TMS Update: Is this what feeling better feels like?

So, it’s been about six weeks since I started Transcranial Magnetic Stimulation. As I type this, I’ve had about 26 sessions, with another ten or so to go.

How am I feeling? Is it working? Better. And yes. It is working. And I feel reasonably convinced at this point that it’s not just the placebo effect.

Let me discuss the second part of that question first, because I think it’s almost the most important. Why do I think it’s not a placebo effect? Because life is NOT perfect. I think – I don’t know, but I think – that if this was a mere placebo effect, I’d be sitting here, flying through the sky. Life would feel perfect. There would be birds and sunshine and candy everywhere and all that crap. Then, eventually, the effect would wear away, and I’d crash hard.

Simply put, that isn’t true. Everything doesn’t feel perfect. I’ve still gotten depressed about things, upset. Most of the time, it’s been normal life events. On a couple of days I’ve still woken up really down, but that feeling fades easier than it did before treatment. Simply put, things aren’t magical.

So then, let me tackle the question in the title: Is this what feeling better feels like? Maybe? I can’t answer that question definitively yet, because I don’t know . Look, I’ve been on anti-depressants and in treatment, as needed, since I was 18. I’m 35. Half my life. So I’m not quite sure what “normal” is.

Here’s what I do know. Since I started TMS and began to feel it’s positive impacts:

  • I’ve been enjoying things more. A lot more. A couple of examples:
    • As I’ve long since established I am a big computer game nerd. I play these games more, and I just like them more. I’ve had more fun playing them.
    • I was with my wife and my kids at a local food fair. I’m sitting there, eating this big ole Taco Salad. My son is leaning on me, eating Mac & Cheese. He’s snuggling in. I’ve got my little boy, good food, happy environment, great music. I felt good. I felt lucky. My phone was firmly in my pocket. I felt like I was in the moment. That didn’t happen before.
  • I wake up in the morning without this impending sense of dread. Without feeling like there’s a ceiling over my head, pressing down. It just feels like the world has less pressure. I still feel stressed, still feel overwhelmed. But the world doesn’t feel like it is filled with nearly as much darkness.
  • I’ve been less snappy. Less grouchy.
  • I’ve had an easier time concentrating and getting things done. My motivation is higher.
  • You know that myth about the depressed writer? Bull. Depression does help give you insight and experience for writing, but if it’s too severe, you ain’t writing. And I’ve had a much, much easier time writing lately.

Arguably the most important observation since this started has been from my wife. She was skeptical when TMS first started. She told me last week that she didn’t think it would work, and part of her almost wishes she didn’t know I was doing it so she wouldn’t risk being fooled by a placebo effect as well.

Why? Because she noticed the difference too. She told me the other day, unprompted, that she sees it’s working. She sees that I am happier. And my wife is smarter than me! So if she is noticing this, it makes me more convinced that this thing really is working.

Are things perfect? Hell no. They never will be.

But they are unquestionably better.

DISCLAIMER: 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. However – and again, this is just me writing – I’ve had my TMS from the TMS Center of the Lehigh Valley. I am grateful for their skills, professionalism and willingness to work with my rather insane schedule. I highly, highly recommend them if you are local to the area.

TMS Update

Well, as I type this I am 10 sessions into the 30 session Transcranial Magnetic Stimulation sessions. 1/3 of the way there. Woohoo!

How’s it going so far? Well…maybe better? Honestly, yeah, starting at the beginning of the 2nd week, it did start to feel like I was feeling a bit better, but let me define what I mean. Birds did not start singing. The sky is not the bluest it has ever been. Depression is still there. Life is not perfect.

But, to some extent, I have to say, it does feel like things have gotten a bit better. My life hasn’t dramatically improved, but there does seem to be a bit less…pressure. Like, the ceiling of depression which pressured down on me seems a bit lighter. That’s the best way I think I can put it.

To be clear, this may be placebo. The readings that the Doctor gave me showed that depression probably wouldn’t start to improve until week four. When I mentioned this to him, he said some people did feel better in week two, but for many it was longer, and it is certainly possible that this is just placebo. So I guess we will see!

Some other notes:

  • For me, there are no side effects. Even the slight headaches that during the treatment have become more tolerable. I haven’t taken a Tylenol before a treatment since it started, and my head has not hurt a soon as the treatment has ended.
  • You really do build a resistance to the minor pain caused by the treatment. Of the ten times I’ve had it, I’ve fallen asleep three of them, which is kind of funny.
  • I went through the math in my head the other day. As I said in the last entry on this subject, the magnet taps your head for four seconds, then rests for twelve. During the four seconds in which you get tapped with the magnet, it makes contact 40 times. A session is twenty minutes, so you get tapped 3,200 times a session. Multiply that by the 30 sessions, and congratulations, you’re getting smacked by a magnet 96,000 time over six weeks!

Only 64,000 taps to go!

“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.

Depression and meditation

Ugh, just writing this article makes me a little depressed. Why? Well, cause I can’t stick with this. No matter how hard I try, I absolutely, positively cannot stick with meditation – and that’s despite the evidence I’m about to write about below.

The studies are clear and I have written about the subject before: Meditation helps with depression. According to one study published in The Lancet, meditation may be as useful as anti-depressants at keeping depression at bay (side note: Damnit! I really need to look at this again!). This study noted the benefit of mindfulness meditation, which is a specific type of meditation.

What is mindfulness meditation? Mindful.org describes it simply: “Take a good seat, pay attention to the breath, and when your attention wanders, return. By following these simple steps, you can get to know yourself up close and personal.”

Want to know more? I found a few interesting resources on the subject. First, there’s this, from Headpsace, a meditation app I’ve used before. The article details the struggles of a very depressed man who tries meditation in a desperate attempt to get some relief and how meditation changes the way he thinks. The Washington Post ran a similar story earlier in the year, in which the author discusses how the Headspace app (this isn’t a sponsored post, I swear) helped them relearn their thinking.

Want more info on the research behind meditation? Check out this article on Mindfulness-Based Cognitive Therapy, which is a specific type of meditation designed to help those with depression.

If you’re interested in more information on how meditation may help people with anxiety and depression, look at this pretty fascinating article from Harvard, which details specifically how depression can physically change your brain.

I will say this: As I’ve bitterly noted repeatedly, there have been many instances where I have actually meditated with some regularity, only to stop after some period of time. But, during those times, I did notice some changes about the way I was thinking. Specifically, I found myself focusing less often on anger, frustration and bitterness. I found myself better able to let things go, and it felt great. Sadly, inevitably, a busy life caught up with me, and I let the practice fall away.

Time to try again!

As always, I conclude with a question: What has been your experience with meditation? Have you practiced it – or do you practice it – on a regular basis? Notice any changes that you want to share with us? Please tell us your story in the comments below!

Finding light in the darkness

I’m going to write about two things that personally motivated me to deal with my own demons in a very public way. The short-term inspiration for this is me rereading the acknowledgements section of Redemption. The longer-term inspiration for this is a public tragedy and a low period in my life.

Okay, first, here’s a small section of the acknowledgements in Redemption:

To Robin Williams. Yours was a life well lived, and I hope to be part of a positive story of those influenced by how it ended.

Let me go backwards. Robin Williams completed suicide on August 11, 2014. He had long suffered from a slew of mental health challenges, including depression and substance abuse. However, Williams was suffering from “diffuse Lewy body dementia,” which ultimately contributed heavily to his suicide.

William’s suicide ultimately inspired me to go public with my story. That started when some idiot on Facebook decided to spout off shortly after Williams’ death by saying something along the lines of, “So sad Robin Williams committed suicide. He just needed to pray to Jesus more!”

No, you schmuck, that’s not how it works, and that ignorant comment got me so damn fired up that I wrote an op-ed in my local paper, detailing my own struggles with depression, anxiety and suicidal ideation. That, in turn, set my career in motion in a very different way, making me become much louder about mental health issues. I’ve spoken at events detailing my own struggles, cofounded a mental health caucus, appeared in PSAs and introduced legislation designed to help those who are suffering from mental health challenges. I know that the work I’ve done in this realm has helped people – and I know I have a lot more to do to help more.

It also inspired this speech, the most difficult one I have ever made:

Fast forward about seven or eight months, and I’m struggling, in the midst of one of the most depressed periods of my life. I’m struggling at work, my wife is struggling at work, and life just generally sucks at the moment. I go back to see my therapist. I increase my medication. And then I realize something else: I desperately need an outlet. Something to help get me through everything I am suffering from. I decide to start writing again – I wrote fiction as a kid and had published the non-fiction book I wrote, Tweets and Consequences.

And I remember this goofy plot idea I had as a kid, twenty years ago, about kids getting trapped on a spaceship. And I realize something: That’s not a bad plot. But what if I could make it more? What if I could fold in a mental health message as well?

And thus, Redemption is born.

For what it’s worth: I have a character named Robin in Redemption. In all fairness though, that’s also my daughter’s middle name, so let’s call that character’s naming a 50% tribute to Williams and 50% tribute to my daughter.

The death of Robin Williams helped me and countless others find their voice and seek help. I know that this may be cold comfort to those he loved and those who loved him. But I sincerely hope that they can take some solace in knowing that Williams’ life and death helped so many, including me. His was a life well lived – and, as I said above, I hope to be a small part of that story.

You can always find light in the darkness. Pain makes us great, and with time and therapy, you can turn the most agonizing periods of your own life into something incredible.

As long as you breathe, there is hope. The trick is just finding it sometimes.

Transcranial Magnetic Stimulation?

You know, you first hear about something like this, and you think it sounds like some sort of witchcraft nonsense. Magnets? To help depression?

Apparently. And it’s scientific based.

I write about this now because I had an appointment last week to explore this as a treatment possibility, and it is likely something I’m going to pursue. Here are the basics, per the Mayo Clinic:

During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. And it may activate regions of the brain that have decreased activity in people with depression.

 Though the biology of why rTMS works isn’t completely understood, the stimulation appears to affect how this part of the brain is working, which in turn seems to ease depression symptoms and improve mood.

The most important question, of course, is this: Does it work? According to the evidence I have seen, yes, and that’s in tests involving a placebo. More research is needed, but this appears to work.

Thankfully, the side effects are very mild, per the Mayo clinic.

Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions. They may include:

  • Headache

  • Scalp discomfort at the site of stimulation

  • Tingling, spasms or twitching of facial muscles

  • Light headedness

The biggest drawback, as best I can tell? The Doctor I spoke with told me its most effective to do it every single day, for 4-6 weeks. Session, I think, are 30-45 minutes. That’s a heck of a time commitment. That being said, sucks for me. It’s not the Doctor’s fault that this is the way the brain works, but it’s certainly a challenge with my schedule – going to Harrisburg and vacation means I won’t have that kind of time until August.

So, let me conclude by asking you for your experiences. Have any of you out there had TMS? Any experiences to share? I’d love to hear them!

Coping Strategy: Do Something

I was down a few weeks ago when this particular memory bounced into my head.  I was sitting in my therapists office, discussing something – what, I don’t remember.  I think I mentioned to him how I had gone to the gym (unrelated, but hey, exercise can really help depression), despite the fact that I had been really depressed at that moment and didn’t feel like it at all.  And I remember he said that was good, because that moment when you are most down is exactly when you should get up and do something.

It wasn’t meant to be particularly profound.  But it’s one of those things that REALLY stuck with me.  My wife calls it faking it till you make it.  I referred to it as “pushing through,” but that struck me as simplistic, as if you can just willpower your way through depression (sometimes you can; often you can’t).

Imagine yourself as depressed as you have been.  What do you want to do?  The answer there is obvious: Absolutely, positively nothing, aside from this:

depressed on couch

That, as far as I am concerned, is the worst thing you can do.

Please keep in mind I’m only speaking from my personal experience and this isn’t medical advise, but I’ve always found that lying down and swimming in depression leads to one thing and one thing only: More depression.  And guilt.  “I SHOULD be doing my chores.  I SHOULD be hanging out with my kids.”

Is that guilt warranted?  Of course not.  Everyone deserves time to lounge around and do nothing – yes, you too, depressed person. But – and again, this is just my personal experience talking here – sitting around when depressed just leads to feelings of self-loathing and guilt.

This would be my advice to you, dear reader: Just…try doing something.  Anything that’s actually active and engages your mind, body or both.  It may be reading a book.  It may be going for a walk or heading to the gym.  Write.  Play a game.  Do jumping jacks.  Hell, I really don’t care.

What I do know is that, based on my own experience, is that sitting there, doing nothing, in the long-term, can equal a surrender. As best you are capable, get up, get moving. Will it make you feel better? Hopefully.  Maybe.  But doing nothing will certainly continue to sap your hope away, and anything is better than that.

Any specific strategies you want to share? Leave them below!

What anti-stigma really means

Call this one a brilliant thought that I had in the shower the other day.

There are plenty of anti-stigma campaigns related to mental health.  In many cases, the goal of these campaigns is simple, noble and necessary: to defeat “mental health challenges in the workplace and at home.”  This is vitally important work.

There’s good news related to that though.  In many areas, anti-stigma campaigns have already done their job.  For example, a poll taken in my home state of Pennsylvania (March 2017) shows high levels of comfort in terms of working with someone with a mental illness, a vast improvement over previous levels.  While there is still a long way to go, this poll shows significant movement in the area of mental illness.

I was thinking about this poll the other day, and it had me thinking: What does anti-stigma really mean?  Obviously we need to continue to work on critical areas like discrimination and access to healthcare, but I’d argue there’s more than that.

My argument is this: The most powerful sense of stigma is self-stigma.

Consider this 2012 article, which describes self-stigma as when “patients agree with and internalize social stereotypes,” resulting in:

•Patients often think that their illness is a sign of character weakness or incompetence.
•Patients develop feelings of low self-esteem and become less willing to seek or adhere to treatment.
• Patients anticipate that they will be discriminated against, and to protect themselves they limit their social interactions and fail to pursue work and housing opportunities.

As a result, patients find themselves less willing to seek treatment and social support, leading to lower rates of recovery.

This realization has had me rethinking how I approach the notion of anti-stigma campaigns.  Of course they should be focused on ensuring that all of society views people with mental illness not as sick freaks who are weak, but as real people suffering from real disorders that can be treated like any physical illness.  I want to push society to a place where all of us – those with mental illness and those without – view people who are suffering from a mental illness the same way that someone views a cancer patient.  No one who suffers from a mental illness should do so in fear, shame or silence.  They should talk about their therapy appointments the same way a cancer patient discusses chemo or someone with a broken leg discusses physical therapy.

I suppose, then, that what I am saying is this: Anti-stigma campaigns shouldn’t just address societal stigma.  They should address self-stigma as well.

As always, I welcome your thoughts – am I onto something here?  More importantly, have you found any anti-stigma campaigns that fulfill what I am describing?  Let me know what in the comments!

National Depression Screening Day

I’m a bit late on this, but October 5 was National Depression Screening Day.  The day itself, first created in 1990, is an effort to encourage people to determine if they are depressed and seek treatment for their illness.

Common depression screening tools

There are multiple depression screening tools available.  These tools, often available in online questionnaires, allow users to determine if may be suffering from depression.  Ideally, an appropriate screener will then link to resources which will enable a person to get help.

From what I have seen, the Patient Health Questionnaire (PHQ-9) is the most common tool to determine depression.  It’s brief – just nine questions – and allows for the user to easily determine if they are potentially suffering from depression.

There are, of course, many more depression screening tools, including:

  • Hamilton Depression Rating Scale (HDRS)
  • Beck Depression Inventory (BDI)
  • Patient Health Questionnaire (PHQ)
  • Major Depression Inventory (MDI)
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Zung Self-Rating Depression Scale (SDS)
  • Geriatric Depression Scale (GDS)
  • Cornell Scale for Depression in Dementia (CSDD)

Does depression screening work?

There is evidence which shows that depression screening can make untreated individuals aware of their problems and encourage them to seek treatment.  Depression screening also appears to be relatively accurate, and its systemic use can make doctors more aware of depression with their patients.

The biggest benefit of depression screening

Depression screening is a useful, if flawed tool, which allows for an individual to determine if they are depressed.  That being said, depression screening increases awareness of depression.  It allows someone to determine if they may be suffering from depression, and seek help.  It also treats depression just like any other physical aliment – this, in turn, has the power of reducing stigma.

Study: Depression can be treated with…anti-inflammation drugs…??

A friend was kind enough to send me this article, and this one is too strange sounding not to share: According to a new study, depression is “a physical illness caused by a faulty immune system” that can be treated with anti-inflammatory drugs.

From an article on the study:

Current treatment is largely centred around restoring mood-boosting chemicals in the brain, such as serotonin, but experts now think an overactive immune system triggers inflammation throughout the entire body, sparking feelings of hopelessness, unhappiness and fatigue.

It may be a symptom of the immune system failing to switch off after a trauma or illness, and is a similar to the low mood people often experience when they are fighting a virus, like flu.

“In relation to mood, beyond reasonable doubt, there is a very robust association between inflammation and depressive symptoms.  We give people a vaccination and they will become depressed. Vaccine clinics could always predict it, but they could never explain it.

According to the article, more tests will begin next year to see if anti-inflammatory drugs can help alleviate depression.

Obviously, this piqued my curiosity, so I did a little bit more digging.  First, this area of study isn’t new – there are studies dating back at least six years that would support the notion that inflammation and depression are linked.  From that article:

Previous studies have linked depression with higher level of inflammatory markers compared to people who are not depressed. When people are given proinflammatory cytokines, people experience more symptoms of depression and anxiety. Chronically higher levels of inflammation due to medical illnesses are also associated with higherrates of depression. Even brain imaging of people with depression show that their brain scans have increased neuroinflammation.

The article went on to recommend that everyone take anti-inflammatory steps (which are good for you regardless), including better diet, stress reduction, exercise, mind-body exercises and breathing exercises.

This is new to me, and fascinating.  That being said, it makes me nervous.  I’ve always operated under the assumption that depression – and mental illness in general – are not caused by – or treatable with – a single bullet.  They are a combination of things: Genetics, stress levels, thinking patterns, etc., that make someone mentally ill.  As such, the notion that one thing – inflammation – could be the cause of depression – well, it gives me pause.

It would be so, so wonderful to be wrong!

Two points about this research, and understand, please, that they are coming from a layman, not a doctor!:

First, more tests are required, so don’t run out and buy an anti-inflammatory today.  More information, specifics and treatment options are still needed.  For now, keep going to therapy and taking your medication, darn it!

Second, let’s say, for a moment, that future studies confirm a connection between inflammation and depression.  That does not (necessarily) mean that you should stop taking your medication or going to therapy.  Remember, all body-mind reactions are a two way street.  Yes, your body can affect your mind, of course, but the way you think can affect your body.  When you are scared, your heart rate accelerates, your breathing speeds up and you get sweaty.  Don’t think that being depressed, having negative emotions or damaging thought processes can’t potentially cause the inflammation that causes depression.  I’ve always believed – at least for me – that a combination of medication and therapy are the best way to deal with depression.  If you believe that too, don’t think that therapy will no longer be necessary just because you take some pills that can make the swelling go down.

This is fascinating.  And potentially hugely promising.  I can’t wait to track more information about this, and I really hope that this can provide people with real relief in the future.