I'm sitting in the haphazardly-remodeled former summer kitchen of an 1853 farmhouse in Vermont, watching a good friend endure his third session of Transcranial Magnetic Stimulation (TMS) -- a procedure that, in clinical trials, has been shown to have some success against treatment-resistant depression.
My friend is sitting in a chair that would make any dentist proud. But, instead of an X-ray machine honing in on his molars, a curved contraption is firmly cupping the top of his head in a precise position above his left frontal lobe.
Every 28 seconds, a rapid-fire tapping goes off. From my seat a few feet away, it sounds like a toy machine gun. From where he's sitting, it feels like a kid with a good sense of rhythm using a ball-peen hammer on the inside of his skull. Four seconds on. Twenty-eight off. The session will continue for approximately 40 minutes, 3,000 pulses in all. A complete treatment is typically five days a week for six weeks.
The first day he found it almost intolerable -- using troubling analogies to other medical procedures. But, as promised by his psychiatrist and a remarkably well-informed company technician, the treatments are getting better each day. Soon, he might be able to listen to a book on tape during the process -- although neither Stephen King nor Tom Clancy need apply.
My friend is enduring this treatment because nothing else is pulling him out of his years-long walk on the dark side. He's tried medication, meditation, bodywork, alternative therapies, and supplements. No change. Even things that worked before are barely make a dent this time around. Certainly nowhere near the dent this Atlantean machine sounds like it's making.
I'm there partly to provide a little moral support, but mainly out of semi-professional curiosity. Six months ago I published a book about depression. In addition to describing my own battles with the beast, I spent a great deal of time explaining in layperson's terms the diagnoses for different mental illnesses as well as the theoretical bases behind prescription drugs, counseling, herbs, supplements, and various "natural" therapies.
Afterwards, I innocently subscribed to a system that alerted me any time there was an article on the Internet about new drugs, clinical trials or treatments.
I soon went from considering myself an expert to a rank amateur, overwhelmed by how quickly people are coming up with new options for dealing with treatment-resistant depression.
There are frequently articles about off-label prescribing, in which the doctor gives you something that the FDA has only approved for a major depressive episode, for example, but he thinks might help with chronic pain. Or the FDA itself grants new approvals based on new trials. For example, Latuda, which it approved for schizophrenia in 2010 was also approved this year for bipolar.
On the other end of the spectrum, recently there was a story about a hospital that "failed a futility analysis" (that's gotta hurt) of a broadened trial for a specific kind of deep-brain stimulation.
Meanwhile, pharmaceutical companies are designing all kinds of new-fangled molecules to focus on specific neurotransmitters and receptors (typically boosting or blocking the effect of one or more.) The National Institute of Mental Health has even announced a trial involving low doses of ketamine, the popular party drug that, in high doses, is known as Special K.
Researchers continue to work on the TMS therapy described above as well as Vagus Nerve Stimulation (VNS) which uses a pulse generator under your skin. Even Electronconvulsive Therapy (ECT) has become vastly improved since the early days when the descriptions had visions of Frankenstein dancing in our heads. For descriptions of all three brain stimulation therapies, click here.
I certainly do not know what will cure your depression. I can offer a few unconventional ways to help you get through the day. No guarantees. (I have to say that.)
1. Get "addicted" to watching a specific half-hour sitcom every day. One with lots of episodes. M.A.S.H., Seinfeld, Weeds, Arrested Development. Whatever. My wife spent a winter watching Six Feet Under. An odd choice, I suppose, but it helped to have something that involved laughing to look forward to.
2. Get up close and personal with a tree. Any tree. The bigger the better. No, you don't have to hug it. Just get a cup of tea or something and lean against it. Sometimes, if you ask nicely, the tree might take pity on you and suck up some of your depression/anxiety. A little New Age, I know, but give it a whirl.
3. Say -- out loud if possible -- "I feel great!" "I feel great!" "I feel great!" We're talking Tony the Tiger intensity here. No need to do it more than once or twice a day. I know you won't believe what you're saying. (I sure didn't). But you're planting some seeds. It's like jamming a turning wheel (i.e., those depressive thoughts stop for a few seconds).
4. If your schedule allows, volunteer somewhere occasionally. The more mindless the better! I shelved books in a library. Stuffing envelopes is good. Picking up litter. It's not that you suddenly won't be depressed, it's that you won't feel so worthless.
Finally, if you feel you've run out of resources, contact your local chapter of NAMI, The National Alliance on Mental Illness.
Treatment-resistant depression is no fun. Been there. Done that. I can only end this post the same way I did Part One. With a quote attributed to Harriet Tubman: "If you are tired, keep going; if you are hungry, keep going; if you want to taste freedom, keep going."
I really, really hope you find some relief.