressful, too ugly (and I mean that in more ways than one), we’ll be depressed. This study would seem to be a validation of Hari’s theory.

This isn’t the first study which would seem to tie physical environment – and access to a good, healthy, clean environment – to depression. A 2018 study showed that levels of depression for residents at British care homes could be predicted based on whether or not they had easy access to the outdoors, and there is also ample evidence which shows a connection between a physical environment and mental illness.

In a sense, this is an extension of the famed Broken Window theory of urban planning. That theory, in essence, is this: Small neglect (like an unrepaired broken window) leads to larger and larger crimes. The reverse can also be true: Cleaning one section of a neighborhood can lead to the cleaning of others.

My conclusion here is not one that I haven’t said before: More research is needed. But this study is a powerful incentive which captures yet another positive benefit of neighborhood revitalization – it may ease the symptoms of depression.

This is how depression & sleep trouble are related

For me, there have always been two markers that are my “canary in a coal mine” when it comes to depression – the two factors that tell me I’m depressed even when I may not realize it right away. First is eating. Some people eat more, some stop. I’m the later. I drop weight when I am depressed.

The second, and the one I wanted to write about today, is insomnia. Simply put, when I get depressed, I have a huge problem sleeping. When I get to sleep, I usually stay asleep, but the challenge for me is that I can’t sleep when I’m depressed. I’ve never been exactly sure why. Maybe it’s because I cannot shut my mind off, or maybe it’s because there’s some unresolved conflict that is prohibiting me from sleep.

Unfortunately, I’m not the only one who gets these issues. Even more unfortunately is this: When you are depressed, you can’t sleep. And not sleeping may mean more depression.

Alright, first, the evidence. Sleep and depression are strongly connected, and it’s not just me saying that. This comes straight from the DSM-V (Diagnostic & Statistical Manual):

Insomnia (inability to get to sleep or difficulty staying asleep) or hypersomnia (sleeping too much) nearly every day

So, one of the formal criteria for diagnosing a depressive episode or illness is the above. Unfortunately, it’s a two-way street, as not getting enough sleep – or getting a poor quality of sleep – can lead to depression. From The Sleep Foundation:

The link between sleep and mood has been seen over and over by researchers and doctors. For example, people with insomnia have greater levels of depression and anxiety than those who sleep normally. They are 10 times as likely to have clinical depression and 17 times as likely to have clinical anxiety. The more a person experiences insomnia and the more frequently they wake at night as a result, the higher the chances of developing depression.

There’s so much irony in the discussion about depression and sleep it’s ridiculous. What always frustrated me the most, however, was this: When you can’t sleep, and you are having prolonged trouble sleeping, all you can think about is how YOU CAN’T SLEEP, and this will worry you/frustrate you/depress you. This, in turn, will worry/frustrate/depress you even more, and then – you guessed it – you can’t sleep! It creates a vicious lack of sleep cycle.

Do I have any magic cure? No. Heck no. While there is plenty of advice on how to sleep when you can’t, I’ve found that everyone’s experiences are deeply personal. Related to that, I can tell a story about how I broke through my sleep issues when I was depressed. There was a period where I wouldn’t be able to sleep for 3-5 days a week. Not until 3am or so, only to become a sleepy zombie the next day and not be able to sleep at all the following night, and thus, the cycle continues.

One night, I’m in Harrisburg for session. I can’t sleep, it’s 2am and I am miserable. And I remembered something my therapist said a week or so before about how he had patients who had broken through their anxiety and phobias when they accepted the worst. And as I laid there, I said to myself, “You know what? Screw it. I’m done. I’m not gonna sleep, I’m gonna have the worst day of my life tomorrow, and then when I drive back to Allentown, I’m gonna crash the car. It’s over and I accept!!”

I slept that night.

It was an interesting moment for me, so if I have any piece of advice, it is this: When you accept the worst, you can get where you need to be.

Any thoughts, tricks or tips are appreciated! Leave them below!

The connection between depression and rumination

I was thinking about this the other day…haha, okay, that’s funny, and you should understand why shortly. Ages ago, I remember seeing a story about the connection between depression and rumination. For these purposes, rumination is roughly defined as thinking, non-stop, and in a bad way. Thinking about your problems. Thinking about being depressed. Chaining all of your depressed thoughts together, one into another, until it avalanches into something terrible. Thinking about all of the things that are wrong, that can go wrong, or that will go wrong. All of this leads to an increase in your levels of depression.

First, the link:

Numerous longitudinal studies point to rumination’s negative effects: For example, research Nolen-Hoeksema conducted on Bay Area residents who experienced the 1989 San Francisco earthquake found that those who self-identified as ruminators afterward showed more symptoms of depression and post-traumatic stress disorder.

The article goes on to note many others studies which have come to the same conclusion: People who think too much and think too much about negative things are much more likely to show symptoms of depression.

Why does this happen? Well, this paragraph lays it out nicely:

Many ruminators stay in their depressive rut because their negative outlook hurts their problem-solving ability, said Nolen-Hoeksema. According to her research, they often struggle to find good solutions to hypothetical problems. For example, if a friend is avoiding them, they might say, “Well, I guess I’ll just avoid them too.”

In addition, ruminators express low confidence in their solutions and often fail to enact them–for example, failing to join a bereavement support group despite intending to, said Nolen-Hoeksema.

Not only does ruminating lock you into negative thought patterns that can extend your depression, but it makes it harder to seek out and receive social support.

Alright, so, rumination sucks. Let’s pivot then to something more positive (see what I did there?) – how do you break the cycle of negative thoughts and move onto something more positive? According to this article in Psychology Today, there are a few things you can do. First, stop thinking about the negatives. That’s obvious, but a good way to do this is to instead concentrate on times when things did work out okay, and specifically by “shifting your neural network.” The article specifically advises that you rely on friends and family to help you break up the negative thoughts, use a memory jogger (like pictures, a video or an upbeat social networking status), or listen to good music that will remind you of the positive experience.

Another way – although I admit this one can be very difficult – is to try to “unhook” your thinking. Stop just mindlessly focusing on whatever ails you. Instead, unpack it. Examine it. Ask yourself, what’s really bothering me, here? Is there anything I can do about it? Make a plan of attack in your head to deal with whatever the problem is head on. If you find there’s nothing you can do, no problem! Put it in a little box. There is no sense wasting your valuable time and energy on something that you cannot touch or do anything about.

There’s more, but these are two of the more valuable ways that I’ve discovered. I have to say, this is useful for me. Most of my depression comes from runaway thinking – aka rumination – that I cannot control. I’m going to make a real effort to change my thinking processes here and bring this under control. Maybe meditation will help too? I don’t know.

Either way, I’d love your thoughts, as always! What strategies have you used to bring your own head into shape? Let us know in the comments below!


Six questions: Interview with John Corey Whaley, author of Highly Illogical Behavior

So this is an interesting one, mainly because the book deals with a topic I’ve barely tackled: Agorophobia. Today’s book is Highly Illogical Behavior by John Corey Whaley. From the blurb:

Sixteen-year-old Solomon has agoraphobia. He hasn’t left his house in 3 years. Ambitious Lisa is desperate to get into a top-tier psychology program. And so when Lisa learns about Solomon, she decides to befriend him, cure him, and then write about it for her college application. To earn Solomon’s trust, she introduces him to her boyfriend Clark, and starts to reveal her own secrets. But what started as an experiment leads to a real friendship, with all three growing close. But when the truth comes out, what erupts could destroy them all. Funny and heartwarming, Highly Illogical Behavior is a fascinating exploration of what makes us tick, and how the connections between us may be the most important things of all.

1) Did this book come from your own personal experiences with mental illness, or that of someone close to you?

I’d say it was a combination of both, but Solomon’s anxiety is definitely an exploration of my own.

 2) Were you trying to write a story about mental illness, or were you using the agoraphobia to make a broader point? I suspect the answer lies in the middle, and if that’s the case, what made you use agoraphobia specifically? 

While I did set out to tackle mental illness as a subject, I also wanted to make sure the story was really a character study more than anything else—and a way to help readers empathize with someone like Solomon.

3) Your book is clearly remarkably effective at taking shots at the stigma which surrounds mental illness. How did you write a character that was so multi-layered, and in the words of at least one reviewer, so much more than his mental illness?

That’s a tough question to answer! I guess I’d say that I focused really hard on making sure Solomon-and the other characters-all left more of a lasting impression on the reader through their personalities and not their problems.

4) The cover design – with the different colored lines and someone walking in what looks to be a box – is one of the more noticeable covers I have seen. What inspired that?

I can’t take any credit for the cover, but I will say I LOVE IT. It’s simply the chaotic lines of color leading Solomon outside to the crazy world, where his friends are waiting.

5) Members of minority communities tend to suffer even greater from mental illness – can you talk at all about how your book attempted to address the subject of mental illness among the LGBT population, and why you chose to go that route?

As a queer American, and one with mental illness, I’ve seen up close the effects of mental illness on my community. It was important to me portray a young gay man with mental illness who wasn’t defined by EITHER thing solely.

6) As noted in the blurb, one of your main characters tries to “fix” another’s mental illness. What’s your advice to those who think this is a viable strategy?

Anyone who wants to help someone with mental illness deserves a chance to be heard, sure, but it’s very important that those without mental illness understand that you can’t “fix”  a person. Mental illness is wired into a person, so much care, research, and care must be taken when helping someone deal with their illness.

Want to tell your story? Great. Here’s how.

Last week, I wrote an entry about why telling your story – your own personal experience with mental illness (or anything, really) is so important. Study after study shows that the best way to reduce stigma is to put a human face on it. The power of saying, “Me too” cannot be underestimated – that’s why it is literally called the #MeToo movement.

That being said, telling your story can be absolutely terrifying. You may have no idea what to say, how to say it, or what the reaction is going to be. The fundamental truth is that once you put yourself out there, there’s a before and after in your life. As I’ve said repeatedly about my own life, I found the ability to tell my story in the courage of those who told there’s. To that end: Here are some tips about what to say, and how to say it:

Pick your medium. You don’t need an op-ed. You don’t need to stand on a chair and scream, “I HAVE DEPRESSION!” Telling your story may be as simple as opening up to a friend of colleague, or resolving yourself to do so in the future. It may be a long-winded Facebook post or blog entry (and I am the MASTER of those, with an emphasis on long-winded!). In all seriousness, understand that different medium will have different impacts. Pick the one that works best for you.

Read/watch others. Reading and watching what other people have said will give you a much better idea of how to say what you want to say. You’ll learn what works and what doesn’t. More importantly, paying attention to the stories of others will remind you of a fundamental and very important truth: You aren’t the first, and you aren’t alone.

Read from the experts. Related to the point above: Read what others say when discussing your particular issue. Know what words and phrases are good, and what don’t work as well.

Understand that most people will be overwhelmingly supportive. In a weird sort of way, one of the things that disoriented me the most was how kind people were. It never felt like something that was “so brave” or anything like that – it just felt like something that had to be done. And that became almost a source of anxiety – that now I had this standard to live up to. So, as strange as it may sound, brace yourself for the weird sensation of people being really, really nice and appreciative.

Understand that some will not. There will always be morons and unkind people. Just keep in mind that when someone inevitably says something ignorant, it says more about them than you.

If medium-appropriate, make it a story. Part of making in impact with your story is telling it as a story. When I discuss my own battles, I always begin with something like this: “On August 11, 2014, my life changed forever. That was the day that Robin Williams killed himself.” I think that’s a good hook and a good way to start. Anyone reading will think, “Huh. That’s interesting. Why did that have an impact on him?” And it goes from there. Tell your story as a story. Be specific. Use visuals. Give dates, times and locations. Don’t approach your personal story as an academic book report, replete with cold numbers that fail to convey passion – tell your story with the personal power it deserves.

Understand the impact. This is the one that I missed the most. Depending on who you are and how you choose to say your piece, you may wind up having a greater impact than you realize. When I told my best friend what I was going to do, he correctly noted that this would have a much greater impact on me or my career than I could have ever anticipated. When I told my mentor, she told me that she’d be surprised if the piece I wrote didn’t make state-wide news. Both were correct. Understand that people will look at you differently – and probably in a better light.

There. Hopefully, this post can serve as a guide to help you tell your story. As always, let me conclude with a question: What did I miss? What helped you tell your story? What didn’t? Please let us know in the comments!

How anxiety affects your life – in ways you may not even think about

I have to be honest: On a personal level, I’m really lucky. My struggles over the past few years have more been with depression than anxiety. Honestly? I’d prefer it that way. When my anxiety was at its worst – when it was worse than the depression, worse than any physical pain I’d ever really experienced – I struggled. Panic attacks could come anytime, any place, for no reason, and they felt like a snowball rolling downhill – once they started, they simply could not be stopped. That was absolutely terrifying and a pain I wouldn’t wish on my worst enemy.
Fortunately, I cannot remember the last time I had a real anxiety attack, and I am beyond grateful for that. My anxiety has morphed into something more generalized; a constant, gnawing worry that searches for something to be worried about. I have a really difficult time relaxing. That sort of thing. To be clear, I’d take this over anxiety attacks in a millisecond, but it doesn’t mean I’m without the scars from those battles.
That’s something I think about frequently: What ways are my own mental health affecting my life, even if I don’t still actively suffer from certain components of it? Here are some answers to this important question: How does anxiety affect your life in ways you don’t even realize?
You become less adventurous: Anxiety makes you afraid. And fear makes you less willing to try new things or explore different facets of life. One of the many, many reasons anxiety sucks so much is because that fear places your life into a little box that seems to squeeze in. You only go to familiar places. Talk to familiar people. Engage in familiar activities. Why? Because doing something new is scary. And that may lead to an anxiety attack. Unfortunately, I’ve found that those scars remain.
Worry becomes the default state: In those moments where you have nothing to worry about, you find something anyway. You find something to take all your nebulous fear and latch it there, because it makes you feel better. Yes, you read that right. A personal equilibrium becomes a fearful state.
The moments of peace are few and far between: This is related to the above, but honest to God, I don’t remember the last time I felt really, truly at peace and relaxed. There is ALWAYS something to stress about, to be worried about. It’s always there, like a predator and a prey. Is that just being an adult? I’m not sure. Which leads me to…..
You don’t know what is normal: This is one of the strangest questions, and it’s more a philosophical one, I’d argue: What is normal? How much anxiety/depression/fear is “okay” – how much is “acceptable” – and how much isn’t? It’s a strange, esoteric question, but a vitally important one, because how you answer it will greatly alter the level of treatment you get. I don’t know what normal is, because I don’t think I’ve been there in decades. If ever.
Anything to add? As always, I’d love your thoughts. How else has anxiety hurt you in ways you haven’t thought about? Let us know in the comments below.