Tag: Transcranial Magnetic Stimulation (TMS)

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7th Inning Stretch

Here we are. It has been seven months since I began my recovery from my fourth back to back severe and treatment resistant depression. It is the longest span of time of relative health I have had in 4 ½ years. I never intended to count the time like this but it is so significant after what I have been through these past years. When you have been to hell and back and tried medication after medication, endured 4 psychiatric hospitalizations, intensive medical treatments which included ECT (electroconvulsive therapy), TMS (transcranial magnetic stimulation) and ketamine infusions, you do need to take a step back and recognize where you were and how far you have come. Time is important in this process. Seven months is significant. I have learned quite a bit in these past seven months and it doesn’t include thinking that all is better.

The process of recovery from major depression differs from person to person. During my briefer periods of recovery in between these past episodes, I was thankful and always felt that each one was the last. I felt too well to imagine anything obstructing that feeling. With this last episode, which was long, painful and haunting, I was cautiously optimistic. I tried a new medication from a class of drugs that I had never tried before. I had to stop my previous anti-depressant and wait two weeks before starting this new medication and began this process while hospitalized in July.

Once I began to feel better, think more clearly and feel more connected to people, I was hopeful but, again, cautious. With each month I have been able to really be “with” people, work and enjoy my life. At the same time, I do have struggles. If I do not sleep well for a couple of nights I become irritable and it can play out in a way that is certainly not fair to my husband and daughter. If I do not eat regularly I will not only get headaches but I will start to feel sad. I still have memory issues as a side effect of the ECT and sometimes I can laugh it off and others it is extremely frustrating and makes me feel angry. I am slightly traumatized by the experiences I had with ECT, TMS and the ketamine infusions. The ECT and TMS certainly helped and unfortunately the ketamine didn’t but the act of going through it all still frightens me when I think of it. It was terrifying and it was upsetting to be with and see so many other people struggling urgently with mental illness as these treatments are seen as the “last ditch” effort to ease someone’s symptoms and pain.

I have bad days as everyone else does and I have days that are “bad” but in a different way where my symptoms make themselves known. There is no cure for depression or anxiety. It is always there inside of me. I am working hard in therapy with a new therapist and this process brings up a lot of topics I have worked on in the past. It aggravates my anxiety and provokes in me anger, sadness and a bit of humility. It is hard. It is difficult. It is humbling. The positive of this experience has reminded me that I can feel better, even much better than when I was in a severe depression but there is always work to be done on myself. I’m not out of the woods and I have realized in the past seven months that I never will be. It is simply who I am and I am learning to accept it. I suffer from depression and anxiety and I own that. They will always be there in some form. I am not cured and I pray I do not have to endure another severe episode but I am doing everything in my power to care for myself. These past 7 months have provided me not only with better mental health but with more knowledge and understanding about myself. I will take this opportunity to stand up, raise my arms above my head and take that stretch.  Time is meaningful.

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What’s Good for the Body is Good for the Brain?

I have sacrificed my body for the sake of my mind and I have mixed feelings about it. I have taken medications to combat my depression since I was 19 years old. They have either helped me feel better or they have made me feel nothing or they have given me stomach issues, a severe dry mouth, headaches, anxiety, irritability, insomnia, weight loss, etc. It has truly been luck of the draw. Additionally, I have had treatments that were quite invasive and terrifying at times.

ECT (Electroconvulsive Therapy):  I began ECT three summers ago while inpatient on a psychiatric unit. I was as scared as I have ever been about anything as I began these treatments but I was desperate to feel better after suffering for months with a severe major depressive episode that was medication resistant. I did 24 treatments over the course of 5 months and it brought me out of my depression and kept me well for several months. Unfortunately, another major depressive episode took over which prompted another course of ECT. I had 21 treatments over the course of 5 months and was well for a few months after this. The aftermath of having ECT consisted of short-term memory loss where I was not be able to find the words during conversations and would think a thought only to forget it seconds later. This went on for years and while it decreased in severity over time, it still lingers. Additionally, the experience itself of having ECT has traumatized me, not because I received poor treatment, on the contrary my doctors and nurses were stellar and I always felt safe and cared for. What was traumatizing was going under anesthesia for each treatment and seeing other more severely ill patients. These memories linger and there are times when I need to discuss it with my therapist in order to move on.
I also underwent 6 more ECT treatments just over a month ago which was prompted by another psychiatric hospitalization as a result of my 4th severe depressive episode within 3 years. My memory issues and word-finding difficulties resurfaced but not to the same extent as in previous treatment cycles.

TMS (Transcranial Magnetic Stimulation): In the fall of 2016 I began a new treatment during my third major depressive episode which does not requite anesthesia (bonus) and allowed me to drive myself to each treatment. Magnets are used while pulses knock on one’s head for about 40 minutes. I underwent treatments five days a week for 6 weeks and then had maintenance treatments before finishing after a total of 8 weeks. I would sometimes have mild headaches after a treatment but otherwise I did well. I began to feel better after 4 weeks of treatments and was brought out of this 3rd episode. Unfortunately after only a few months, I was overcome by another major depressive episode. I began another course of TMS but after a couple of weeks of treatments my thoughts started to change and not in a positive way. My therapist noticed and after consulting with my psychiatrist it was deemed in my best interests to stop all TMS treatments.

Ketamine Infusions: Directly from there, I began ketamine infusions. I began with four treatments which consisted of receiving an IV infusion for 40 minutes. I ended up having 6 treatments where the one positive effect was feeling more focused but they did not help my mood. They also were emotionally painful during the treatments as the medicine heightened all of my negative thoughts and feelings which resulted in some traumatization. After my last infusion I was immediately hospitalized on the psychiatric unit. That’s when I agreed to a few ECT treatments as I had to wait while my old anti-depressant was being washed from my system before starting my new anti-depressant which comes from a class of medicine I had never tried before due to dietary restrictions. Luckily the form of this new medication is a patch that I change daily and because it is transdermal and it is a lower dose I do not need to worry about the food restrictions.

So what has my body been through in just that last 3 years? I have had numerous induced seizures, magnetic pulses to my brain, a hallucinogenic and many medications all of which have affected my brain and every other organ and part of my body. When it comes to psychiatry there are many mysteries that remain but I am sure of a few things most of which involve having the best and most appropriate care:

1. I have received the best care possible from my first therapist in New York City to my current therapist whom I have seen on and off for well over 20 years. My current psychiatrist and the doctors, nurses and social workers who helped and guided me these past few years are simply the best of the best.
2. My body has undergone a lot and there have been consequences, medically and emotionally, but I ask myself was it all worth it and I honestly can’t give a straight answer. I wish I responded easily to medication and I wish I did not have to have any of these invasive treatments but the bottom line is this: there is no cure for depression. What choice did I really have, especially when I have a husband and daughter to consider, not to mention myself and the rest of my family and friends?
3. I can’t say I would do it all the same if I had to do it over but I would still trust my doctors just as I have over the years. Even while at my sickest, I would only tolerate excellence on the part of those who treated me. My therapist who probably knows me better than anyone else is the best of the best, hands down, no question. She is highly intelligent, witty and can read between the lines like no one else. With each depressive episode over the past 3 years she has cared for me in the most humane and attentive way as one would want to be cared for during such a threatening illness. The nurses and doctors in the ECT suite were warm, friendly, smart and always tried to create a sense of peace while I was internally fighting my anxiety. The psychiatrist who follows my care whenever I am inpatient is quite brilliant but he is down to earth and he not only works with me, he considers me as a team player. My outpatient psychiatrist listens to me and takes into account my experience and never takes over as the “expert.” I would not have it any other way.

While every inch of my body and being has been through more than anyone should have to endure I am now recovering and as I am I am reclaiming my body and soul in a way I haven’t before. I am taking yoga classes that incorporate mindfulness and after only a couple of weeks, I am starting to feel more in charge of my self, more like the captain of my being. It makes me feel strong and forces me to stay in the moment when that can be very difficult as I try to deal with thoughts and memories of the past 6 months of a horrific illness. By no means am I saying that yoga is my savior but for now it feels good at a time when not much has felt good. My body and brain have suffered unimaginable terror and it is now time for a well deserved break.

I can’t say what the future will hold in terms of my depression but for now I am taking over and I am the one making the decisions regarding my being. This is what is good for my body and my brain.

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Caution, Caution

Five weeks later, after a week in the psychiatric unit and several ECT treatments and new medication, I have begun to feel better. What exactly does that mean? Well, for one thing, I am thinking more clearly than I have in about 6 months. Thoughts are clear and follow a pattern and for the most part are not negative toward myself. I can also be and feel more involved in conversations and feel present in social situations as well as at work. Time will go by and instead of me feeling misery with each passing second, I surprise myself when hours have gone by without my tracking them. My mood is definitely better which was sparked by the clearer thoughts. My mood is more reality based and not as negative toward myself. I can be “with” my husband and daughter and really be there. I know they both feel the difference, just as I do.

With this renewed sense of clarity though comes with it a review of the past 6 months and realizing and recognizing how ill I was. Thoughts occur to me that are deeply painful and there are moments I need to write them down as part of processing them. My therapist says I will need to let them go but since it’s only been a couple of weeks of beginning to feel better, I need more time. I am not ready to let go yet as it is important that I process certain thoughts and occurrences in order to be able to let go and move on. Because I was so ill, it was difficult to understand or even acknowledge my thoughts when I was in it. I knew I was quite ill but at the same time it became my “normal.” As I come out of it, the realization of how confused and painful my thoughts were is overwhelming at times and I need to let myself process, cry and mourn. I do feel I am in a period of mourning–the time that was lost and the reality of what this horrid illness did to me, physically and mentally, represents a huge loss.

It is a lot to absorb and I think it is vital to those around me to understand that just because I have had an upward swing these past 2 weeks, and I do believe that will continue due to this wonderful new medication, I am currently enduring something very deep and existential the likes of which I have not experienced before and if I did, I simply do not remember. There is no magic act where I have been cured and all is wonderful now. I have to find my new normal, just as I have after each of my other episodes of severe depression. This is a true process and I know I am on the right track, I just think it is important for those around me to understand that this process is ongoing. I may not have those ongoing feelings and thoughts of harming myself but I am not cured. They sometimes lurk in the background and luckily I now have more strength and understanding and can talk to my therapist and psychiatrist about them. I am very well aware that I am at risk and luckily I have a husband who is on guard and a therapist and psychiatrist who also are taking stock of what I have been through and where I am at now.

It is a good place to be, certainly a better place than the past 6 months. I have endured treatments that were invasive and, at times, terrifying. Transcranial Magnetic Stimulation (TMS), Ketamine Infusions and Electroconvulsive Therapy (ECT) held their own stress and hope and represents how I have and will continue to jump through those hoops that my therapist, psychiatrist and other doctors at Yale present to me. I am a good patient and I always have been. I listen and I advocate, even at my sickest. It is a true collaboration and I consider myself extremely lucky to be part of this amazing collaborative team; not only that but I am considered an important part of this team. I know many people who do not have this experience and feel on the periphery of their treatment team which, in my mind, is a sin. I know how lucky I am and would not be where I am now if I did not have a respected place within my own team.

I will give myself the time needed to process the many thoughts and memories of the past 6 months that come up. I will talk things through with my therapist in order to understand and course through these memories and thoughts so I can let them go. I know I will need time to get there and I know I have the support of my family and friends as well as my therapist to get me through to the other side. I will always have memories: certain smells and sounds may bring me back to those moments immediately before I was given anesthesia for an ECT treatment. I just need to allow them and talk about it in order to process it if I need to and/or let it go. This is easier said than done right now which is why I will repeat the importance of doing this on my own time. The past 6 months have been pure hell and has affected my family and friends but as my therapist has said to me numerous times, it affected me the most and the worst: I was the one with the severe depression. There is much to process, feel and mourn and I know I will get to that next stage of letting go within my own time frame and with the support of those around me.