The Truth About TMA

By the time I ended up in my new psychiatrist’s office, I knew had already exhausted all standard and typical plans of treatment.

I had stopped going to talk therapy in August, in part because it wasn’t effective, and in part because I couldn’t afford it anymore. The therapist I met and “clicked” with five years ago when I started therapy didn’t take insurance, and her rates slowly went up, and up, and up. I can’t blame her for that. She did give me a discount because of my financial situation. But when it felt as though we weren’t seeing things the same way anymore, the financial aspect was the final straw that caused me to send the email stopping our appointments.

Little did I realize that my psychiatrist - who had been handling my medication management for the past five years - would retire just a few weeks later. I knew at my last appointment, which was in September 2022, that things were bad, that a med change was in order. But since my doc was going to be enjoying retirement and unable to manage the medication change (and the inevitable bumpiness that follows) she didn’t want to do anything immediately, since I woudn’t have anyone to support me. (The practice hadn’t hired anyone to take on her caseload yet, and the other practitioners caseloads were already full.)

After many weeks, dozens of phone calls, arguing with my insurance company, and sitting on wait lists, I was able to get a referral and appointment to a new psychiatrist. The PHQ9 that I filled out in my intake paperwork was about as dismal as it could be. This standard assessment for just how depressed a person is uses a five point scale over nine questions. I’ve filled these out more times than I can count throughout the years and I have always made an assessment as to just how truthfully I should answer before I start circling numbers. It’s a careful calculation between will they believe that I’m in need of help and will they insist that I immediately check into inpatient. But at this point, I wasn’t in a position to care if they did. The only reason I hadn’t so far was because I was unsure of who my kids would do without me. Though I knew that I would never intentionally harm myself if only for the sake of my children, the suicidal ideation was present and persistent.

Sitting in her office, there was immediate relief when she recognized immediately what I had long suspected. “You have treatment resistant depression,” she told me. “But, there are several things that we can try.”

The first was the anticipated medication change. I was immediately started on a new medication; on top of the SSRI (selective serotonin reuptake inhibitor), and NDRI (neodrepinephrine and dopamine reuptake inhibitor), I was also given an anti-psychotic which would, in a small dose, would help the other drugs to work more effectively and make everything seem more manageable. I was also asked to consider esketamine or TMS (Transcranial Magnetic Stimulation) as a more dramatic solution to attack my chronic depression that didn’t typically respond to medications, anyway.

Esketamine treatments would require a two hour appointments (or longer) and rides to and from the clinic twice a week for several weeks. And then there is the matter of taking a form of ketamine (administered through a nasal spray), and the potential side effects thereof. The other option, TMS, requires daily thirty minute appointments for six weeks or longer, but I would be able to transport myself each way, and the most significant side effects were discomfort during the procedure and a headache afterwards. The choice seemed clear, especially in considering the evidence (a success rate of 70%, imaging showing how a depressed brain is less active than a typical brain and that TMS “wakes up” the inactive areas, etc.).

At my first TMS appointment, where they mapped my brain to find exactly where they should direct the magnets, I was made aware that while my insurance covered the procedure, I would have to pay a $30 co-pay for each of the 36 sessions. I was already broke, but I was also broken; this process was quickly turning into my one last hope, and I couldn’t not pass the opportunity, even if it would mean even more credit card debt.

After a weird first session - in which it felt as though my brain was being zapped with an electrical current - I decided that I hated it, but also that I would be back tomorrow. And the day after. And every day that I needed to in order for me to get out of the fog, to be able to feel again.

The routine was to wake up, get my kids off to school, and head out to my appointment. The tech would bring me back to the procedure room, get me settled into the reclining chair, give me earplugs, dim the lights, and get the machine started. Each session lasted 18 minutes and 45 seconds, with intervals of four seconds of zapping (which felt more like tapping over time) and ten seconds of rest. With dim lights and closed eyes, it was easy to just be for a while, knowing I was doing exactly what I was supposed to be doing, with no guilt of “not doing” anything. When it was done I would collect my things and be off to the rest of my day.

I don’t remember exactly when I first realized it was working. There wasn’t a particular ah-ha moment, just small bits of evidence that continued to add up. I was able to focus again, and get work done. I was able to look around my messy house and begin to make it organized and functional again. I was smiling, and talking to friends instead of avoiding them. I was actively breaking into song. (I know how ridiculous this sounds. But, I think many parents would understand the type of song we find ourselves belting out around small children.) I was looking with hope into the future - something I hadn’t been able to manage in well over a year.

It’s a long process, but I am nearing the end. I only have a handful of sessions left, and I am looking forward to having one less thing on my daily to-do list. But I am so grateful that I did it, that I can feel and experience things again in a meanful way.

How long the effects of the procedure will last varies for each individual, but evidence shows that the positive impact can last for several years, or that the procedure is never needed again. But for as annoying and inconvient (and expensive) TMS ended up being, I would gladly do it again, and again, and again if it meant I can feel as well as I do now.