Over the past few months, I have been undergoing Transcranial Magnetic Stimulation (TMS) for my treatment-resistant Depression. How do we know my Depression is treatment-resistant? Well, I have needed to go on Disability for it 4 times during the past several years. Each time was months of not working. During those periods, I underwent Intensive Outpatient (IOP) therapy twice, Partial Hospitalization Program (PHP), Dialectical Behavior Therapy (DBT) and my continued regimen of Cognitive Behavioral Therapy (CBT, talk therapy), and medication. Even with all of that, I still struggled quite a bit and even attempted suicide (see Almost There and Back Again: A Fat Man’s Tale » Can’t Juggle). Clearly, I needed to kick things up a notch.

My goals for this post are as follows:

1. Share the fears/trepidations I had going into the process
2. Provide some technical (but not clinical) descriptions of the mechanism of the process
3. Describe my experience (what it felt like, etc)
4. Share the results I have experienced (foreshadowing: it helped tremendously)

Whether you are living with mental health challenges and looking to learn more about TMS, have a loved one going through it, or just enjoy brilliantly written blog posts, then this one is for you.

My fears about TMS

Going into this process, I had several worries.

I was afraid of the commitment. When my depression and/or anxiety is acting up, I isolate like mad. Anything that makes me leave my basement office, let alone venture out into the world, afflicts me with dread and even outright fear. So, the idea of doing this every weekday for 36 treatments didn’t exactly give me a warm fuzzy.

Physical pain is not my favorite thing. I was afraid that it would hurt, and I would be hard-pressed to see it through or even so distressed that the efficacy of the treatment would be reduced.

To borrow from The Grinch, “There’s one thing I hate all that noise noise noise noise!'” Loud noise is a major trigger for me. Especially if it is sudden. Because of this, I no longer go to concerts, the movies, plays, or any other events that include sound as a major component. Don’t even get me started on fireworks or air travel. I’m not sure why noise is so problematic. It was not an issue for most of my life. It just jumped aboard my symptom train a few years ago like some asshole hobo.

The setup

Next, they kicked on the machine (which pulses) and tried various points on the front left to find my motor cortex. This involved the highly scientific process of “fuck around and find out” until my right arm twitched on its own. Then they reduced the power of the pulses to the point where my arm stopped twitching. That was used as an anchor point to locate the target regions of my brain for each protocol (described below).

I was there for the Depression protocol, but they offered me additional protocols to help with both my Anxiety and the rumination/suicidal ideation at no additional cost. It just meant being there for a bit longer.

Yes, please!

See the following posts for more on my suicidal ideation and anxiety.

• Almost There and Back Again: A Fat Man’s Tale » Can’t Juggle
  • This one goes pretty deep into my suicide attempt, so buckle up before reading it. Or skip it if that is not something you’re up to.
• Cat Pee, Suicide, and Bananagrams » Can’t Juggle
• Anxiety Disorder, ACID, and Cash Money » Can’t Juggle
• Meet Dave: My Anxiety Vampire » Can’t Juggle

Each of the three protocols I underwent target different areas of the brain and feature pulses at different rates. They can provide therapeutic benefits by [like a shit ton of science stuff]. Pretty cool, right?

Depression (Standard Protocol)

For depression, the machine zaps at a rate of 20 pulses per second for two seconds. Then it pauses for an interval of 11 seconds before pulsing again. This grouping of pulse and interval is called a train. In this protocol, there are a total of 78 trains over about 20 minutes.

Each pulse feels like someone tapping on my head with a hammer; not enough to injure, but enough to definitely get my attention. So, I would say it fell short of being painful, more like medium discomfort. During each pulse, the left side of my jaw would want to contract, so I had to be careful not to bite my tongue. In addition, it contracted the surface of my scalp such that it fell like someone pinching the skin. I enjoyed chatting with Gabby, the TMS technician. I had to pause speaking during the pulses though since I could not really control my mouth. It was… fun.

The pulses sound like someone walking on a smooth stone floor in high heels, but loud enough to dominate any other sounds. It did NOT trigger my anxiety, so I was good on that front.

I’m not going to lie. This is not a good time. But it is not as bad as I had feared.

Modified OCD Protocol for Ruminations

While this protocol does not have suicidal ideation in its name, it can have benefits for that, which was the goal for me.

For this protocol, the emitter sits just about on the top of my head. The pattern is 1 pulse per second for 10 minutes. If you are interested, it targets the Supplementary Motor Area.

This one also feels like someone tapping with a hammer, just like the Depression protocol. The sound is the same as well. Not sure if it is the different location or the frequency of the pulses, but this protocol was the easiest for me to tolerate by far.

Anxiety Protocol

The typical target location for this one is on the front right of the head, basically like the Depression location, but just on the opposite side; the right dorsolateral prefrontal cortex (DLPFC). I found that location unbearable (even at only 80% pulse intensity). There is an alternate location for this one in the back right of the head, more or less a few inches behind the right ear. This location was much more tolerable and has about the same efficacy.

The pattern is 5 pulses per second for 5 seconds, then a 5 second interval with no pulses. It does this 67 times over about 12 minutes.

The pulses in this protocol felt less intense than the others, almost like whoever was tapping my head with a hammer started using a smaller hammer. The sound was also more of a buzz than a solid impact. I found it was also a bit quieter than the other protocols.

My results

I will share again that TMS is not an enjoyable experience. But for me, it was a far easier experience than I feared it would be. And my results were well worth it.