Transcranial magnetic stimulation (TMS) #1

Ok, there were two separate things happening last night and I wasn’t ready to talk about it but I’m going to give it a shot now.

TMS uses a small electromagnetic coil controlled by a computer program to deliver short, powerful bursts of magnetic energy focused precisely on the left side of the brain’s frontal cortex.

http://www.butler.org/programs/outpatient/how-does-tms-work.cfm

First part: TMS– I was prepared going into the appointment because I completed the first part of my workbook online which explained everything. Dr S. gave me a quick overview and then fitted me for my cap and secured it under my chin, and gave me some ear buds. It took him only 5 minutes to find the exact spot on my prefrontal cortex that needed to be treated. (I’m going to use another quote because my depression brain is really slow and I’m having a REALLY difficult time explaining.)

During the first rTMS session, several measurements are made to ensure that the TMS coil will be properly positioned over the patient’s head. Once this is done, the TMS coil is suspended over the patient’s scalp. The TMS physician then measures the patient’s motor threshold, by administering several brief pulses. The motor threshold is the minimum amount of power necessary to make the patient’s thumb twitch, and varies from individual to individual. Measuring the motor threshold helps the physician personalize the treatment settings and determine the amount of energy required to stimulate brain cells.

https://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tms/faq_tms.html

The actual treatment process is 18 minutes and I was crying for the majority of it– not because it hurt, it was uncomfortable but tolerable– but because my depression was very severe and I kept thinking to myself that my track record of treatments and medications working out for me for the past 16 months is pretty much zero. The Ketamine infusions can be very effective and I experience relief but it’s not consistent. The machine would make a calming sound to warn you that the pulses are coming, and they made my face twitch, my scalp is tender, and my teeth hurt– i’m going to use a mouth guard from now on.

For the second part: suicidal ideation is ramped up. I’ve been feeling hopeless, exhausted, and scared. I tried to communicate this to Dr S. and Danielle after the appointment, and I felt like the doctor was being flippant but I don’t think Woody agreed with me. He would give me all types of treatment options I could do– group therapy, CBT, IOP, ECT– but.. I’ve done pretty much all of that. I told him that I don’t think my depression can get any worse and he suggested that I be hospitalized which confused me. I haven’t been sleeping well for the past few days– It takes at least an hour to fall asleep and then I’m up 5-10 times feeling restless, and he didn’t say anything about it until I emailed him later that night.

We are going to try a Ketamine compound nasal spray ( which is $60 instead of $400), taper off my Wellbutrin because he doesn’t think it’s helping, add Mirtazapine to help me with sleep, switch to a different augmenting antidepressant which could help with sleep as well as depression and anxiety. 

I couldn’t speak to Woody on the way home, not because I was mad at him but because I felt so unheard and invalidated. When we got home, I went straight to my room and sobbed. I couldn’t let the kids see me like this. I took some Hydroxyzine to help me calm down and eventually was able to talk about it.

exhausted yet? me too.