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My Experience With Transcranial Magnetic Stimulation and How It Works

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When my previous awesome psychiatrist retired, I was left sort of in a lurch. I bounced around a lot. I think I tried five different psychiatrists in three different locations. I tried two or three and was horribly burned by them. We moved out to Orlando, Florida, and I found one guy out there in Haines City. He was … OK? He did what he was supposed to, but I didn’t really benefit from his guidance and chemistry knowledge. He definitely didn’t help with all the times I went into the hospital.

Anyway, I moved back to St. Petersburg, Florida, and that’s where I accidentally stumbled upon Dr. Kawliche. (I totally got his permission to use his name and stuff! Hooray!) The office Kawliche was at when I met him was super strict: $150 a no-call-no-show strict. As I said, I had been burned by three or four other psychiatrists, so I was super nervous. I went in and he was wearing a cool button-down and an epic tie. I can’t remember what was on the tie exactly, but since then he always wears something kind of quirky. But, I digress.

He quickly listened to my bouncing and diagnosis, and then mentioned something about having a better location to see me at in Brandon, Florida. At first I was all, “Brandon!? That’s 45 minutes to an hour away!” But then he mentioned something weird. He asked me how many medications I had tried.  He handed me a list with medications on it and asked me which ones I had taken. I had tried somewhere around five of them, I think.  It turns out, these were all antidepressants, and that it was fairly common in patients with depression for these medications to not work. As in, the success rate of antidepressants is ridiculously low. In one study, a placebo and antidepressants were used and only 20 out of 100 people saw improvement. That is wild! The placebo itself saw 20 to 40 people who reported changes, and only 40 to 60 in the real medication. Twenty people. Twenty percent. That’s it.

Where am I going with this? That’s what I wondered with Kawliche as I sat there nervously awaiting my new medication. He mentioned something I had never heard of in my life. You probably haven’t either. It’s called repetitive transcranial magnetic stimulation (rTMS).

This will take some explanation. Do not confuse rTMS with electroconvulsive therapy (ECT). It is completely non-invasive. ECT also uses electrical current while rTMS uses magnetic current. Totally different.

So then, what is it? I am going to try to explain it in as basic terms as I can, but it is a little complicated. The Mayo Clinic describes TMS as an “electromagnetic coil [that] 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.”

Basically, they take this paddle-like device, place it against your head in a certain area and run a magnetic current into the part of your brain that is “sucking” at life. There have been several studies about how this works and it can sound super scary. Do not panic. It is not threatening as it sounds. Bear with me.

One of the studies I found gets really technical about the whole thing. They say, “When the copper coil is held to the head of the subject, this induced magnetic field generates an electrical current, which is parallel to the plane of the coil and of adequate intensity to cause localized depolarization of superficial cortical and subcortical neurons, generating a propagating action potential that is then used to study the various neuronal functions.”

This is a really fancy way of saying they wake up your neurons and make them start firing so you can produce the happy chemicals! Hooray! After loads of medications not working, this sounded like a pretty sweet deal. I decided to give it a try.

There are some things you need to know about how the process works, though. First of all, insurance currently only treats major depressive disorder (MDD) with rTMS. At first, my doctor had my diagnosis code under MDD, until he got to know my condition better. I am back under bipolar I again, so I no longer qualify for rTMS. Sucks right? Do not fret! They are still doing studies on plenty of other conditions that apply. Did you know you can get TMS for complicated pain issues? It also helps with autism in children! Pretty impressive right? They add new codes all the time, so be patient.

So, you have MDD and you found a provider like Kawliche — excellent! They will send in your insurance paperwork. Even with insurance though, it can be really expensive. I think Kawliche with insurance still charges $100 to $150 a session. That adds up really fast because, here comes the next part, it’s a five-day-a-week, six-week commitment. That’s right ladies and gentlemen. You have to do this for 30 days. Every day. For six weeks. It can get pretty pricey. I handled this situation by having excellent choices in insurance. Some of my medications were ridiculously expensive, even with insurance. So, I picked an insurance where I would meet my out of pocket relatively quickly. Once I met it, I decided to give it a shot.

I was really anxious. I met some awesome people, though. The first person was the coordinator who was hilarious. Then, I met the administers of the actual TMS. I sat in a comfortable room, in a comfortable chair and they fitted a little white cap on my head. They were going to do what they called a “mapping” for my first day.

The mapping consists of “a single magnetic pulse applied to the motor cortex generates a twitch in the corresponding muscle known as the motor-evoked potential (MEP). The intensity of the stimulus required to produce the response is the motor threshold (MT), which has been defined as the lowest stimulus intensity required producing MEPs of >50 μV peak to peak amplitude in at least 50% of successive trials in a resting or activated muscle.”

This is super fancy explanation for when they pass a current through your head to make your hand twitch. They want that twitch because it lets them know where your pulse threshold is. Too weak and nothing will happen, too strong and it may sting. At no point in time, they made sure to tell me, should the TMS sting, hurt or make anything twitch after the mapping. From there, they mark where on the head they have to position the paddle and they let her rip!

It was … weird? They offered me ear plugs, but I’m hard of hearing, so it didn’t bother me in the slightest. What did it feel like? It felt like someone was poking me in the head really fast for four seconds. Then it would pause. Then it would poke me in the head really fast for four seconds. This procedure repeated for what they call “trains,” and there were 75 of them. The treatment lasted for 19 to 37 minutes and the ladies talked with me the whole time! Mostly, they asked me some really fun questions. They were survey-like questions about my symptoms I really hadn’t thought of before then.

Things like “In the past two weeks have you thought about hurting yourself?” Or, “In the past two weeks have you had difficulty sleeping?” Most of the time we just chatted about life, though. It was pretty fun.

The first time I did TMS, I got through the six weeks and I was barely on the threshold of “relief.” However, I didn’t want to die. I was sleeping OK. I was eating (kind of, I was diagnosed with binge eating disorder around the same time). I was able to concentrate on basic tasks. I felt, well, good. I felt good. Better than I had in two and a half years. The best part?

One study reported, “A 5 week, randomized, double-blind, placebo-controlled trial involving 10 daily applications of high-frequency rTMS to the left PFC in 54 drug-resistant depressed patients revealed rTMS to be an effective and safe adjunctive treatment for drug-resistant major depression.” And one out of two people are treated successfully, and the only side effect I had was a mild headache a couple times. This was shocking. So, I did it again.

This time, I met the threshold for relief. It lasts about three to six months, and insurance will not pay for it again until three months have elapsed. I could live again. It was beautiful.

Getty image by metamorworks

Originally published: January 21, 2020
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