Depression is a heterogeneous disorder: the combination of symptoms, its etiology, and treatment responses are varied and wide-ranging. Just as each patient’s experience with depression is unique, individual experiences with transcranial magnetic stimulation (TMS) may differ. Through sharing the stories of three patients (whose names and details have been changed to protect their privacy), this post is intended to demonstrate how varied the TMS experience can be.
I. Kaitlin sought TMS treatment as a last resort. Over decades, she had tried several antidepressants to no avail, as she either did not respond to them or was unable to tolerate the side effects. For years, her depression robbed her of her energy and time, such that she would lie slumped on the floor as hours of the day passed. Simple tasks such as brushing her teeth in the morning felt insurmountable. For the first half of TMS, Kaitlin’s mood fluctuated. On some days, she would notice a newfound optimism that allowed her to work, tend to her family, and run errands. On others, she would wake up with the same nauseating sense of dread, one that she likened to a perpetual cloud over her head, weighing her down. Kaitlin felt that one of the most debilitating aspects of depression was the cognitive inflexibility that she experienced. One Monday, at the beginning of her 4th week since starting TMS, Kaitlin noted that she had finally felt able to accomplish a work task that had been on her to-do list for months. For the first time in months, Kaitlin experienced stronger working memory and ability to focus. It was a subtle change, but one that she realized when she compared it to the way that she used to be. Kaitlin believes that TMS allowed her to regain her creativity and joy in her life. Kaitlin has been in remission from major depression for 6 months since the completion of her last TMS treatment course.
II. Michelle was diagnosed with major depressive disorder when she was a teenager. She also struggles with social anxiety. When she came to Principium Psychiatry for TMS treatment, she was in between jobs, and her depression made it extremely challenging for her to seek out new opportunities. As the TMS treatment sessions went on, Michelle noticed she was less irritable and became better able to regulate her emotions. She felt as if she could engage with others without having intrusive thoughts regarding how others perceived her. By the end of the second week of daily TMS treatment, Michelle noticed a difference. She described, “I’m not jumping-off-the-walls happy, but I’m feeling an absence of something…I no longer have that sense of impending doom when I wake up in the morning.” Michelle also likened the change to a “sudden lifting of a weight off my shoulders,” a gradual relief that took place over the course of treatment. She regained energy to go to the gym, she felt more hopeful, and began looking forward to starting the day. It was a feeling that she had not had in years. She also reported being able to more easily disengage the negative, repetitive thoughts. She recognized her own distorted perceptions, particularly when it came to social interactions. Michelle noted feeling more in control of her life, a sense that came with a heightened awareness of her own thought patterns that were detrimental or maladaptive. By the end of her TMS treatment course, Michelle felt eager to restart the job search process, a noticeable change from when she was starting out TMS treatment.
III. For years, Robert struggled with work-related anxiety. Pressure to keep up with assignments, learn new skills, and train his assistants left him feeling overwhelmed and depressed. Over nearly the entire course of TMS treatment, Robert did not notice any improvement in depressive symptoms. By the end of the fourth week of daily TMS, Robert had given up hope that TMS would help him at all. It was not until nearly the last couple of sessions in the 36-session treatment course that Robert first began noticing a change. Over the past week, he noticed that the work felt more manageable, and that his improved concentration allowed him to accomplish tasks with greater efficacy and ease than before. He no longer felt sluggish and scattered. He noticed a decrease in ruminations regarding work, as well as decreased stress and anxiety. Robert also noted becoming more cognizant of his own physiological responses to emotions such as hopelessness or anxiety, and was able to reassess them with enhanced clarity of thought.
Responses to transcranial magnetic stimulation (TMS), as with any treatment for depression, manifest in different ways depending on individual circumstance. For further questions or to schedule an initial consultation, please visit our website or give us a call at 212-335-0236.