rTMS, the last experience

That’s a wrap. I’ve completed my last round of rTMS.

I reread my first post on TMS and the first paragraph is pretty rough, but it’s also still pretty accurate. Today I nearly aced the depression inventory (not in a good way) and my tremor has blown into a full body quake at times. It’s like shivering with anxiety. The staring into space actually hurts when my eyes dry out. I do realize I just came back from a long and exhausting trip, so I’m working on self care too.

I mentioned that I got a visitors badge every day at the hospital, and I just said “TMS” and they write it and hand it to me, then I use the required hand sanitizer. Which is prodigious. I used to slowly walk the 20 feet to the door so I could rub it all in/off, but in the end I usually just opened the door handle with disinfectant still all over my hands. I figured I was helping them sanitize the door. No charge. I also mentioned that I figured they would know me on sight and write my badge without my saying “TMS” but that it would probably happen on the last day. And I kid you not. It was the last day. I’ve done the math and over the last few months I’ve had 144,000 pulses of magnetic energy tapped into my head.

Anxiety somewhat better, depression worse.

Bit more info:

Diagnosis: (still) Major Depressive Disorder, severe, recurrent episode without psychotic features
This means it’s pretty bad since they used the words “Major” and “severe” and it keeps coming back.
But I don’t have the psychotic features, which would be delusions, hallucinations, or both.

Depression Symptoms: depressed mood, sadness, anhedonia, fatigue, feelings of worthlessness/guilt, difficulty concentrating, hopelessness and suicidal ideation

The PHQ-9 is a depression inventory and rating system. The GAD7 is the same but for anxiety. I take both before pretty much every appointment with my Psychiatrists, so I’m pretty good at them. Just meaning I know how to take them, obviously.

My score on the PHQ9 for depression went up one point between starting and ending TMS. I wonder if that messes with their outcome statistics, since I got worse not better. On the GAD7 for anxiety, I’m down 6 points, which is an ok improvement. I think that takes me from severe to moderate. Anxiety is a lot more unpredictable than depression, as it comes and goes and varies in intensity. So it’s hard to inventory well.

Highlights from the official notes in my chart:

  • He reports some noticeable improvement in anxiety, but no appreciable difference in depression
  • Presents with appropriate and depressed affect
  • He did not experience side effects with TMS
  • He may be a candidate for future ECT treatments, as he had a better depression response to that, but he also had significant side effects with the ECT treatments
  • It is possible that he may notice further improvements in depression after finishing with TMS, and if that is the case he may be a candidate for TMS treatments again in the future
  • Overall, patient has not achieved greater than 50% improvement in depressive symptoms, throughout TMS series, as indicated in rating scales (that’s the diagnostic goal, at best cut the depression in half)

I have a feeling the little improvement I got in the anxiety is about as much as I will get. I don’t really want to get more memory issues, nor do I want to put my wife through the pain and hassle of getting me to and from ECT. Though I really enjoyed the peanut butter and jelly sandwiches she would bring me in the afternoon when I finally came out of the anesthetic haze.

I am currently between programs, having done a PHP and an IOT and now I’m starting another PHP on Friday with a different organization, just to mix it up. Also going through a lengthy intake process to get into a Treatment Resistant Depression clinic, and from what I’ve seen so far they really know their stuff.

Much like COVID, what we thought would be a few weeks has strung itself out into months. It was the anxiety that put me in this hole, it’s the depression that’s holding my head under water.

This is apparently the logo for the current episode of depression. Drew it in program.

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