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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 Day 1

Today I officially began the TMS process, which I talked about in this post. This is a seven week commitment and 36 treatments, and there’s a chance it won’t even work. There’s a chance it will though, and that chance is worth the effort after almost 20 years of trying medication after medication after medication after medication, etc., and failing all of them. This is something new and different.

Today was like freshman orientation – lots of paperwork and lots of preparation and meeting the people I’ll be working with for many hours of my life for the next seven weeks. I didn’t have a treatment today, but they did use magnetic waves to map the left side of my brain in order to see where the most effective spot to treat was. They did this by taking lots of tape measurements of my cranium, drawing symbols and numbers on it, and drawing lines on my face with surgical marker. It was sexy. Then they made a grid of the specific area of my brain they were going to treat.

Four different people asked me if I needed to go to the bathroom in a matter of three minutes. Perhaps I looked like someone who might pee in their chair. They had me lay my forearms on a table, hands face up, and they explained that they were going to administer magnetic waves in the left side of my brain and make my right hand twitch. Then they were going to gauge how strongly my hand twitched to figure out the most effective spot to stimulate my brain for the treatment. They used an instrument that looked like those giant glasses attached to the chair at an ophthalmologist’s office, and it would make a clicking sound and my hand would twitch as a result, just like they said. I felt nothing. Just my hand moving of its own accord.

They went row by row, cel by cel in the grid. After each row I had to stretch my hand, make a fist, and wiggle my fingers. There was a technician who reminded me to do this and giving me instructions.

Click. Twitch. Click. Twitch.
“Make a fist. Stretch your hand. Wiggle your fingers.”
Click. Twitch. Click. Twitch.
“Fist, Stretch. Wiggle wiggle.”
Click. Twitch. Click. Twitch.
“Fist. Stretch. Wiggle Wiggle.”
“Can you say ‘jazz hands’ instead of wiggle wiggle please?”
“No.”
Click. Twitch. Click. Twitch.
“Fist. Stretch. Jazz hands. Ugh.”
“Thank you so much.”

The process took about an hour. It was tedious, but I will say that the technicians and staff were very sensitive to the needs of mentally ill patients. Before they took measurements they told me that they would need to stand very close to me for a few minutes, but I could let them know if I needed them to back off. They explained everything in detail before they did it, and the program coordinator even told me ahead of time that there would be a man and a woman technician, and that if that was an issue for any reason that I could let them know. It’s always nice to be in an environment where I don’t have to fight the system to get what I need. It’s a rare situation to be in, and I’m always thankful when I come across it.

I have to wait for more insurance paperwork to come through before I start my actual treatments, and who knows how long that will take. Even though they’ve explained to me in detail what to expect, I’m still nervous about all the unknowns. The slight discomfort doesn’t worry me. For one thing I have twenty something tattoos, so whatever happens I can deal with it. For another thing, I don’t care what I have to go through if it will make me feel better. I’m nervous about the unknowns. They said that the depression and mania can get a little worse during treatment before it gets better. They recommended seeing a therapist more often, and keeping my support system close. That’s scary. But I will do my best to push through.

I will update the blog once I get an actual treatment and share how it went. For now, I’m going to go to the bathroom because no one gave me the opportunity to go while I was at the doctor’s office. So inconsiderate.

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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!