ANXIETY IS BETTER; NOT SURE ABOUT DEPRESSION. ALSO NEUROPLASTICITY.

My depression does not come from nowhere and is not formless. It is the result of my firm and immutable belief that life/ the gods/ the universe hates me and/or is punishing me and that it is impossible for me to be loved. This is based on my experiences throughout my life. No matter how much I have tried, and tried, and tried, I cannot connect with someone; I have no love in my life. I am alone. Always have been. Always will be. That is the belief that my life sits on.

I have to admit that for the last week or two, I have been feeling pretty good. I have felt the tug of depression but not too strongly. Just when going to sleep at night. Not sure whether this is the effect of treatment or just a good phase I am going through. I just can't tell. It is possible that it is the TMS. Possible. I think my anxiety is down quite a bit. And my depression is often a reaction to anxiety: I just cannot deal with anxiety so I think of things to depress me so I can sleep. It works.

However, two nights ago, I fell into the pit of depression. There's an actor I just crushed on and when I do that, all my beliefs about the hopelessness of my life erupt. (I haven't crushed on a 'real' man in several years. In part b/c actors are 'safer' since they're aren't really real, and in part b/c there just haven't been any men around me since I went off work on sick leave.) Horrible things went on in my head and I finally I cried myself to exhaustion and slept. I was depressed and subdued all the next day.

At the time, while I was torturing myself emotionally, the depression felt just as deep as it ever has. Now, I'm not so sure it was. And it only lasted a day and a half or so. I'm not as upbeat as I was before it hit me, but close. Again, the result of treatment or just a fluke of mental health?

Today while in treatment, my psychiatrist stopped in with a medical resident whom he was explaining the treatment to. He said that it is believed the treatment helps b/c it increases "neuroplasticity."

From Wikipedia:
Neuroplasticity, also known as brain plasticity, is an umbrella term that describes lasting change to the brain throughout an individual's live course.

  

So right now, my brain should be more able to be changed. Maybe if I think things I would LIKE to believe instead of what I DO believe, even though I don't currently believe them, they might change my brain for the better. Things like:
I CAN BE HAPPY!
I AM SEXY!
I CAN BE LOVED!
I think I can grant that it is possible for those thoughts to be true even though I don't believe they are currently. So I put them as pop-ups on my phone with reminders several times a day. We'll see if they help. Maybe my brain can adapt and accept them. Who knows...

PS, they say everybody likes blogs that have pictures better, so here is one of the lake behind the hospital one hot windy day last week.

TWO WEEKS DONE: NOT SURE IF HELPING. ALSO DEPRESSION IS MY DRUG.

Two full weeks under my belt, nearly half way done, and I don't feel any different. I am sleeping better than before I started but I go through periods of sleeping well, not sleeping well, back and forth.I still sink into the black pit regularly, hating my life, hating my future, wishing I had never been born, looking forward to dying some day, can't come soon enough.
The best I can say about TMS is that I don't feel any worse.



I'm not sure that anything can get rid of my depression. My whole life has majorly sucked and my future has nothing but sucking in it. Even if my brain isn't depressed my life is.
I am concerned that TMS will take away my access to my pain. I know that should be a good thing but my pain is like a friend. It is the one constant in my life. Whenever I want I can touch my pain, like a missing or chipped tooth. It is comforting to cry sometimes, especially at night when I can't sleep; it puts me to sleep. What if the depression and pain are still there but out of reach? What if I can't cry when I want to? What if it just makes me dull and numb rather than sad or happy? What will I do then?
What I hope is that it will at least relieve the depression that drains all the energy and will out of me, and that I will feel like doing things again. Like cooking, tidying my room, creating, being social. All those things are too draining for me to do regularly and have been for a lot of years. Just give me back energy. I would be grateful for that.

DAY FIVE: SO FAR, SO GOOD. ALSO ENJOYING THE LAKE.

One week of treatments under my belt. I've decided to try a week of taking only 1 Naproxen with my morning meds instead of two for a week and see if it affects my reaction to the treatment. If it doesn't I will try none next week.

Walked along the lake for a while after the session. The wind was up so it was rough and there is a tiny rocky beach in one spot where the waves crash and thunder. It was delicious! Very therapeutic.
Saw these ducklings there the other day. So cute, especially the yellow ones!

TREATMENT END DATE? COLD TURKEY OR TAPERING OFF?

I met with my psychiatrist on Wednesday, after my 2nd treatment. He says that we will review the treatment at the end of 4 weeks. If necessary, we can add more sessions. Also, he doesn't like the idea of just finishing the treatments and going cold turkey. Although there is not yet any research for or against, he would like to taper off the treatments gradually. I agree.

DAY FOUR: SNAP!

Friday was my fourth treatment. We've maxed out on both sides now so it won't get any worse. The only uncomfortable bit is my jaw moving. On the right side, I snap my teeth. Not much though. If I bit my tongue it would hurt but no more than all the other times in my life I have done so. Ouch! And even though my jaw muscles are being stimulated on both sides, I haven't had any muscle ache after. So far so good.

Since I can't take a photo myself, here is much what my treatment looks like, only the lounge chair I sit in is more comfortable than this looks, and I wear a lycra cap. The cap is marked to make sure that the exact same spot in my brain is stimulated each time.


Image: http://www.alibaba.com/cache/TMS-Transcranial-Magnetic-Stimulator-_141738849.html

Below is what the actual instrument looks like, though the one used on me is attached to a stand like in the photo above. My psychiatrist says it puts out 3 Teslas, similar to a standard MRI. The best MRI available uses 7 Teslas.


Image: http://www.prescouter.com/2012/09/transcranial-magnetic-stimulation-possible-cure-for-tinnitus

DAY THREE: R.I.P. MY SWEET GIRL.

Was even easier than Day Two. No aftereffects. None at all.

Started out pretty blue. Today is the 2nd anniversary of the death of my older cat. She was my baby, my best friend and my confidante for more than 20 years. I miss her as much as if she died yesterday. I cried on the bus on the way to the hospital.

The therapy was short: 3 minutes per side and bing! I was done. A friend picked me up afterwards and we ran some errands and she treated me to lunch. We gabbed and gabbed. We went back to her place for tea and crafts but her puppy is so cute we just sat on the balcony petting the dog and cat.

I walked home (Hot!) and stole lilacs from a couple places so now my room smells like spring!

It was a good day.

RIP my kitty-love.

DAY TWO

Sorry, no photo. The hospital doesn't allow photos to be taken in the treatment areas. I guess I could enquire who could give me permission and request it. But give me a break: I have depression and don't want to do much of anything. I made it to treatment today. That's enough.

Today J started me at the level I ended at yesterday and I jumped on the first buzz. Actually, I jumped at the first 3 or 4 buzzes. I found out that the treatment level will be 120% of my motor thresholds which were 28 & 32. So that would be 33.6 and 38.4. We aren't quite there on the left side, but I made it to the full level on the right side. Tomorrow I'll have to ask what the units are: 33.6 whats?

Some things I have read say the treatment is noisy but I don't find it so. It's about as loud as a busy tone on the phone.

This session wasn't much different than the first day although I felt a little funny afterward. Not dizzy exactly. More like my glasses were on crocked and I couldn't quite focus. I sat in the waiting room and checked my voice mail and after about 10 or 15 minutes it was gone.

As for any effect, it's too early to tell. I haven't been feeling too bad lately, the last week or so, and sleeping fairly well. It will be interesting to see when/if I notice any improvement and if I will be able to tell if it is from the treatment or I'm just in one of my rare but not unknown better phases.

TMS, DEPRESSION, COGNITION AND SENSE OF SMELL

I am also participating in a research study being run by two grad students at the local university: The Effects of ECT or rTMS on Olfaction and Cognition in Patients with Depression. "The purpose of this study is to determine if ECT or rTMS afect the ability to detect and identify odours and improve cognition. It has been demonstrated that individuals who are depressed have a decreased ability to detect odours, and suffer from cognitive deficits. As well, it has been demonstrated the ECT and rTMS are extremely effective treatments for depression. The goal of this study is to determine if patients whose depression improves after having ECT or rTMS, also show an improvement in their ability to detect odours and cognition. These findings can help shed light on the link between areas in the brain responsible for cognition, the sense of smell and the areas responsible for depression."

I know, sounds boring, but hey, anything for science.

So in the process of participating, I got to have a functional Magnetic Resonance Image (fMRI) of my brain done. Hey, it even looks like me!



It's weird to see all the structures of my brain, just like in my university psychology text books, and to think that the inside of my head really looks like that. That what I can see in this photo is what makes me, me. It's not just bad luck or my fault or a curse. It's squishy things inside my head, that maybe TMS can change. Even just a little.

One part of the study consists of remembering numbers and pushing the correct buttons while in the MRI. The other part consists of being blindfolded and smelling sticks with odours on them. My ability to discern odours is very slightly below normal for my age.

When the whole series of TMS is done, we'll do the fMRI and the Sniff Tests again and see if there is any difference. Stay tuned!

FIRST SESSION OVER AND DONE.

The worst part was getting up at 6:30 AM to be there by 8:00. The nurse, J., was friendly and told me everything she was about to do, which I like. That way, nothing is a surprise.

First I had to take off my glasses and put them and my cell phone in a basket on the desk. The magnetic pulse could damage the phone at close range. Then J put a tight-fitting Lycra cap on me - I'll get a photo tomorrow. She did some measurements and marked spots on the cap in marker. Then she put the magnet on one side of my head and buzzed me - the goal was to make my thumb twitch minimally. My whole hand twitched and tingled so she dialed the magnet down. They want the lowest level where she can still observe my thumb twitch, my motor threshold. When she was satisfied, I could hardly tell by watching my thumb that anything was happening and I felt nothing in my hand. It tickled on my head but didn't hurt. The level on the left side of my head was at 32 and on the right 28. Or the other way around.

Next I reclined in a lounge chair, and J. warned me that the muscles of my face, jaw or neck may be triggered, and that it shouldn't hurt but the best thing to do was to relax and just let it happen. If I clenched or tried to control it, my muscles could be sore afterward.

She had me turn my head to the right and she placed the magnet on my head. It weighs 8 lbs (about what my smaller cat weighed) so it was noticeable but not heavy. She then tightened it so that it was pressed firmly against my head and my head couldn't move. That didn't bother me but it might some people.

She turned on the magnet and it buzzed me for about 2 seconds (one one-thousand, two one-thousand) and stopped for 5 seconds, then buzzed again for 2 seconds. J raised the level each time. The first few times it actually tickled at the spot on my head where the magnet was focused. After three or four times, my eyelid started to twitch so I closed my eyes. It felt like someone lightly tapping my head with a pencil - I could feel it but it didn't hurt. And on the opposite side of my head, the side pressed against the chair, it felt like someone was touching my hair.

J continued to raise the level and my jaw started to tingle, then twitch, then move side to side. It wasn't comfortable but not painful. I tried to just stay relaxed and let it happen. The magnet felt like someone tapping firmly on my head. Again, not painful

After a total of 3 minutes, I was done on that side. I turned the other way and the whole procedure repeated, eyelid twitch, jaw wagging, pencil tapping and all. The only difference was that instead of feeling like someone was touching the side of my head opposite the magnet, it felt like someone was touching me on the very top of my head. Three minutes and we were finished. I filled out a couple short depression indexes and I was on my way. I felt fine afterward, no headache or dizziness or anything. Back tomorrow but not until 11 AM. At least I get to sleep in!

TODAY'S THE DAY

I go for my first treatment this morning. I'm a little excited. Not that I expect it to work. I don't really. I can't imagine anything changing me. I think I'm looking forward to..., I don't know. I think I am so starved for attention and caring that just having medical professionals do something for me is better than sleeping in and doing nothing.
Gotta go. Don't want to be late. More later.

START DATE!

I finally have a date for my TMS therapy: May 24!
I have to go into the clinic next week to sign consent forms. Then at the first session they will tell me about what is going to happen. I am looking forward and dreading what is to come.

Looking forward because maybe it will help. Dreading because I doubt it will.

I have been told that the sessions will be 10 minutes long, five days a week for five weeks. I am scheduled for what is called the “Theta Burst Protocol.” The researcher who has been developing it, Dr. Jonathan Downar, Toronto Western Hospital, speaks about it in this video in 2014:
https://www.youtube.com/watch?v=x1D5OXCuQro

Just go to the 15 minute mark which is when he starts talking about treating treatment resistant major depressive disorder (MDD). For statistics about mental health and treatment availability, start at 8 minutes (and for the U.S. just multiply the numbers by 10). The Q&A after the main talk has some good info too. 

MORE ABOUT ME

Well, read the Blogger Profile, then come back here.

Done? Okay. As you read, I have been struggling with depression and anxiety for a long time, and I’ve tried a LOT of different treatments with little success. Some success, or I probably wouldn’t be here, but not enough.

I’m not working now. I left work on Sick Leave three and a half years ago. I was in a meeting with my supervisor and another colleague to discuss some problems in the office; I started crying and couldn’t stop. So I just left. I never went back.

I was on sick leave for a year and a half, and when I was ready to return to work, my job wasn’t there. The office had been reorganized and my position had been split into three (no wonder I was crying, doing the work of three people!). 

Then my cat died. She had been with me for more than twenty years. She was my baby, my best friend and confidante. She was old and sick and it wasn’t unexpected but I felt like my world had collapsed. I had enough savings that I decided to take the summer off from looking for work to help me adjust to life without her. When I started looking, I couldn’t find anything, not even interviews. I have been a senior administrative assistant in universities, with experience in non-profits and fundraising, but all of a sudden, nobody wanted me.

Also, I had waited too long since my last day of paid employment so I didn’t qualify for unemployment insurance support, and I had too much savings to qualify for welfare. So I started burning through those savings, small as they were to start with.

I have applied for Canada Pension Plan Disability Benefits (CPPD) but for a variety of reasons, have been refused. As soon as the TMS therapy is finished, I am appealing the decision with the assistance of the local legal aid clinic. The process takes on average three years.

Among the reasons I was refused was that I tried to return to work after my sick leave, and because I have taken some temp work and continued to apply for work. I guess if I’m well enough to try to work for a couple days at a time, I am not disabled. So now I don’t try to earn any money and I don’t even look at job postings. Someone who is receiving CPP Disability is allowed to earn a certain amount without penalty; I guess just not when you are trying to qualify in the first place.

I have also applied for Ontario Disability Support Benefits (ODSP) and should hear soon. I have to be refused before I can appeal the decision. The appeal process generally takes a year.

Just over a year ago, I put all my belongings in storage and moved in with one of my sisters and her husband for a few months while I looked for work. That was the idea. But I kept crying over cover letters and only got two interviews which were unsuccessful. Now I am on welfare (my savings are gone), and rent a room in a house, share a kitchen and a bathroom with a couple PhD students and a hoarder.

For more than twenty years, I used to be a self-sufficient member of society, even with depression and anxiety (I have never been hospitalized luckily) but now I no longer am. That in itself affects my depression and anxiety greatly.

I want TMS to work but it is no magic bullet. I find it hard to believe that it will allow me to improve enough to function again, even harder to believe that I can ever be not depressed.

My family doctor referred me to the local mood disorders clinic last year. I had to wait 4 months to see the psychiatrist. He referred me for TMS. It has been a 4 1/2 month wait for that. It's a long wait, but because this is Canada, there is no charge to me. (CANADA ROCKS!)