End of TMS

My perception of the rollercoaster of moods is that it came about suddenly. I don’t know if that is entirely true but I felt the same way with its end. It just seemed as though one day there weren’t any rides anymore. My mood varied from day to day and even within a day but it wasn’t the unexpected or unusual moods of the coaster.

I finished my last full week of treatments and was heading for the home stretch. The next two weeks was a weaning period and the treatments dropped to twice a week. At this point I had many conflicting experiences with TMS, but I refrained from final judgement until it was over. I was determined to finish the course and was still hopeful I’d see improvements in anxiety.

I did feel some improvements; maybe I needed more than the structured course? However, I didn’t feel any anxiety benefit, a continued source of disappointment. Also, I kind of missed going every day. I had fallen into a routine and the staff were familiar and welcoming. It was like going to work and seeing your work friends.

During these last weeks of treatments I began to feel more level. Gone were the days of the rollercoaster ride of moods. I’m still not sure how to describe how I felt and continue to feel. It’s not normal or even “back to my old self” and it’s not depression free. The only way to describe it is as improved, and more level.

I truly did want more sessions. Since everyone is different and reacts differently to treatments of any kind I think perhaps I would benefit from an extended treatment duration. The protocol is strict so it’s not going to happen but patients are monitored afterwards and if necessary “maintenance” treatments are sometimes offered.

My last TMS treatment was a bit of an anomaly. With all the progress I’d made I was expecting a quick visit. A few new things were going on in my life and my anxiety was a little higher but going to my treatments was now familiar territory. I arrived in the building and immediately felt off. Something wasn’t right. I’ve had off days before so I just went into the session knowing I’d get through. Once in the chair I became restless, which wasn’t the usual anymore. Restlessness soon turned into anxious thoughts and a desire to leave. Soon enough I was in a mild panic, with subtle physical symptoms of sweating, palpitations and nausea. I thought I was past this but here it was happening during my last treatment. I wanted to end it but I knew I’d have to answer to my therapist and my partner, so I pushed though employing all my coping mechanisms. I made it and oddly enough my last session ended not too differently from my first. I chalk it up to a few extra stressors that week. This is how life is with anxiety and panic disorder. Every day is different and presents it’s own set of struggles.

I definitely feel better than when I started my TMS adventure in May. I can find enjoyment in some of the things I used to. Enjoyment of music returned and for me thats a biggie. I can smile a little more and am even more motivated to participate in my CBT homework. Hell, I even went out to a club for the first time in over a year. Yeah, it was work anxiety wise, but at the end of the night I did enjoy it and I felt a sense of accomplishment, and a certain contentment at having enjoyed something once again.

Enjoy; I enjoyed; those are words and phrases I’ve not uttered in a while and thats how I know with certainty my overall mood has risen. Sure I still have bad days, but I also have decent days, ok days, and sprinkled though some of the decent days are some good moments. I’m hopeful that these good moments will expand into good days.

Are my improvements attributed to TMS alone? I can’t honestly answer that question because there are too many variables, depression has a lot of components, and I have overlapping conditions.

Anxiety keeps me down but the mood improvements I’ve had over the last two months I believe are beginning to help me deal with it better, do my therapy homework, and strive for improvements and a return to normalcy. I continue to battle my anxious, pessimistic mind by trying to be positive and I strive to take one moment at a time, walking with the demonsbymyside.

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TMS… Rollercoaster

My TMS treatments continued daily and each day presented its own unique set of struggles, moods, feelings, and emotions. Anxiety reigned supreme virtually 24/7, however; the anxiety about actually going to my daily treatments lessoned as the days passed. Sitting in the chair and undergoing the treatments themselves was still was ridden with anxiety, albeit I did not have an additional panic attack until the very last day, which I will explain later.

My routine became waking up, taking my meds, calming and controlling my anxiety levels (which are always high in mornings) and going to my daily treatments.

Beginning around week three I began to notice some subtle changes and moments of mood improvements. They were usually short and occurred within an hour or so of the sessions. Sometimes it was just the enjoyment of music in the car, other times it was a full sing along. One day I just kept driving and singing along to my favorite tunes for about 30 minutes. Other times it was a less intense feeling and a burst of energy.
In contrast, a few days later I would be in extreme fatigue that would last days at a time. This mystery fatigue continued on and off for about 3 weeks in the mid range of the treatments. There were days where I slept up to 12 hours a day between nighttime and daytime naps. Some days the fatigue was accompanied with a feeling of being down and other days my mood was ok but physically I was weighed down.

By about the end of the third week and into the fifth week I started experiencing inconsistent moods. You could even call them mood swings. Some of my behavior was out of character. I had moments of agitation, irritability, and in one instance, outright anger. This is where the rollercoaster analogy comes in. Up, down, and all around my moods seemed to go, sometimes in the same day. I would feel ok, then out of nowhere i’d snap at someone for a trivial reason. My patience was extremely thin. Though these moods were bothering me they weren’t overly intense or in any way debilitating. They were just different, not what I was expecting, and not what I normally experienced in depression.

I asked more than one of the doctors on staff if these moods were indicative of the treatments and could they represent a persons progression through various components of depression. I’m not sure I ever got a concrete answer but I did get plenty of reassurance that it wasn’t that out of the ordinary and it certainly wasn’t dangerous. Everyone reacts a little differently to the treatments and to the symptoms of depression as a whole. Since every mood I described can be a component of depression it was conceivable that I was experiencing these moods while my overall mood improved; which it was, slightly and slowly.

This period wasn’t easy because sometimes I couldn’t put my finger on exactly how I was feeling at any given moment. I also saw no improvements in my level of anxiety. Many days it was exacerbated by the onslaught of new, different, or just unexpected feelings and moods.

I went into this treatment knowing it was for depression but with the hopes that it would have a positive influence in reducing my level of anxiety. I started getting disappointed that my treatments were nearing their end without any anxiety improvement. The doctors assured me that even once the treatments are over patients report improvement weeks afterwards. Since I was noticing a overall improvement in mood I continued to hope for anxiety benefits and continued to ride the rollercoaster.

Next post…. End of TMS

TMS..The First Weeks

My TMS treatments consisted of 36 treatments. It takes a bit of a commitment because as I said until the final two weeks the treatments are daily. Each visit begins with standard questions to see if there is any change in my medications and if I have had thoughts of hurting myself or others. Then a paper strip is put around my head which is a measurement tool for placement of the coil. The chair is reclines and the coil is put in its pre-determined location just above my head. A test pulse is given to make sure it feels ok to me and to check placement. Then the pulses begin. After each group of pulses there is a twenty something second pause until the next. A tone sounds to let me know the next round of pulses will commence. This continues for just under 40 minutes.

You can listen to music or watch TV to help pass the time. The staff is super nice and very accommodating. Since I wear glasses that have to be removed because of the metal I can not watch TV but I now play my iPod to pass the time.

I say all that very matter of fact but in reality it was much more difficult for me. As I said before I don’t like medical procedures and my anxiety is at such a high level that just getting and staying there was an achievement. A part of my anxiety is a fear of being alone away from home so my partner accompanied me to the treatments.

Initially each time they put me in that chair I wanted to jump up and leave. I would sit motionless lost in my anxious mind, using every technique I have learned to remain calm and hold back the panic. Many days that first week I wanted to give up and just go home. Having my partner with me and utilizing all my tools helped me stay in the chair and complete each session. Working through anxiety is exhausting and I’d go home and rest afterwards.

I felt no effects during those first sessions. It’s been reported that some people can start experiencing noticeable improvements as early as the first week. For me it was all about enduring, getting there, staying in the chair, and finishing each treatment. I was fatigued the entire week from the added stress and anxiety.

Towards the middle to end of the second week of treatments I began to notice some changes. Subtle and what I call moments. Sometimes after the treatments for an hour or so my mood would improve. One of the first things I noticed was that I was listening to my favorite music in the car again.

I have always loved music and it is a big part of my life, but for about a year I hadn’t really listened to my old favorites or anything pop current, I couldn’t handle a pounding beat, and I didn’t feel any enjoyment from it. Instead I would listen to calming, spiritual, meditative music, or mindfulness podcasts.

That my enjoyment of music was slowly returning was a sign that something positive was happening. It was very inconsistent and some days it wasn’t there at all, other days it could vary from fifteen minutes to an hour or better. It was still an improvement and I reveled in actually enjoying something I haven’t been able to enjoy in over a year.

Next post…..Rollercoaster

TMS (Transcranial magnetic stimulation) & Me

“Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven’t been effective.” – Mayo Clinic. For more details visit Mayo Clinic

TMS therapy is offered at the University where my psychiatrist is located. TMS is currently only approved for depression using a specific protocol. (number of treatments, the length of each treatment, and the strength of the pulses)

I found TMS treatments intriguing since it’s an approach to depression without the trial and error of medications. My doctor thought it would benefit me. I researched it on the internet and was especially interested in any effects it might have in reducing anxiety. I read some anecdotal evidence that it may help alleviate anxiety symptoms. Depression and anxiety sometimes being comorbid, my doctor’s opinion is that those whose conditions are closely linked benefit (from anxiety relief) the most.  Still, I was hopeful that it would help with anxiety since that is presently my primary debilitating condition.

I’m not convinced that my anxiety and depression are as tightly linked as my doctor thinks they are but I was willing to try something since my conditions are debilitating and keeping me from work, social activities, and living life fully.   Cognitive Behavior Therapy and meds (Wellbutrin XL & Xanex) are my standard treatments and I have been making slow and steady progress, but this seemed like it could be a literal “jump start”.

During the initial consultation TMS therapy was explained to me and I was asked to complete questionnaires and rating scales to determine my beginning level of mood, depression, and anxiety. (Hamilton Scales?) These scores served as my baseline. Every week the forms are completed and the data compiled. In addition to my self evaluation, the provider also asks similar questions and completes their own set of forms for scoring.

The first session is to “map” your brain to determine the measurements for the placement of the coils.  The TMS machine is something like a mini MRI and it makes loud tapping noises (earplugs are worn by everyone in the room). The coil never actually touches your head but you can feel a repetitive tapping on your scalp akin to having a woodpecker going to town on your head. The physical discomfort for me was minimal. The other part of the initial session is what, looking back,  I call finding your twitch.  They have to find out where the pulse will cause your fingers or face to twitch, which, if I am explaining it correctly, determines the final placement of the coils for treatment.  The aim is to get the coils in the correct area of the brain without producing the twitches during treatment.  After the first session TMS treatments are given daily (Monday to Friday) for about 6 weeks. The last two weeks are for weaning off and the treatments drop to twice a week. Each treatment lasts approximately 40 minutes.

Of course my anxiety rears its ugly head at the beginning of this process and I almost didn’t go through with the therapy after my initial session.  You see, I don’t like hospitals or medical procedures,  and simply sitting in a chair at the doctor’s office for 40 minutes was a challenge I had to constantly fight to overcome.

I nearly called the whole thing off once my face started twitching.  I panic at the slightest physical abnormality and having my face and fingers move uncontrollably set me off; I had a panic attack in the chair during the initial session but managed to calm myself and made it through. Desperate for any potential for relief I put every tool I have to work to keep me in that chair.

That was the beginning of my TMS adventure. I have linked information on TMS at the top of the page because I’m not always the best at explaining the details and technical information. If your interested in the therapy I would encourage you to read up on it. Also, I welcome any questions.

Upcoming posts will be about the experiences of my on-going treatments and their results.

Fear

Part of this blog was to share my experiences with anxiety, panic attacks, PTSD, and depression.  Having spent most of my life not talking about it has made writing and sharing more difficult than I had imagined.  For me,  writing about my feelings, emotions, and thoughts is a therapeutic and personal affair; often times not conducive for storytelling or blogging.

Then there is fear, the most loathsome of four letter words.  It effects my ability to write.  I fear compromising my privacy.  I fear the very public forum I am trying to learn and embrace.  I fear whatever criticism may be levied against my lack of writing skills.  I fear telling my stories and giving permanence to my thoughts, feelings, and emotions.

Fear, I’ve typed the word six times now and each time I fear I’ve misspelled it.  It just doesn’t look right to me in black and white.  I know it more as an ever present feeling.  With only four letters, it is such a small word to play such a large part in my life.  Fear is at the root of my illness.  It manifests physically as well as mentally.

Anyone who has had a panic attack knows the pounding feeling of fear rise up and consume them.  For me,  it’s shaking, sweating, dizziness, disorientation, my heart pounds, and I get a sinking sick feeling in my stomach that is just waiting to lurch up into vomit.  My accompanying thoughts are of doom, fainting, falling, being alone and helpless, death, and that I must get home NOW.  It can and has rendered me uncommunicative and incapacitated.  Fear rules!  Until, maybe ten, twenty, thirty minutes, or an hour later fear recedes like the ocean retreating to low tide.

It’s then that the exhaustion hits and all I want to do is rest and sleep, sleep, and sleep some more.  Fear has won a battle; but I live to fight another day, to ride out the waves of the next high tide of fear.

I fear the fear for it walks by my side.