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October, 2017.

It feels like a huge woodpecker is hammering away on your head for about 35 minutes. Five days a week.  Not a pleasant sensation. But when you have been battling depression for over thirty years and Medicare is footing the bill, you just might be willing to commit to six weeks of Transcranial Magnetic Stimulation (TMS).

I was.

 

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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.

This treatment for depression involves delivering repetitive magnetic pulses, so it’s called repetitive TMS or rTMS.

During an rTMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. It’s thought to activate regions of the brain that have decreased activity in depression. Mayo Clinic

And so, at the end of October 2017, I sailed through the intake interview and scheduled my appointment times. I spend a considerable amount of time discussing my concerns with the psychiatrist in charge of my case.  I wanted to make sure that the treatment would not cause insomnia or anxiety.  I couldn’t afford either. I was in precarious mental condition as it was. I was told that they would begin treating the depression by stimulating the left side of the brain. Should anxiety or insomnia result, they could switch the treatments to target the right. Highly unlikely, they told me.

Two weeks into treatment, I started noticing an uptick in my anxiety and to experience sleep disturbances.  The story changed then. The technician administering the treatments began telling me of other patients who had had similar problems. How they often resolved by the end of treatment. At week three, we made the decision to switch to treating the right side. This coincided with me coming down with a horrendous cold, and I can recall barely having enough energy to walk the dog three times a day, get groceries, and make it up to San Rafael for my appointment.

At some point during that week, I recall getting up from the couch and feeling a sharp pain in the inner thigh of my left leg, right in the area where my varicose veins have been located since my teens.  By Saturday, after hiking in the hills, the leg was red and warm. My goddaughter said it probably was nothing but I had to consider the possibility of a deep vein thrombosis. (DVT).

A trip to the ER in San Francisco confirmed it and I was put on blood thinners. My anxiety was overwhelming.  I was convinced that the consistent hammering on my head for three weeks was responsible.  Decided to stop treatment.

Insomnia got worse and worse. My daughter and her partner, and Ariel started taking turns spending the night. Dog walkers helped out with Aggie. Friends stopped by. I felt like I was losing my mind. My daughter took over communicating with my psychiatrist as I was just too confused to communicate. We tried trazadone. Upping the trazadone. Then on to Lunesta. At ten days, the psychiatrist sent me in for a quick examination and a EKG before prescribing 20 mg of Zyprexa. (Olanzapine)

Olanzapine improves sleep continuity and increases SWS in patients receiving SSRI treatment. These effects are apparent after the first dose of olanzapine and are maintained for the next 3 weeks. The ability of olanzapine to increase SWS is probably attributable to 5-HT(2A/2C) receptor blockade, which has been identified as a relevant mechanism in the therapeutic effect of olanzapine in SSRI-resistant depressed patients. NIH

I slept.

But the trauma didn’t just go away.


img_0079I can remember decorating the tree with my daughter that Christmas. It was a Sunday. I guess I was on my 8th night with no sleep and I was sitting on the couch. We were listening to Christmas music and I remember wondering if I would still be alive next year.  If I would be able to survive this.  I was getting further and further detached from everyday life. I felt frozen within a nightmare deep inside myself . And there was no waking up from it. Because I wasn’t asleep. I was living in this alternative universe 24×7.

In my mind, the DVT and the insomnia became paired with the TMS.   And the insomnia took me back 30 years to the severe bout of insomnia which precipitated my worst psychiatric crisis. The crisis that earned me a label in the Diagnostic and Statistical Manual of Mental Disorders. And launched me into a symbiotic relationship with psychotropic medication.

Spending about a month on Zyprexa was like living in a pit of quicksand.

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What to do if you get caught in quicksand:

    1. Make yourself as light as possible—toss your bag, jacket, and shoes.
    2. Try to take a few steps backwards.
    3. Keep your arms up and out of the quicksand.
    4. Try to reach for a branch or person’s hand to pull yourself out.
    5. Take deep breaths.

 

I was terrified to cut down on the dose, terrified about not sleeping.  Gradually, with the help of my psychiatrist and my therapist, we titrated down to 5 mg by Spring 2018.

 

 

 

 

 

 

 

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