W.H., a 38-year-old woman, has suffered from major depression and anxiety, as well as post-traumatic stress disorder and trichotillomania—an impulse-control disorder sometimes called hair-pulling disorder—since she was 19 years old.
Over the years, she has tried a variety of anti-depressants, mood stabilizers and anti-anxiety medications, with little relief.
“What was happening was they would work for me, and then they would slowly not,” said W.H., who asked to be identified only by her initials. “We would adjust the dose or the medication altogether, and I would feel good for a while but then slowly start to crash and burn.”
Five years ago W.H. and her family relocated from Wyoming to Montana for her husband’s work. The change was a rough adjustment for her, and she noticed her symptoms getting worse again. Then she was introduced to Dr. Erin Amato, of Montana Psychiatry, who suggested she try transcranial magnetic stimulation therapy. W.H. jumped at the opportunity.
“You know, when you’re desperate you are willing to try anything to feel good,” she said. “At some point I think you just hit the wall when you don’t really know what it’s like to not be depressed.”
Amato explained that TMS therapy, unlike some other forms of brain stimulation such as shock therapy, is pain-free and is even safe for pregnant women. Patients simply wear a helmet and feel a tapping sensation for two seconds before a 20-second break. Although the tapping may feel uncomfortable at first, Amato said all of her TMS patients say they can handle it without problems.
Amato said it works “by delivering a magnetic pulse over an area of the brain that’s been identified as being sluggish, or the activity is just not there and is leading to problems with depression. It helps to stimulate that area of the brain, which causes a cascade effect to where it’s penetrating deeper areas of the brain that are also involved in mood and emotions. By delivering that magnetic pulse over that area of the brain it stimulates electrical activity, and it’s that electrical activity that then leads to an anti-depressant effect.”
“I’m not typically a late person, and it drives me nuts to be late,” she said. “The first time I noticed something was happening was week three into therapy. We were having a snowstorm and I was running behind. With every passing minute I’m watching the clock on the dash, but I noticed I wasn’t feeling anxious.
“I wasn’t feeling the persistent thought that I need to put the pedal to the metal and get moving. I wasn’t thinking, ‘Am I going to have to reschedule my appointment? I’m messing with everyone else’s schedule by being late.’ It’s a trickling effect and a compounding thought process that I would normally have, and by the time I would arrive somewhere I would be a complete mess. It was the first time I wasn’t like that. I was just, ‘Okay, I’m late. People are late.’”
Besides feeling less anxiety, W.H. said, she hasn’t felt as depressed since starting the treatment, and her PTSD symptoms are better as well. Certain sounds and situations are no longer as triggering for her.
The therapy usually lasts from four to six weeks and is administered five days a week for the duration of the treatment. The therapy itself lasts just 20 minutes, and patients are able to drive themselves home afterwards. For patients who have tried multiple medications without success, TMS can be quite helpful.
During the first visit, Amato said, she goes over all the safety precautions, such as abstaining from alcohol for the duration of the treatment. Most major insurance companies cover TMS, she said, and her team goes over payment options for patients as well.
Amato also discusses the possible side effects, headaches being the most common. There may also be some scalp pain where the treatment is delivered, but the risk of seizures with TMS is no greater than that associated with many anti-depressants. After patients are aware of the side effects and risks of TMS, they can start the therapy.
Major depression is such a problem in Montana that the state has consistently placed in the top five for the highest suicide rates in the country for the last 40 years. Amato believes a number of factors influence the suicide rate in Montana.
“Part of it has to do with the stigma still associated with mental illnesses,” she said. “There’s also a lot of isolation in our state with people living in rural areas, and there’s easy access to firearms, which are a very lethal means that people use to complete suicide.”
Medication doesn’t always work for every patient. Some may try more than 15 medications without relief. Others give up long before that. And even if a certain medication works for some people, they may experience intolerable side effects that affect their quality of life. All of those consideration led Amato to search for alternative therapies.
She has been offering her patients TMS therapy, which was cleared by the Food and Drug Administration in 2008, for two years now. Amato has had great success with the treatment and is excited by its possibilities.
“There has to be other treatment approaches that we utilize,” Amato said. “It’s an exciting time in psychiatry because we’re seeing the emergence of novel treatments. It brings me great hope for the people that I work with that have suffered for too long.”
She said TMS therapy has worked for 75 percent of her patients. Some patients have even experienced complete remission from their depression, and for Amato that is exciting news.
“The message I try to give everyone is, there’s always reason to hope because there are exciting things happening in our field,” she said. “I think that message of hope is so important for people to have because our state does consistently have one of the highest suicide rates in the nation, and I think that that is an unfortunate outcome when people have lost hope.”
W.H. is a testament to that message of hope. She’s optimistic that her results will keep getting better, and she believes TMS therapy has significantly improved her life.
“At this point it almost feels like it’s been life-altering for me,” she said. “It’s been life changing.”