Brain magnets versus depression
I have medication-resistant depression, the kind that petulantly refuses to be treated – or to remain treated long – by SSRIs or SNRIs or tricyclics. The past two years have been my longest period without a recurrence since I was a teenager (the rest of those years were spent either trying new medications or else just “winging it,” which I don’t recommend). All of my greatest discoveries happened in those two years, all of my most exciting becomings happened in those two years, but for the past seven or eight months, I’ve been living in a fog. It’s harder this time, because although depression is familiar enough now as to be almost companionate, I have so much more to lose.
Those who have gone through it will know that being treated for depression is, among many, many other things, supremely irritating. It is an aggravating process of slowly increasing the dosages of medications, waiting to see if they work, and then, when they don’t, tapering back down and restarting the whole process again with a new drug. Sertraline, fluoxetine, citalopram, venlafaxine. Four to six weeks of building, two to four weeks of waiting, four to six weeks of tapering, repeat. Sometimes they just don’t work. Other times they come with a laundry list of horrendous side effects (depression hurts, Cymbalta can help. But it will also hurt, so you know, roll the dice I guess).
I am impatient. I want more for my life than this Sisyphean task. It is simply not good enough, especially not now, not after I have experienced a real remission and seen how good life can be. So when my psychiatrist suggests one day that instead of another three months of trying a new medication, we put a large magnetic coil on the front left hand side of my skull so it can send electromagnetic pulses into the part of my brain that so often feels empty and dead, I don’t hesitate. Let’s waste this thing.
Dr. Yanbo Zhang, an assistant professor of psychiatry at the University of Saskatchewan’s College of Medicine, who is not involved in my treatment, said that the procedure my doctor recommended, called transcranial magnetic stimulation (TMS) has been around since the 80s, in several forms, although it wasn’t approved by the FDA and Health Canada as a treatment for major depressive disorder until 2005.
Less invasive than its cousin, electroconvulsive therapy – which Zhang said I might know “from the movies, that looks quite scary” – TMS is typically reserved for people whose major depressive disorder hasn’t responded well to medication and psychotherapy. The general premise is that short, intense bursts of magnetic pulses will stimulate neurons and improve the functioning of the brain. Right now, Saskatchewan is one of only four* provinces that covers the treatment in its general health plan. “Access is limited,” Zhang told me. There are only three machines in Saskatchewan, two in Regina and one in Saskatoon.
The day of my consultation, the psychiatrist who oversees the TMS – different from my regular one – has me watch a three-minute YouTube video about the woman who played Leisl in Sound of Music and had TMS to treat her depression. The doctor is ill and he sneezes into the crook of his elbow while sliding his MacBook across the desk so I can watch and for some reason I think about Ebola.
In the beginning of the video, Liesl – whose real name is Charmian – is fragile and trembling, like a broken bird. She flips through photo albums from when she was young and happy and twirling in the Alps with Julie Andrews and singing about love with a blonde Nazi named Rolfe. By the end she is pert and smiley, lacing up a pair of clean white running shoes so she can show the interviewer the garden in the backyard of her bungalow. I want Liesl’s backyard and her bungalow. Or, perhaps more accurately, I want the kind of functioning brain that leads to backyards and bungalows.
After the video, the congested doctor gives me a release to sign, which strikes me as funny. TMS has few side effects, the most common of which is headache, although according to Zhang, it can cause seizures in those who already have seizure disorders. Meanwhile I never had to sign a release for the medications whose potential side effects were intrusive thoughts of suicide, chronic anxiety, insomnia, weight gain, weight loss, sexual dysfunction, kidney damage, and – I cannot stress this enough – compulsive gambling.
During the consultation I am repeatedly asked if I have any metal in my skull, as though a steel plate or bolt in my head might have slipped my mind the first time I was asked. I say no all three times, and they are eventually satisfied that the magnet will not send some errant piece of metal on a catastrophic tear through the soft, pink lobes of my brain.
The Friday before treatment starts, I am assigned a white fabric cap. It is $25 and my only out-of-pocket expense. Zhang said that in the provinces where TMS is not covered by the general health plan – that is, everywhere but Alberta*, Saskatchewan, Yukon and Quebec – every session costs $80-100. At twenty to thirty sessions, that’s up to $3000. It’s a stark reminder that even though this country ostensibly has Medicare for all, the quality and kind of treatment you get is largely dependent on where you live.
And in the U.S., it’s even worse. There the average cost for TMS is $12,000 to $15,000. I’m not sure if that includes the $25 cap. Zhang said that along with limited access, the cost is a large part of why the treatment isn’t offered more frequently, even though it has minimal side effects and about one third of people who receive it experience a full remission. He adds that it’s still cheaper than psychotherapy.
Before I can start, the LPN who administers the treatment, Paul, measures my skull and draws all over the cap with a Sharpie. I want to make a joke about calipers, but I’m afraid he won’t get it, or worse, he’ll get it, but he won’t think it’s funny. I keep my mouth shut instead and it is a rare win for silence. At least, I’m silent. Paul likes to talk, and he thinks he’s funny. This is relatable because I, too, think that I am funny. Paul thinks I should take up hookah to relax, but he tells me this “as a friend, not a nurse.” Later I will have to scrub my head to get rid of the blooms of ink left behind when the Sharpie bled through my cap.
The Mayo Clinic website says that TMS is painless, but this is a bald lie. There is a painful, staticky hammering above my left eye, like an electrified woodpecker has chosen to roost there. I roll my tongue up so I don’t bite down on it when my jaws clack together from the spasms each of the twenty separate pulses send radiating through my skull. The machine clicks in my left ear. It’s deeply uncomfortable but the treatment only lasts for three minutes. I go into the clinic every day at 9:30 and I am done before 9:40.
Even though I’ve been through this before, and even though I’ve come out on the other side every time, there is still an awful, gut-wrenching terror that this is it – my mind is irreparably broken. It is difficult to keep myself from falling into despair and I don’t always succeed. Allowing a machine to hammer magnetic pulses into the part of my brain that so often feels empty and dead seems farcical. At home, I Google Liesl to see if the treatment worked and find out she died of frontotemporal dementia four years ago. Sometimes I don’t feel anything and sometimes I want to die with such ferocity that it steals my breath.
But I can’t die now, I’ve already committed to the bit. Instead, I wait and I hope for something I’m not even sure exists. I’m not prepared for the day when something in me flips like a switch in the middle of the afternoon and suddenly I’m breathing again.
I repot my ivies and sing along to “Goodbye Earl,” and when it gets to the part where the girls buy some land and a roadside stand out on highway one-oh-nine, I tear up because it’s so beautiful. One day at treatment Paul tells me that it is like a light has come back on in my eyes and I feel that. Later that evening my friend and I laugh until people stare and I am myself for the first time in months and when I get home I write this paragraph that I hadn’t expected to write when I first started this story three weeks ago.
It’s all routine and unremarkable and unspeakably beautiful and while there’s still far to go, it doesn’t seem like it’s too much to ask that it could stay like this for awhile.
*Zhang said that Alberta does not have the treatment, however the province had plans to begin funding TMS in 2019. As of press time, Alberta Health has not responded to request for comment, and the Government of Saskatchewan has no jurisdictional scans.