Like most of us, I didn’t have an amazing 2020. My emotional and psychological capabilities were pushed past their breaking points, greatly impairing my psychological state and quality of life. I have a long history of battles with anxiety and depression, and the source (ADHD) has only recently been fully revealed. This past spring, after finally approaching ADHD treatment in a realistic way, my doctor mentioned the possibility of TMS because they had acquired a machine and the means to use it to treat patients. I had asked my doctor about it the previous May or June, but it was too early at that time to consider it. By spring of 2021, however, the things that were affecting me had gotten worse and had taken their toll for nearly a year. My doctor brought up TMS and suggested I dwell on it for a while. Considering I had already done research on it, I decided pretty quickly to go for it.
Transcranial Magnetic Stimulation, or TMS, is a relatively new psychiatric procedure used as a more permanent or long-term treatment for depression, specifically for those who have been unable to adequately treat their depression with medication. It’s become something that insurance can cover now, and is growing in availability. Some may confuse it with ECT or Electro-Convulsive Therapy, which has been around longer and is more controversial and stigmatized. TMS actually bears very little resemblance to ECT; TMS doesn’t send electricity into the body like ECT does, but instead sends small magnetic pulses into very specific, pinpointed parts of the brain. A cartoony approach would be saying TMS is to ECT what a chisel is to a sledgehammer- one is way more precise. There are people who receive ECT with successful results today, though, and there is some stigma for ECT left over from the bleaker periods of mental health treatment in the mid-20th century. While the science behind TMS is still being studied, the idea is that electromagnetic pulses stimulate the part of the brain that has basically become dormant, numbed or fatigued from prolonged depressive stressors. The stimulation sort of “wakes up” that part of the brain so that it can then function more like it did when it was healthier. When I began treatment I learned that the opposite can be done too, for anxiety- the same location on the opposite lobe of the brain receives far slower pulses to try and calm it down, or make it less overactive.
TMS is done in regular visits over an extended period of time. In my case, I went five days a week if nothing came up, as long as I had enough sleep. Per the doctor’s recommendations, if I had less than 4 hours of sleep, I didn’t go. Treatment lasted for 6 weeks, the first two weeks being exclusively depression treatment (which is astonishingly quick) and the latter 4 are both depression and anxiety treatment (which is slow, and takes about 30 minutes in my case, instead of about 3). Once that concluded, there were another 6 sessions covered by my insurance that were used for “cooldown” sessions, or alternatively could have been used for “maintenance” sessions. Cooldown sessions are exactly what it sounds like- a few sessions to phase the treatment out. Maintenance sessions are for later, if the depression or anxiety return in some form and necessitate more TMS treatment.
The process itself is fairly simple and easy to get used to. It’s also painless and comes with a negligible fraction of the side-effects one would expect from any psychiatric medication. The only side-effects I’ve experienced that I can say for certain are due to the TMS are a couple of mild headaches, and some occasional pain and/or discomfort during the procedure itself. Even then, the amount of power being used can be adjusted if the pain becomes significant. In my case the power was adjusted once after a week or two, so the pain went from moderate to very mild. Otherwise, on severe lack of sleep or alcohol intoxication the risk of seizure becomes significant, and in some it can worsen mania, especially those with bipolar disorder.
As I was told at the beginning, the effects of the treatment began to show around two weeks in. That varies from person to person and some may not show positive results until a full 8 weeks have passed- after the entire treatment and some cooldown has been completed. However, according to my doctor, people who show positive results early on tend to have exponentially more positive results overall as time progresses.
Near End: At the time of this writing, I am near the completion of the main 30-day treatment and will transition from that into a more spread-out series of six treatments over the following two weeks. Normally it would be more spread out than that, but I’ll be leaving town to spend time with family. More changes are likely to occur, which I will include as they happen, but it seems important to document the results I’m experiencing so far.
While TMS was not the only change I made with a positive impact during the course of the procedure, I have still noticed a significant improvement in my mental state. The most noticeable change is in my internal monologue. Prior to TMS, I was constantly at war with myself, with two inner monologues arguing over whether to do “the right thing” or to do the most self-destructive things possible. Within a couple of weeks of starting treatment, that no longer seemed to be the case.
Going in, my doctor cautioned that although the effects could be very significant, they weren’t a cure-all, and right now near the end of treatment I have a good understanding of what that meant. When you’re in a crisis or some kind of recovery, it can be easy to forget what is and isn’t exclusively a psychiatric issue. It’s almost like the “happy pills” myth has become so widespread that there’s a part of us that wants that to be true. However, the truth is that they are designed to return you to baseline and allow you to function as a normal, healthy human being. Despite not being done with treatment I already feel very close to that point.
That comes with some reality checks- primarily that, as obvious as it sounds, anything that exists outside of my brain or realm of control remains unchanged. While it did not change my employment situation, I was able to find work, very possibly due to an increase in what I’m capable of in applying for them. However, the relationships I lost are still gone. My trust issues remain. The political climate in my home country has not changed. And for all I know, the people I lost and the people that hurt me don’t know about the constant work I have done on myself. There is still a disconnect between what people are like and what I thought they were like prior to understanding my own neurology (and how different it is from 95% of people). These things are all specific to my life and, again, are mostly things that I cannot change. The treatment does, however, make me more capable in dealing with these issues and the effects they have on my life.
Post-Treatment 1: As of this writing I am two days past the final session of TMS. Everything mentioned above still applies, along with some things that are either new developments or are newly discovered. The most significant of which is that all suicidal ideation and any suicidal intention whatsoever are gone. There are several parts to this: Common suicidal urges, the urge to “escape”, the occasional regret over having not done it when it was the “right time” (disclaimer: there is NO right time). All of these thoughts and urges are gone. In cases of extreme stress there can still be intrusive thoughts about it but not only is that the worst-case scenario, it comes with zero intent. This is not to say that it won’t ever come back.
Post-Treatment 2: By now it is about three weeks following the completion of TMS, after which I was out of town visiting family for a while- probably the best possible thing I could have done.
While some difficult times have returned, my overall mental health is still noticeably better. While visiting with my dad there was a conversation that led to me fully appreciating the depth of my financial struggles, which resulted in a heavy depression in both the physical and mental sense. It went away that night, gave way to heightened productivity the following day, but it came back after some miscommunication with someone else. I then went and visited friends and after I had regained the strength to tell myself it wasn’t permanent, and that I could pull it off, the issue went away and hasn’t resurfaced.
Post-Treatment 3: A few days ago I had a brief post-treatment appointment with my psychiatrist to talk about progress and changes moving forward. For now we’re keeping things as they are. My overall state isn’t quite where it was when I was getting treatment, but it isn’t a concerning dip and I assume is just me returning to baseline. The weather is also different- cloudier, cooler, which also has an effect even if it’s my favorite time of year.
Thus far the effect has been significant and very necessary. Ironically the anxiety treatment, which wasn’t the focus, seems to have had the greatest effect. The part of all of this I’m most thankful for today is that I don’t have anxiety and depression playing off of each other and kicking me when I’m down. They’re still there sometimes, but their effect on my life is no longer significant. They don’t hold on to me like they used to. If I have a stressful day at work and it comes out, it will eventually go away. It used to be that once it clouded my perspective, my perspective stayed cloudy.
Post-Treatment Update 4: It has now been about 15 months since completing TMS treatment. If anything I’d say previous impressions have been reinforced: It’s a substantial and effective treatment, but not a cure-all. Not long after the previous update I began working more often in a day job, which I enjoyed, but my workplace was decimated by the Omicron variant of Covid, I was unable to visit family for Thanksgiving or Christmas, and I severely worsened my own state through depressive isolation brought on by the weather and a misunderstanding of my own needs. While things like suicidality did return because of that and a trial of Adderall, they eventually disappeared again thanks to other measures. By now I feel confident in my recovery and hopeful in my future. I do think TMS was instrumental in my recovery, but as with psychiatric medication, the most important factor in my mental state has been a thorough understanding of how my brain biology works and what it needs. The most recent development, less than a week ago, was the discovery that I had mistaken my extreme social anxiety with introversion- meaning I had often isolated myself in an effort to “recharge” while that does the exact opposite. Everyone has different needs in their mental health regiment, and for me, and maybe you, the most crucial part is understanding in extreme detail what those needs are.
As I wrapped up this article, a new report came out in the New York Times about an experimental treatment that acts almost like a “pacemaker for the brain”. The woman they focus on had not only done TMS, but had been in more intensive care and had even had ECT. The treatment sounds very promising, even if it’s only for the absolute worst cases of depression and has to be implanted. It uses magnetic pulses, which sounds similar in concept to TMS but in this case much more intensive for someone who needs constant treatment. Between that, TMS, and other things such as medically regulated psilocybin, I really think there are huge advancements in treatment ahead. It’s phenomenal that we may soon exit the era of psychiatric care that was almost totally dependent on prescription drugs. These new treatments appear to offer more permanent effects, fewer side effects and better effectiveness in ways that for some may make prescriptions less necessary, and for others make prescriptions finally enough to beat the disease.
Have you considered TMS? Have you received it? Tell us about it in the comments!
Mayo Foundation for Medical Education and Research. (2018, November 27). Transcranial magnetic stimulation. Mayo Clinic. Retrieved October 28, 2021, from https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625.
Belluck, P. (2021, October 4). A ‘pacemaker for the brain’: No treatment helped her depression – until this. The New York Times. Retrieved October 28, 2021, from https://www.nytimes.com/2021/10/04/health/depression-treatment-deep-brain-stimulation.html?referringSource=articleShare.