Larry has suffered from depression is whole life, but it wasn’t until 20 years ago he decided to seek help.
The local police officer, who has requested his last name remain anonymous, said his doctor put him on seven-to-eight medications to try to relieve the symptoms he experienced with major depressive disorder.
“Some would work for a short period of time, some wouldn’t work at all,” he said, noting the medications that did somewhat work would often take about a month to kick in.
Then, 10 years ago, Larry found success with Symbalta – a medication that “worked really well” for about five years. But, five years ago, he noticed his depression started to creep back. It had become really difficult to control, he said.
After more failed medications, his doctor informed him of a different treatment. A treatment that was “literally designed for people like you,” Larry recalled him saying.
That doctor was Dr. Kalyan Dandala, the chief medical officer for Associated Behavioral Health Care in Bellevue. And that treatment was transcranial magnetic stimulation, often referred to as TMS in the medical community. Dandala had just begun offering NeuroStar Advance Therapy’s TMS treatment at the Bellevue location in December 2017. Already, the clinic’s program is full and they’ve opened up a second in Kent. Associated Behavioral Health Care plans to offer TMS at all four of its locations, including its facilities in North and West Seattle, before the end of the year.
Dandala explained that TMS is, to put it simply, localized magnetic stimulation of the prefrontal dorsolateral cortex, or left, front part of the brain, which is the lobe that is usually under activated and can be responsible for depressive symptoms.
“TMS activates that part of the brain,” Dandala said. “It allows for dopamine, serotonin and another neurochemical glutamate to connect from the mid part of your brain to the front part of your brain.”
Once activated, neurotransmitters flow freely and connect. In 37.5 percent of patients who have gone through TMS treatment, that connection is permanent, according to clinical studies with NeuroStar Advanced Therapy. About 60 percent of those patients significantly responded to the treatment.
When Dandala asked Larry if he’d be interested in TMS, Larry said at that point he had to try something because he was “sick and tired of this whole medication thing.”
Larry was in.
For the first three weeks he didn’t notice much of a difference. The sessions were about 19 minutes and he was recommended to undergo 36 sessions – six weeks of five weekly sessions and then a tapered approach of one week of three sessions, one week of two and one week of one.
Then, on the fourth week after having completed 20 sessions, he went from feeling “super depressed” to having major anxiety issues. He started to have difficulty sleeping, felt irritable and was constantly worrying about everything. But because he communicated with his doctor on how he was feeling, Dandala and the TMS specialists recognized they had to do some re-mapping.
They adjusted the magnet and within one week Larry’s anxiety dissipated. On the fifth week of treatment, he started to feel “really good.”
“I would get up in the morning and instead of being tired and not having slept very well, I’d have a lot of energy,” he recalled.
However, the biggest difference he noticed was the change in his depression. When he would start to feel depressed about something, instead of being sucked into this dark hole, he would be sad for 15-20 minutes and “then off doing something else like a normal person.”
His depression was no longer enveloping his entire day.
Dandala explained people without depression can experience pleasure and joy and go back to that moment in their memories. A depressed person will have a temporary benefit of pleasure but their prefrontal cortex, which is the executive function part of the brain that takes in sight, smell, sounds and information, puts a “checkpoint” on the rest of the brain and there is a disconnect to those happy feelings associated with memories.
The “disconnect” is analogous to a water pipe with sludge, he said.
“Say that you had a water pipe and you’ve got a whole bunch of sludge in the water pipe and you connect that water hose to the faucet and you can only get so much water on the other side, but if you clean out the sludge, so to speak, you get a smooth stream of water,” Dandala explained.
TMS depolarizes those misfiring neurons.
Unlike electroconvulsive therapy (ECT) – a controversial practice often referred to as electroshock therapy – TMS does not require anesthesia and does not inflict seizure activity on the brain. The less-than-20 minute procedure only requires patients lay in a chair and stay awake as a small magnetic coil is placed on their heads. The treatment is widely covered by health insurance and Associated Behavioral Health Care even takes Medicare.
Without insurance, the full treatment costs $12,000. And while Dandala said some experience a headache at the magnet’s location for the first four-to-five sessions, that side effect passes after the first week.
Even so, that temporary side effect is much less when compared to what anti-depressants can impose on someone’s life, Dandala pointed out.
“The biggest hush, hush problem that a lot of people, gosh, I want to say the vast majority have with medication management, is sexual dysfunction,” Dandala said. “A lot of decrease in libido, and anorgasmia in both males and females.”
Anti-depressants can also cause weight gain, dry mouth, nausea, gastrointestinal issues and people tend to report “feeling like a zombie,” Dandala added.
“TMS is definitely going to take on more clout in the future for addressing a lot more psychiatric issues and, unfortunately, it hasn’t taken on enough steam yet but I’m glad it is now,” Dandala said. “I think the drug companies successfully pushed it down for a long time because of their lobbying.”
But Dandala is hopeful now that insurance companies are now beginning to see the successes of TMS and that the medical community is finally embracing it.
Larry, as one of Associated Behavioral Health Care in Bellevue’s first TMS patients, completed his treatment at the end of January.
While he is still taking anti-depressants, he has a plan for getting off of them, and will continue psychotherapy, as he has for 20 years. Before TMS, he said on his best days he hoped to reach the bottom of the threshold that people without depression function at. Now, he feels like he is at that line and sees above it every now and then.
“I still do get depressed feelings,” Larry said. “But instead of getting sucked down, I’m able to get out of it.”
For more information about TMS or Associated Behavioral Health Care, visit www.abhc.com.