If I lose my chronic depression, how much of myself will go with it?
I am about to embark on a course of transcranial magnetic stimulation to address the treatment-resistant depression that has been plaguing me most of my life. Until now, I have had little hope that my depression would ever really go away. At the same time, I’m ashamed to admit that I am a little nervous — even somewhat reluctant — to part ways with my melancholy. Depression is an essential part of my identity.
Five days a week for the next six weeks, a doctor will place an electromagnetic coil on my scalp, near my forehead, to stimulate nerve cells in the region of the brain that involves mood control and depression.
The repetitive magnetic pulses can ease the symptoms of depression, often around the 15th session, according to my doctor. He has been practicing this scientific art for 20 years, initially on a research basis, and clinically since 2008, when the FDA approved it. But neither he, nor anybody else, knows exactly why TMS works, when it works.
He sees the worst of the worst: those for whom all other treatments have failed. He says his success rate for alleviating depression through TMS is between 60 and 80 percent. He views my chronic mild depression as almost more insidious than my bouts of major depression — a serious round of which I have been recently battling — because it is unrelenting in its effort to pull me under, a constant current against which I must fight.
The idea that these magnetic brain pulses will mysteriously draw my mind out of its dark depths while I lie there doing nothing is enticing and sounds almost too good to be true. For more than 20 years, I have been in psychoanalysis with a very skilled psychiatrist, and I have been seeing a capable and caring psychopharmacologist. I have tried, with varying degrees of success or failure, approximately 15 medications in nearly every major category: tricyclics, SSRIs, SNRIs, antipsychotics, atypical antipsychotics, benzodiazepines, and lithium.
Pamelor did little to nothing for me. Paxil shaved the edge off my anxious depression but overwhelmed me with fatigue. I got quite a boost from Fetzima, which had the unfortunate side effect of also making me faint. Abilify made me restless and lowered my white blood cell count, putting me at risk of infection. Remeron made me gain weight. Nothing has really worked, at least not for long or without untenable complications.
Right now I’m on a drug cocktail that has helped pull me from the vice grip of a major depressive episode during which I was so despondent that I considered suicide and hospitalization. The drugs have also delivered an aggressively dry mouth and uncompromising sedation — and they have failed to cure my persistent melancholy.
At times during this arduous journey, I have lost heart and gone off medication altogether out of a sense of frustration and in an attempt to inhabit what I sometimes think of as my unadulterated “real” self. My depression, a disruptive and sometimes crippling bedfellow, has always been a key ingredient of my make-up, a reliable fixture in my daily reality.
In fact, I think, through it all, I have had an undercurrent of worry that if treatment were to work, and my depression were to disappear altogether, I might actually feel that a crucial part of me had gone missing.
The distress and agony that I have suffered, and even the more mundane constant pain, have rewarded me with a highly developed sense of empathy. I almost wonder if I might feel a version of the phantom pain people often experience after losing a limb.
Lying on my psychiatrist’s couch four days a week, free-associating about my thoughts, feelings, and dreams, has helped me mature, given me insight into my demons, and carried me through some major life challenges (family discord, career shifts, and infertility, to name a few). But it has been a long slog with no end in sight. Psychoanalysis has helped me hold my subconscious motivations up to the light to inspect them from every angle. But transforming my insights into action, into major shifts in character, seems to be taking an agonizingly long time — commensurate with the degree of trauma I suffered in childhood, my psychiatrist says.
And so, when my psychopharmacologist recently recommended that I look into TMS, I agreed. After two in-depth consultations, my doctor determined that I was a viable candidate for the procedure. For the first time in as long as I can remember, someone was extending the possibility of a cure, a way out of the dark torture chamber where I struggle through so many of my days.
Entertaining the idea of bidding my depression farewell has made me wonder anew what it must feel like to be happy, undisturbed, at peace, content. After a round of TMS, would I awaken to a new reality and say, “My goodness! Is this what it’s like to be normal?” Would I become more productive, more confident, more in-tune with my three children? Would I enjoy food and sex more? Would I finally be able to live in the here and now, without constantly looking over my shoulder or peering around the next corner to see which specter threatens to spook me next?
These possibilities feel almost overwhelming or dangerous, like more than I might be able to contend with after a life so long in the shadows. I worry that the outcome of the procedure will be only subtle or that it won’t work at all. I’ve fretted that subconsciously clinging to my depression might actually sabotage the effects of TMS. The possibility of failure fills me with trepidation, because, at this point, TMS is my only way out. And, as is true with all treatments, there are no guarantees.