Initially, my extended TMS course didn’t seem to have much of an effect on me, except perhaps to kick my insomnia into a higher gear. After much thought and discussion, I decided to stop TMS suddenly rather than taper my appointments.
Getting TMS treatments every day had begun to feel pointless. We’d tried several adjustments and protocols, remeasured my motor threshold, and extended my treatments beyond the planned schedule, but none of it made me feel any different.
At this point, I’ve tried what feels like an exhaustive list of medications. Combine that with my lengthy treatment with ketamine infusions, years of therapy, and now TMS, and I can’t help but see a hopeless picture. I know I’m not out of options, but the pattern leads me to conclude that any further effort to get better will result in the same outcome: more depression.
However, I know that’s a logical fallacy. Just because many treatments didn’t work does not mean that the next one won’t work. It’s hard to grasp that when you’re deep in depression, though. I left the TMS clinic feeling hopeless. It’s indescribably discouraging to try treatment after treatment, clinging to a tiny scrap of hope that just gets smaller and smaller as you go.
I sometimes feel as though I’m trapped inside myself, carried along by my depressed body like a prisoner. I’m in here — I’m just unable to break through the impenetrable walls around me no matter how hard I try. At other times, I feel as though depression has eroded my mind, letting the essence of me wash away. The “me” I am when I am not depressed seems to be gone. The movement stops, the lights go out, and I wait in internal darkness for some motivation to stir in my mind. The little scrap of hope flutters somewhere out of reach.
The second version is how I felt when I stopped TMS.
Ending TMS meant that I needed to consider my next steps. ECT is one option, and I’m interested in doing a consultation, but the thought of actually starting that process is daunting. I had increased my dose of Emsam, the MAOI I take, and figured I would wait a little while before doing anything. In the meantime, I wanted to get a handle on my insomnia.
I did not sleep more than five or six hours a night in the last two months, so that’s been a barrier to my mental health, too.
Increasing my usual sleep medication helped but then plateaued, so eventually, I decided to try Temazepam. I was a little nervous about taking it because I don’t like feeling impaired, especially if I’m uncertain of how it will feel. But alas, I was tired. I read the medication info sheet front to back because that’s the kind of person I am, took the pill, and prepared for a blissful night of uninterrupted sleep.
Yeah, right. It was one of the most unpleasant nights I’ve ever had. I was unbelievably restless – not just my legs but my whole self. I didn’t stop moving for hours. I was too hot, so I moved downstairs to the couch, but then I could feel my heart beating, and the sound of my breathing was grating in my ears. Sometime around 4 AM, I fell asleep, only for the sun to come up two hours later.
Some people (but not many) have paradoxical reactions to benzodiazepines. I now know that Temazepam is not for me. It was a learning experience.
One category of medications that I had not tried before now is the atypical antipsychotic class. Seroquel is a drug in this category. It’s used as an off-label treatment for depression, and it is also sometimes prescribed for insomnia due to its sedating effects.
I decided to switch from Trazodone to Seroquel, and overall, it’s been a positive change. I started with too high of a dose and had an unpleasant day afterward, but I quickly adjusted. As long as I give myself enough time to sleep it off, I no longer feel sluggish and half-asleep when I start my day.
I’ve managed to increase my sleep to six or seven hours a night. Although it’s not an enormous difference in terms of hours, I feel like the quality of my sleep is better. I no longer wake up during the night, and I feel slightly more rested overall.
It probably helps that I reduced my lithium dose a little and don’t wake up feeling like a dried-out sponge several times a night. I keep my ridiculous 64-oz. water bottle by my bed for easy middle-of-the-night hydration. My psychiatric np finally told me so many times to drink more water that I stepped up my efforts and bought it. It’s so big that it’s basically an insulated bucket with a lid, and I love it. I don’t have to deal with the extra step of refilling a glass or smaller bottle frequently. It’s a silly reason to not drink water, but when I don’t care about myself enough to keep up with hygiene or eating, refilling a glass of water is surprisingly challenging.
But, I digress. After a few days of no TMS, I found myself feeling – impossibly – worse than before. Whether that was because TMS was helping in small ways or I was simply despondent after giving up on another treatment, I still don’t know. I decided to pick up with TMS where I left off.
The timing makes it difficult to determine which factor caused what result, but after restarting TMS, sticking with the increased Emsam dose, and adding Seroquel, I suddenly felt dramatically better for a few days. I found myself walking Stella with a decidedly peppy step instead of my usual brick-like feet. I suddenly wanted to go places and do things, which is the complete opposite of how I felt before. I actually felt like I could feel the dopamine I had missed so much. I felt happy about nothing in particular.
I always marvel at how impossible it is for me to imagine how it feels to be less depressed. I know it sounds odd, but every time I get some relief from my symptoms, I find that the sun feels warmer, the breeze feels more refreshing, and colors seem more vibrant. I feel like I’ve been released from a state of deadened perception and pushed into a shockingly bright, intense world.
Despite experiencing such improvement before, I’m always taken aback to realize that I could not grasp how distant I felt while depressed. The memory of what improvement feels like disappears when depression returns, and the only way to understand it again is to experience it.
The Current State of Affairs
I don’t currently feel as amazing as I did for that brief time, but I do think that I’ve maintained some improvement. I still feel considerably more energetic, and although my mood has embarked on a journey of hills and valleys, it’s nice that there are still hills.
I’m not sure where this will leave me. I’m planning to do three more TMS treatments and then stop. I don’t feel nearly as desperate as I did when I stopped TMS the first time, but I am concerned that some symptoms seem to have worsened slightly since my sudden improvement.
Part of me thinks that now would be a good time to look into eventually making more treatment changes, whether that’s ECT or something else, since I’m still relatively motivated. The other part of me thinks that I should just focus on adding habits and activities to my life that could help me hold on to the improvement, and see where that takes me. I guess I have some decisions to make.