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The First TMS Treatment

Today I finally had my first TMS treatment for the depression part of my bipolar disorder. I had the prep appointment the other day, but because we were waiting on insurance paperwork to come through, I didn’t have my first actual treatment until today. I was so tired and frustrated from waiting for insurance that I didn’t have any energy left to be nervous about the procedure. That ended up being fine because the procedure was not scary at all.

The technician, who I will become intimately acquainted with over the next seven weeks, walked me through the procedure before we started. She’s very friendly and thinks I’m funny. Every time I say something she thinks is funny she repeats it loudly instead of laughing at it, which is amusing. She told me she liked my shoes (shown in the photo above – I put on special shoes for my first day) and I said, “Thanks, I call them my David Bowie shoes.” She said, “YOU CALL THEM YOUR DAVID BOWIE SHOES!” I’m going to make this a project during my treatment, to see how many of my comments I can get her to repeat in a loud voice.

Anyway, the treatment. They put the cap back on my head and positioned a round instrument on the left side of my head according to the grid they made the other day, and they pressed it into my head. There was a series of zaps that lasted four seconds followed by a ten second rest. It felt like mild electrical waves tapping my head. It didn’t hurt, but it induced a headache behind my right eye that lasted four seconds. It was mild, but if I had a headache like that on a normal day it would be annoying but not painful.

The series of four seconds on, ten seconds off lasted 17 minutes and then I was done. The tech asked me questions about my mental health history, current diagnoses, and rating my moods on scales from one to ten. She said she would ask me those every day.

All in all it was very simple and easy. I have a bit of a headache afterward, and feel a little lightheaded and nauseated, but neither stopped me from getting tacos for lunch on the way home. I do feel mentally exhausted, maybe partly from the depression, but also partly from the brain “workout” I did today. The tech said that usually gets better after the first week. So I’ll have my second treatment tomorrow, then I’ll be in full swing starting next week.

Now I’m going to go stare at a wall for a few hours because that feels like my level of mental competence today. I hope some of this depression lifts soon.

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TMS (Transcranial Magnetic Stimulation)

Transcranial magnetic stimulation, or TMS, is a new, non-medication non-invasive depression and anxiety treatment that uses MRI waves to target and stimulate areas of the brain responsible for regulating neurotransmitters. Dysfunctional neurotransmitter communication is the closest known cause of depression and other mental illnesses, so TMS is a way to potentially treat the source of the problem without using medicated stimulation of the same neurotransmitters. TMS is performed without anesthetic and is reportedly pain free. Insurance will cover it if at least 5 other medications have failed to treat depression successfully. It’s a less invasive procedure than ECT, which is more intense treatment and is done under general anesthesia.

It does not appear to be a magic cure that Pharma’s been keeping a secret from us because the success rate is about 30%, the same as for medications. Supposedly if you have tried several medications without success TMS is less likely to work for you. In the last two years alone I have failed on at least 5 medications. I’m currently on six different medications that are helping marginally but creating serious side effect problems.

The weight gain that is common with some antidepressants and bipolar medications is causing more serious problems than just making me uncomfortable. The medications make me crave sweets and my appetite is through the roof. It’s bigger than self discipline. I’ve gained 30 pounds since starting two different medications, and because I am so hungry all the time my blood sugars are out of control. 400 – 600 mg/dL high. Daily. I should be able to just not eat so much, and I should be able to control myself since it’s actually making me face my own mortality, but I can’t.

I need something to clear itself up – the bipolar, the depression, the insatiable hunger, the grief, the foggy brain, the sleep problems, the kidney damage caused by not only the lithium I’m taking but now my extremely high blood sugars. Something! Help! I’m tired of watching myself die.

So I’m trying TMS. The success rate isn’t as close to 100% as I would like, but it’s not going to hurt me. It might be a little expensive, but insurance covers part of it. Incidentally I learned that TMS can treat anxiety too, but it’s not approved by the FDA. This means that insurance won’t cover it and it’s around $11k.

The treatments take 30 minutes a day, and you go every Monday through Friday for seven weeks. I’ll be awake, there will be scalp discomfort for the first few days and I might get a headache afterward for the first few days. That’s the worst of it. If this can help me get off even one of these meds I’m on I will be grateful. I’d like to get off most or all of them, but I’m cautiously optimistic. It’s something I’ve never tried, and I’m pretty damn close to having tried everything and still feeling very depressed. It’s my normal. What if it could be different?

I’m willing to venture an answer to that question by trying TMS. The answer might be “It can’t be different,” and I’m prepared for that. If it’s anything other than that I’ll be thrilled. I am so tired of trying the same things over and over and getting the same results. I do not want to accept that this will be the rest of my life.

I am going for a final consult with my doctor today. Assuming I go forward with the procedure I will report the progress and the things I learn along the way. Here’s to voluntary brain zaps!

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The Greys and Army Greens

Why does reading about someone who has bipolar give me a start? Why does hearing about someone who committed suicide make me feel just a little bit jealous? It doesn’t mean I’m a bad person and it doesn’t mean I’m crazy, that’s just the nature of triggers I guess. I’m reading a book that mentions someone’s family member who had bipolar (by the way I’m careful to say “has” bipolar as opposed to the more commonly used “is” bipolar because our conditions do not define us) and refused to take medications because they didn’t want to be “dulled.”

The person ultimately killed themselves, and it sounds like they had a lot of struggles in life. I can relate very much to not wanting to be dulled. Taking the relatively large number of medications, in addition to making me fat, turn my brain into fog. My feelings are dull and I don’t get as much enjoyment out of things I normally enjoy, but when I feel sad I feel it too strongly. The thought of getting off my medications just so I can feel something again is very appealing. But the consequence of doing that is that I will probably end up either hurting everyone I love, putting myself on the streets, or dead. At least I would feel life again, though!

I’m not going to go off my meds, but it will never stop sounding appealing. I think of the days when I wasn’t on medications or wasn’t taking my meds like I was supposed to, and though I had huge mood swings on a daily basis, I felt love like fire, I felt joy doing the things I loved, even the lows that I felt so strongly made me feel alive. I was connected to life. Sure, I wasn’t sleeping or eating much, and I would have days at a time where I would cry in bed barely getting up to pee much less function like a human. But that’s part of what made me feel alive.

Now I’m taking all the handfuls of meds like I’m supposed to, but I feel a muted sense of being alive. There are many things that make me happy: my boyfriend, my dog, my friends whom I cherish. The love for those things runs deep. But everything feels muted. I still have the mood swings, but they’re not as extreme. The “even keel,” the “baseline” doctors want me to stay on feels Okay. I am Okay. Life doesn’t have the reds and blues and purples and lively yellows anymore, just greys and army greens. My memory is shot, focus is a challenge, I often feel like my personality has gone into hiding, my hands shake, my energy is in short supply and I’m often too tired to function, but I am Okay.

Not fantastic let’s-get-up-and-go-I-don’t-care-where. Not terrible, hopeless, I’d be better off dead. Just okay. I am so lucky to have people who care about me and are always there to help me through the days, even the days when the high/low extremes come back and I’m not Okay anymore. In the meantime I’m living in the fog and reminiscing about the times when I felt like I was living in brighter colors.

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Grey, Everywhere

Have you ever heard a version of the saying, the only way you’ll get what you want is if you ask for it? In a lot of ways this has proven to be true in my life. I’ve learned to stop waiting for things to happen for me and to start making things happen.  I’ve learned not to complain about my life not being what I want it to be if I haven’t made any efforts to make it so. I’ve learned to trust the things that I want and to think about what it would look like for me to actually go after them. Sometimes with that last one I find that what I wanted, even when it is a genuine, strong desire, isn’t what I really need.

Often this lesson comes along with life experience. For example one time when my nephew was two years old, he felt with all his heart that I wanted to go play with the white and orange lane bumps in the middle of the road. He turned to run into the road, and when my sister stopped him he cried and cried and cried as though by not getting what he wanted, even if it was dangerous, his world had just ended. I think this is a fight that we continue to have with ourselves in different forms our entire life, we just don’t always have my sister to stop us from running into the road. As adults the decisions are ours.

How can we amass four decades of life experience, fully understanding that certain decisions will be dangerous, and still make the self destructive choice over and over again? Just because I want something doesn’t mean it’s the right choice for me. And just because something is the right choice doesn’t mean it’s going to be attractive to me at first. I want a lot of things. I want speech without consequences, I want sex without consequences, I want to deal with my problems by drinking and getting high, I want a baby elephant, I want to live in a self sustaining house in the middle of the forest and never talk to anyone ever again, I want to eat strawberry frosting from the tub with my finger.

Because I’m adult, I can choose to do any of those things. People may try to stop me, but no one can really stop me if I decide go for the frosting tub. I’ve said it before and I’ll say it again, don’t get between a diabetic and a tub of frosting. Just don’t. But any of those other things on the list are either not realistic, or they would have consequences that I do not want. I could speak like there are no consequences, but then I would end up hurting people I love or going to jail. I could adopt a baby elephant but I would ruin its life, and possibly vice versa.

All I’m saying is that sometimes making out lives better isn’t a matter of demanding what we want. I don’t go up to my boyfriend and demand that I want to start living in the forest and may not be home very much anymore. That would not make my life better at all, even though it’s something I think sounds attractive. Because the world isn’t black and white. It’s all grey, everywhere. Want doesn’t equal need. Want leading to happiness is as much a truth as want leading to disaster, so we have to fish around in the grey to make the best choices we can.

My heart can be an idiot and my brain can be a bitch, but every now and then, with effort, they can work together and take care of me.