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!)