By Monique Moate
This post includes discussions of mental illness.
Only a few months ago, I realised I have a disability: a “long-term psychiatric impairment” or “a disorder, illness or disease that affects a person’s thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour” (in legalese). After living with these conditions for around 20 years, it was something of a relief to be acknowledged in this way.
In this post, I would like to discuss my recent experience with transcranial magnetic stimulation (TMS). I finished 21 sessions of TMS. The non-invasive therapy involves clinicians placing electromagnetic coils against your head. These coils send pulses to help stimulate parts of your brain to fight depression, anxiety, OCD, PTSD, and other psychiatric conditions.
However, the procedure is only available for “treatment-resistant depression,” meaning you need to have done the usual psychotherapy and medications thing without sufficient success before they’ll refer you to get TMS.
(Just as a disclaimer, I guess, this isn’t intended to promote TMS or anything. I just felt like sharing my honest experiences, and I hope it might help someone else out there with severe symptoms.)
Why I Decided to Try TMS
I was the first patient my GP had referred to The Monarch Clinic. She thought it was a good idea, as I had been discharged from a hospital not that long prior; and I was still experiencing severe symptoms. It sucked having been sectioned in a hospital again, in October/November last year, as I hadn’t been in one for many years.
During my inpatient stay, my antidepressant Lexapro was stopped. Unknown to me, the med had lost its efficacy after seven years of use. So, I switched to an SNRI I’d never tried before, Cymbalta.
And, thankfully, I recommenced on Seroquel — the extended-release (XR) form, to take a few hours before sleep. Quetiapine not only helps with my insomnia but with other symptoms.
(On a tangent, some GPs are reluctant to prescribe Seroquel, an antipsychotic med, for anything but schizophrenia and bipolar disorder, despite its indications for major depression and generalised anxiety disorder. One reason could be the “growing concerns” a few years back about the off-label over-prescription of quetiapine. And long-term use can cause tardive dyskinesia.)
As previously mentioned, my general practitioner referred me to The Monarch Clinic, part of Monarch Mental Health Group. They used to be called TMS Clinics Australia but changed their name to better reflect the wider range of services they now offer.
Before starting TMS, you have to speak with a psychiatrist. We discussed the possibility that I may have PTSD, too. I asked him why they place the coils to target that part of the brain — not the limbic system?
He explained that my limbic brain had long been in control. Your brain will do what it wants to do. That’s why people with severe symptoms often can’t take in or follow the advice of their psychologists. To do so, your brain first needs to be healthy enough. That’s the purpose of medication and therapies like TMS and ECT.
Dysfunction of the prefrontal cortex (basically, the front part of your brain) is associated with various psychiatric conditions. So, the idea behind TMS (also called repetitive or rTMS) is that the electromagnetic coil sends magnetic pulses to (re)activate the malfunctioning parts of your prefrontal cortex.
According to this article, TMS “involves passing of current through one or more coils positioned on the head to generate a magnetic field that in turn induces an electric field and a current density field in the brain.” It’s like giving the prefrontal cortex a helping hand. I think I remember reading somewhere an analogy that you’d need to think millions(?) of “positive thoughts” to get the effect that TMS offers you.
The psychiatrist told me that depending on your symptoms, they recommend either unilateral (one side) or bilateral (both sides) treatment. As far as I know, TMS on the left hemisphere targets depression while right-hemisphere TMS is for anxiety.
Going into it, I didn’t know whether it was going to help me. The doctor (whom I trusted because he was a medical professional and not a salesman) had said that results tend to suggest the following: around 30% achieve a complete remission, a third find some alleviation of symptoms, and another third are pretty much the same.
In my opinion, it was worth trying. While I’d read about ongoing side effects, it seems that those cases are rare.
First TMS Session
Usually, they recommend four or five sessions a week, but I decided on three per week and that was fine. So, I started my thrice-weekly trips to the clinic, located above Abbey’s Bookshop in Sydney’s CBD. My husband came with me to the first couple of sessions.
During the first appointment, they need to determine the correct coil configuration for you, including where to position it on your head and the current’s voltage. You sit in a comfy chair with your hands relaxed on a pillow. They then reposition the coil while watching for any reactions in the corresponding fingers; the left lobe controls the right hand and vice versa.
When they notice a twitch, they test the same spot and gradually adjust the voltage, watching for three reactions out of five tests. I think they’re basically looking for the lowest dose where they see a noticeable twitch/reaction. It was a bit funny to see my fingers spontaneously react. The brain is an amazing organ.
What Was TMS Like?
I did bilateral treatment. Each session they mark on your scalp where to place the coil.
They treated both sides separately, always starting on the right. From the beginning, I could see why they call it right-sided low-frequency TMS and left-sided high-frequency TMS. The right-lobe pulses felt duller, like a hard tap on your head, with the coil making a clicking sound.
In contrast, the pulses on the left were much more intense. They sounded and felt like sharp electric zaps. Although I wouldn’t call them “painful,” they were a lot stronger.
Each appointment, the clinicians start at a lower dose and gradually increase it to your full dose. For me, the right-hemisphere TMS lasted around 15 minutes while the left side was only for three minutes. On the left, there are brief pauses between each pulse, and the machine beeps before the next pulse.
During my 21 TMS sessions, I had five different clinicians, all lovely. I enjoyed chatting with them. Some were provisional psychologists who’d finished their undergrad and were going to continue on with postgraduate studies to qualify as psychologists. Others were nurses.
Interestingly, during one session, a clinician told me they actually target three spots for those with severe OCD: bilateral and the top of the head.
Did TMS Help Me?
I definitely think so. You fill out psychometric tests periodically throughout treatment (e.g., for depression, anxiety, PTSD, etc.). After 20 sessions, I was reviewed by a psychiatrist who told me that all of my tests showed a 50% reduction in symptoms.
He was happy, I could tell. Actually, he’s the psychiatrist I’d chosen for the ongoing management of my conditions (a good idea if a psychologist and GP aren’t enough), and he’s a friendly, caring doctor.
In addition, I could also just notice a huge improvement in my mood and thinking compared to before TMS. My suicidal ideation was gone. I was interested in my hobbies again. I felt like going places again. I had more energy. I could think clearer. My obsessions with negative experiences were gone. My OCD-like thoughts were much easier to let go of, rather than become preoccupied with.
As I’d mentioned to a clinician, it’s a gradual process, similar to how your mental illness deteriorates in the first place. Gradually. So, often you don’t notice the deterioration or improvement as it’s happening. Only when you compare yourself to how you were in the past some time, do you realise, wow, there is a big difference!
(This article states that: “The [study’s] remission rate was significantly higher in the bilateral group than the sham group.”)
I want to also add that Cymbalta had started taking full effect during my TMS course (antidepressants can take up to eight weeks to do so), and I quit drinking on the same day that I began TMS — the 12th of December, an easy date to remember.
It was a combination of the TMS, medication, sobriety, counselling, and support and care from many people that helped me recover. I’m incredibly grateful for all the help I received. In the future, I’ll definitely continue with TMS treatment if/when I need it.
Monique Moate is a writer, editor and woman of colour living in Sydney with her husband and cat. She cares about mental health awareness and destigmatisation, as well as social and racial equality. Monique enjoys writing about and researching diverse topics and analysing how people use language (including written, spoken and nonverbal language).
LinkedIn: https://www.linkedin.com/in/moniquemoate
