TNS (post #3)
Nearing the halfway mark now. As with the TMS treatment I tried earlier this year, it's been snagged by "technical difficulties."
I sleep with the device which sends an on and off alternating current through wire leads to electrodes adhered to my forehead. The sensation varies from a pleasant tingling to an unpleasant stinging depending on how much voltage is sent and where the electrodes are placed. I've found that as much as a centimeter's difference with placement can mean 'ting' or 'sting.'
Early into the third week, I awoke in the wee morning hours to find there was no current flowing to the electrodes. The device was powered up but no sensation at all. I fiddled with the wires, the voltage setting, switched the lead plug to a second port but nothing. Further fiddling of the wires seemed to fix the problem but only for a few moments....then nothing again. It was an obvious short circuit in the wires. I slept most of the night with a brick. It worked fine when I turned it on. This went on for another four nights resulting in restless sleep and frustration knowing that I wasn't getting a full night's "treatment." I had a follow up evaluation scheduled in a couple days so I just dealt with it. I did e-mail the facilitator to inform him of the problem.
It then occurred to me that I was given a spare set of leads that I completely forgot about. They worked fine. I only wished I'd have remembered I had them the whole time.
During the third meeting with the facilitator there were many questions and forms to document my progress, or lack thereof. I brought the defective leads back and he provided another set just in case. I asked if I would be able to make up the lost time due to the glitches but he said no. It is what it is and it's all documented so there's no do-overs.
Another week went by and the device worked fine until the same scenario repeated itself. Awoke to no electrical current. Now this set has a short somewhere. I was angry and exhausted. I switched to the third set of wires and they worked fine for the time being. Another night of treatment lost. I wonder how many sets of wires I will have to go through and if I'm the only one of the subjects in the group that's having this ridiculous problem.
Though it's still early in the process, I am not benefitting in the least as of yet. Losing time to defective wires just adds to the irritability. There's about five more weeks left and I'm already feeling pangs of this treatment's eventual failure. My mind wanders wondering what the hell I'm going to do next. I realize it's too early and my negative attitude will probably cause it to fail but I have little control of my thoughts and emotions so this is where I am thus far.
The Inner Critic
A typical, daily conversation I have with myself.
Me: I'm grateful for my physical health.
Inner Critic: What good is physical health if you can't enjoy it mentally? Eventually all humans decline and decay. You're no exception. Being grateful for it doesn't change the inevitable.
Me: I'm grateful to have a steady job.
Inner Critic: Oh really? That dead end job? The one that bores you to tears and literally causes you to doze at your desk frequently? The job that's made you into a soulless robot? You know you feel completely trapped. You can't quit and attempt a career makeover. Not at your age. You have no clue what you'd want to do anyway. So you settle and stay put because there's no other options. You're not grateful for the job. You're dependent on the paycheck.
Me: At least my children are healthy.
Inner Critic: So what? You know deep in your heart you never really wanted to bring kids into this wicked, evil world. They'll experience good times yes, but pain and suffering always have more of a lasting impact. You've already seen the effects of life on their faces, in their eyes. Just like you, their physical and mental health will slowly be sucked away and there's nothing you can do about it. Kids break parents' hearts. That's their job.
Me: Well, I have a pretty decent house in a nice neighborhood.
Inner Critic: That house literally breaks your back with all the yard work, maintenance and repair. It's a huge money pit. You know you long to live in an apartment or condo that's lawn-free. The work is never ending. And don't forget that so-called nice neighborhood allowed your house to be burglarized a few years back. That will stay with you and your family forever. Give me a break.
Me: I'm blessed with friends and family.
Inner Critic: Family irritates you to the core and you barely have any friends and you know it.
Me: That was a fairly decent workout at the gym today.
Inner Critic: You should have exerted yourself more. You should have spent more time there. You'll never see results with that prissy routine. You never workout as much and as hard as you should.
Me: Someday I'll beat depression. Some day I'll find a solution.
Inner Critic: You've been saying that for decades. Where has it gotten you? Odds are you'll go to your grave a bitter, lonely sad old man. Face the reality.
Me: Do you ever shut up?
Inner Critic: What's that popular acronym? Oh yes.... LOL.
TNS (post #2)
Well, here I go again. Diving head first into a "promising new depression treatment." How many times have I read that?
Somehow I've made it into a second clinical trial for TNS depression treatment. I was told I was fortunate to qualify at this time because this study is "open labeled" meaning no placebo—everyone knows this is the real deal. The next trial will be "double-blind" where not even the doctors will know who has the real treatment and who has the placebo.
Two appointments so far. First one with the facilitator who interviewed me extensively and had me fill out all the necessary paperwork. I then met the two doctors who are spearheading this research. One a neurologist, the other a psychiatrist. I won't mention names out of sheer common sense. Extremely nice folks. Thorough, attentive, personable and even caring. I was given a neurological exam which went well. They seemed genuinely excited about this study.
Two weeks later the second appointment lasted much longer. I agreed to undergo a brain scan. The purpose of this scan is to literally see what the electrical current is doing in the brain and specifically where it's going by examining the brain's blood flow. I was scanned with and without the device. They used a "tracer" to observe where the current was going. This tracer was radioactive water administered through an IV. I'll repeat that. Radioactive water. I was injected with it not once but six times, one for each scan. Of course I was assured it was an extremely low and safe level of radiation that dissipates very quickly. It didn't bother me at all. As a matter of fact I was hoping a dose of radiation to my unforgiving brain would possibly jar it to a happier state.
The scanner was similar in appearance to an MRI machine. A narrow tube with an adjacent table the patient lies on then slowly moves head first into the chamber. My head was barely half way in. It was comfortable enough. The whole session lasted about two hours. At the conclusion of the test the clinician overseeing the process held a geiger counter near me. That was a first.
Following the test, it was hands-on time with the device. It was nothing more than a basic TENS unit powered by a 9-volt battery. For those unfamiliar, a TENS unit is a small contraption that sends out electrical impulses through wired electrodes that are adhered to the skin with a sticky gel. I used one years ago for my back pain but it didn't really help. I was slightly disappointed to see it was a garden variety product instead of some sleek new prototype never seen by the public. I learned this was precisely the intention of the doctors involved. To design and produce a modified TENS unit like device specifically for people who suffer from epilepsy, ADD, ADHD, depression, and a host of other possible health issues. Since this study is literally in its infancy, the TENS unit serves its purpose at this time.
It's simple to use. The electrodes are centered just above the eyebrows. The voltage settings are determined by my comfort. All I have to do is attach it to my head and sleep with it nightly. In addition to the introduction of the device, I was given an EKG with and without the device and a blood pressure check that lasted an hour, again, with and without. This is all for safety's sake. They will eventually present this study to the FDA but they must make sure it's safe and all testing for safety has been documented.
The first night was restless for me. Later in the day I got a dull headache but not sure if I can attribute it to the unit or not. I felt no difference but it takes weeks to experience results. The neurologist told me I was only one of three that had the brain scan. They will be looking for common denominators in each case so they can zero in on what part of the brain is making depressives so miserable.
He told me I was a pioneer. Thousands of doctors all over the world will be studying the data once released. I will remain anonymous of course but if this works for me, I'll be indirectly helping others for years to come if all goes as planned. I've been here before however. In uncharted waters trying not to get my hopes too high. I've become so jaded. I shared my skepticism with the doctors. They told me they wanted me to be skeptical. They don't want me to develop my own placebo. They need honest answers.
After spending most of the day there I collected all the items and paperwork, shook their hands and thanked them for spending so much time with me. I should have felt some inkling of hope but there was only numbness. As I stepped out of the building to get back to my vehicle, I saw the streets were jammed. It took nearly a half an hour just to travel 5 blocks to the freeway. It took a total of over 2 hours to make my way home in the dreaded southern California 5:00 rush hour traffic. Today I'm a pioneer –– yet also traffic.
TNS (post #1)
TRIGEMINAL NERVE STIMULATION
As I frequently do, I was scouring the Internet for anything new and promising on the horizon. I typed in the keywords "new depression treatment." Up came a select few articles about something called TNS. Not to be confused with TMS transcranial magnetic simulation (see April post "TMS") which I tried and found to be completely useless.
Several of the articles were the same exact story on different psychology or medical websites. It involved a clinical trial for a device that has been successful in treating epileptics. Turns out, along with a dramatic reduction in seizures, an unexpected positive side effect of this treatment was noted: mood elevation. Now a new branch of investigation has morphed from the initial epilepsy study.
My Internet research led me to UCLA's "Depression Research & Clinical Program." A whole department in a major, highly respected university devoted to the study of depression. Luckily I live about an hour's drive from there.
I found a link that read "Our Trigeminal Nerve Stimulation Project using electrical stimulation of a peripheral nerve in adults who are still having symptoms of depression despite using medication (age 18-65)"
As though it was written exclusively for me.
Clicking on the link revealed a flyer that asked:
• Feeling blue or depressed?
• Antidepressant medications not working?
• You’re between age 18 and 65?
yes, Yes, YES.
Sounded like it wasn't meant to be right out of the gate. Regardless, I left a message describing my situation and hoped for a call back thank you very much.
More time goes by with no word. Finally a call from my doctor who informs me she left a message on the very same voicemail but had not heard back. I decided to be the squeaky wheel and left another message basically restating what I had said on the first message. I went back to the website and found another phone number that appeared to be the main department number as opposed to this "direct line" to the study itself. I took a shot expecting another recording but amazingly I heard a live, female voice answer. I launched into my tired speech about my situation and how I hadn't had a response after two messages had been left. She told me that they had been so inundated with calls, they couldn't possibly get back to everyone. It was unprecedented for any study on depression they've conducted. They had never seen anything like this. Literally calls from all over the country were pouring in every day. This explained why the message specified only L.A. area calls. I told her where I live. She replied that was very close and took my name and number to deliver to someone important (I guess.)
Well, yet more time goes by and nothing. Then a call from my doctor. They called HER to get in touch with ME. I was shocked. She gave me a number to call. Yep, it was the very first number I called with the very same voicemail. Sigh. With nothing to lose I left a third message throwing in the fact that my doctor had contacted them as well.
More time goes by. Nothing. Then my cell rings displaying an unfamiliar number. It's the voice from the voicemail recording. He wants to prescreen me on the phone with lots of questions. After about 15-20 minutes he informed me that I had, in fact, pre-qualified and wants me to come in for a 6-hour appointment so I can be screened further to make sure I'm a good candidate. What I thought was a longshot, considering people from all over the country were enquiring, turned into a huge cut in line right to the front door. Didn't see this coming at all.
I am subject number 9.
At the risk of boring the reader even further, here's a brief explanation of this new depression treatment. In the face just beneath the skin are two large nerves that run parallel up behind the eyes and forehead and deep into the brain. The trigeminal nerves function both as the main nerves of sensation for the face and the motor nerves controlling the muscles for chewing. The trigeminal nerves emerge from (or enter) the skull, as opposed to the spinal nerves which come from the spinal column.
The device is the size of a large cell phone. Two wires from the stimulator are connected to electrodes attached to the forehead above each eyebrow by adhesive. The electrodes transmit an electrical current to the nerves. These nerves are like a freeway deep into the brain. Patients use the device for approximately eight hours every night while asleep. It's non invasive. Since it's a clinical trial it's free of charge with no frickin' insurance involvement. In contrast to antidepressants, no major side effects have been noted. Side effects suck so this is good. Maybe it's too good.
They've already had one clinical trial with 5 people. So far they have 4 more recruited for this second trial. 70-80 percent of the subjects in the first trial achieved remission, a highly significant result in a pilot study. At this writing I have about three weeks until the first appointment. I'm hopeful, but guarded. I cannot get my hopes too high. It's a potentially very hard fall. I'm now in wait-and-see mode.
Thoughts
I regret the past...endure the present...dread the future.
An endless roller coaster ride through a forest of thistles.
An inexplicable inability to experience joy.
Blessed and cursed.
Psychedelics
Recently in the news there have been several stories concerning scientists taking another look at psychedelic drugs for depression treatment. Psychedelics have had a terrible stigma because of their use and abuse in the hippie era of the ’60s. Images of whacked-out teenagers tripping and hallucinating are conjured by the mere mention of LSD or "magic mushrooms." Fast forward to the 21st century — the base chemicals found in these hallucinogens have proven to rapidly relieve depression and bi-polar disorders in a matter of hours as opposed to conventional antidepressants that take weeks or even months -- if they work at all. Unfortunately most of these chemicals are illegal today. The chemical found in "magic mushrooms" is called psilocybin. In controlled trials, patients have reported virtual immediate relief from treatment resistant depression. The positive results don't last forever but scientists are intrigued by its rapid effect.
So am I.
Another drug is called ketamine. A study published by scientists found that an injection of ketamine which is an anaesthetic used legally in both human and veterinary medicine, but also abused by people who use it recreationally -- can lift the mood within minutes in patients with severe bipolar depression.
I doubt I'll have access to any of these drugs in the near future because of prohibitive costs or insurance bureaucracy but I'm going to enquire with my psych doctor about any possibility of looking into this.
Of course, there are always risks with new and experimental treatments. This is all in its infancy but I'd be willing to be a guinea pig in a clinical trial. Am I desperate? Am I foolish? Am I nuts to seek out an instant "cure" via a pill? In a word, yes. But I've been a lab rat for decades so this really wouldn't be any different. I am concerned about having a "bad trip" or doing irreversible damage to my already damaged brain. But to experience even the slightest temporary relief could be priceless. Nothing may come of this but who knows? Stay tuned.
UPDATE:
A discussion with my psych doctor resulted in mutual agreement that these drugs are too experimental and risky at this time. Besides, she said using psychedelics is "creepy." I am, however, going to look into a newer treatment via a clinical trial called TNS (trigeminal nerve stimulation). It's basically a devise you wear while you sleep that electrically stimulates nerves in the face. Somehow it relieves depression and has a 70 percent success rate. I'll craft a separate post when I learn more. There will be no tripping on mushrooms apparently.
What would they say?
I'm not suicidal. I don't plot my death. I suppose I haven't reached that point — thankfully. I've seen the pain that suicide causes loved ones left behind. I could never do that to my family. But in a twisted mindset that I don't fully understand, I do have a certain empathy for those that have been so desperate for relief, they chose to take matters in their own hands and end it once and for all.
I once saw snippets of a documentary where the film makers set up several cameras 24/7 focused on the Golden Gate Bridge. The filming lasted an entire year. In that year they documented two dozen suicide jumps and several attempts. I couldn't watch the whole thing. For some reason though I had a visceral understanding of why these people made that final choice of their lives.
Sometimes I experience fleeting thoughts of what the end could be like, often times wishing my life would be cut short so as to be spared any more heartache. Would I feel warmth and relief? Would there be the proverbial light at the end of the tunnel? Would I be punished eternally for committing the sin of suicide? What would people say about me? Would it really matter in the Grand Scheme?
As I continue to tailspin, I have fears of what this continued hell will do to me in the long-term. The toll it takes can easily make you do things you'd never think of doing because of desperation. Of late, I've had fleeting realizations that I'm losing my will to live. This does not mean I'm suicidal. I'm just having a great deal of trouble caring anymore. I hope I won't reach a point where I'll have no option left but to face that awful, final choice.
One for the books
Today my psychiatrist told me she has never in her career been unsuccessful in treating her patients for depression. As she said this she shook her head slightly.
I may have stumped her. Nothing to be proud of.
California Rocket Fuel
After my unfortunate experience with the drug Emsam, (read My Sad, Stupid Emsam Story, April 2010) I swore off ALL drugs forever - even aspirin.
That lasted about 5 months.
During those 5 months I slowly began to realize that my state of "normalcy," when drugless, was teetering on the verge of tears. It angers me so much that a grown man can be brought to weep so easily. One can only endure this existence for so long. It has become clear and ever so sad for me to be resigned to using antidepressant medications for the rest of my life. The irony is they really don't do what they're supposed to do, at least for me. They do take the edge off my emotions which helps me to get through the day but that's where it begins and ends. There's never been a lifting of spirits or relief from the depression itself. Alternative treatments have proven to be disappointing, expensive and futile. I found myself going back down that same slippery slope that leads to the psychiatrist's office. This time with my tail tucked beneath my legs. The doctor put me back on an antidepressant that I had taken prior to my quitting them altogether because I tolerated its side effects quite well. This time she added Ritalin.
Ritalin I asked? I picture hyperactive children bumping off classroom walls when I hear that term. Why Ritalin? It will give me an energy boost I'm told. It's quite common to prescribe Ritalin with an antidepressant. At this point I don't really care anymore. I'll eat rocks if they'll pull me out of this hellhole. So Ritalin it is.
I go on my merry way with my new prescription wondering what I'm in store for now. Weeks go by and there's barely any detection of change. I am less weepy but ever so slightly which is better than nothing I suppose but falls miles short of the relief I desperately seek. I find that the Ritalin causes me to grind my teeth. I catch myself grinding my molars together which is unnerving.
It's been over 4 weeks now and I'm due back for another psych appointment. I tell the doctor there is really no change. She seems stumped and proceeds to ask questions like when was the last time I felt happy to which I responded around the age of 10. There was awkward silence as she jotted notes on her lap. I gazed at the floor reflecting on the words I had just uttered. It's true. I haven't felt joy or happiness since I was a child. What happened? She asks about my libido. I tell her it's definitely declined over the years and I attribute it to my age which she scoffs at. You're only 49 she says. She asks if I've had blood work done recently. I had my regular doctor send me to the lab a couple of years ago to see if there was anything off kilter but all tests came back normal. She thought it wouldn't hurt to try again so she requested a total of 14 blood tests to see if there's some medical indication that's been overlooked.
She decides to bring out the big guns now. A drug called Remeron is prescribed. I've never heard of it. It's a "tetracyclic" antidepressant — whatever that means. She wants to combine it with the Lexapro and Ritalin I'm already taking. Three drugs now. THREE. At the same time. I feel like a lab rat again. It's all trial and error in this world of psychotropic medications. What are the side effects? Vivid dreams, dry mouth, dizziness, grogginess, appetite stimulant, weight gain. She says I could use a few pounds anyway. Whatever.
I ask how long it will take for positive effects to which she responds 3 - 4 weeks. She then tells me about a phrase that was coined by some prominent psychotherapist — "California Rocket Fuel" referring to a combo of Effexor and Remeron which gives a double boost to the brain's neurotransmitters. She'd like to wean me off the Lexapro and pump me up with this potent drug cocktail but not right away. I took Effexor combined with some other drug a few years earlier without any success.
The appointment is over. I take the prescription slip, schedule another appointment, and make my way to the pharmacy. I want to start on the new stuff right away. One pill is 15 mg. Have to take one pill for three days at bedtime then TWO pills thereafter. About 45 minutes after taking the first pill the drowsiness hits me pretty hard. I'm out in no time which is fine by me because getting to sleep is always a chore. Unfortunately, it's a short lived sleep. The rest of the night is a restless slumber. Next two nights is the same story. Now the fourth night I have to double the dose. Again, I'm out like a light but this time I wake countless times in the night. I experience leg flinching, night sweats, crazy dreams, parched mouth, dizziness, grogginess, disorientation. The mornings on through the late afternoon are an unbearable surrealistic journey through my tedious daily routine. Concentration is difficult. Reading is difficult. Interacting with people is a nightmare but I somehow bulldoze my way through the first week thinking what a mistake it is to resort to these synthetic chemicals to feel "happy." What a joke. The side effects are kicking my ass and ruining one day after the next. Since I've run out of options, I have no choice but to ride this out in hopes that the side effects will subside and the med will eventually do what it's supposed to do.
Ten days later I can't bear it anymore. I put in a call to the doctor and leave a voice mail but she doesn't get back to me for whatever reason. I make the executive decision to immediately stop taking this stuff. The next day I'm much better and feel validated for my decision. I don't have a doctor appointment for another three weeks so I just continue with the other meds. Remeron was a dismal failure to add to the growing list of dismal failures. Each time a new med or treatment falls short it takes a piece of my hopes away.
There will be no "California rocket fuel" in my future. On to the next.
Mornings
Sleep is my only respite from the relentless heaviness of depression. But sleep itself is often as elusive as the relief I so desperately seek. Ever since childhood I've been a light sleeper. The slightest sound stirs me out of slumber. Usually if I'm awakened in the night, that's it. I'm up and there's no going back. It also takes an eternity to fall asleep in the first place. In the rare case that I do sleep until morning, it's a restless sleep at best. Great if a prowler targets my home but not great for keeping one's sanity.
Sleep is so important. A luxury. I don't consider myself an insomniac thank goodness, but I have had bouts of recurring nights when I'll suddenly awake at 2 or 3 in the morning consistently for a week or two at a time. These hours are the most painful and dangerous of the day. Instead of rest I'm faced with idle time that my mind runs amok with. I do try reading or even watching television to occupy myself but it's a lonely and sad time span that tends to tailspin into exhaustive, emotional episodes. I mentally beat myself up. Reflect on bad memories. Lament decisions I've made. Ruminate on all my regrets. Pray for relief. Cry for hours. I'll sometimes wander aimlessly through the house trying not to disturb the family in an effort to expend the energy.
Having also dealt with anxiety, I was prescribed a generic Klonopin. The side effect is drowsiness. This has become my sleep aid of choice. For me this drug takes a while to kick in. Sometimes 2 or 3 hours. I take a half dose that gets me through the night. It's just right. No grogginess in the morning and I avoid the nightmare of being alone with myself in the wee hours. I loathe having to resort to this. It's an artificial sleep. It can't be good for me. On occasions when I really need to hit the hay quickly I'll take an Ambien. Strange drug this Ambien. You have to be careful with it. Between the time it kicks in and the time you actually sleep it's capable of making you do things you'll have no memory of the next day. I always make sure I take it immediately at bedtime. Unfortunately we depressives become slaves to these little pills. We depend on them to get us through the day as well as the night. It bothers me greatly but it always seems to come back to being medicated.
Whether the alarm sounds or I just wake on my own, it's the single worst moment of the day. The instant sleep evaporates and reality floods in. Utter dread and sadness barge in like unwelcome in-laws. As the sleep wears off I can feel my face contort. My brow furrows. It's a really deflating moment that sets the tone for the day. Weekends are even worse because there's more time to "sleep in" which really amounts to much ceiling staring.
I should just jump out of bed and take a walk or find something to occupy my mind but it really doesn't help. I have done this many times but I tend to default to just lying there and festering in my misery. No one to blame but myself. My poor wife wakes to my contorted face and at times gets angry. I don't blame her. I would be angry too. It weighs heavy on the marriage. I have ruined many weekends for her and I'm deeply remorseful for that. The vicious cycle continues and each one starts in the morning.
Giving up on prayer
Having been raised in a non-religious household, prayer was always an enigma to me. To this day I don't feel I've ever prayed properly. I'm Jewish — both parents are — but for all intents and purposes my father is an atheist and my mother herself grew up in a home sans religion. They divorced when I was around 6 or 7. At about age 10 I attended a couple years of Hebrew school but lost interest and quit. Yes, a Hebrew school dropout.
In Judaism, prayer is very structured and scripted. It must be done three times a day facing a certain direction reciting certain scriptures in Hebrew, etc. I never learned the protocol yet I have prayed since I was a small child in my own small way. Though I respect tradition and see the importance of following a certain set of rules to accomplish a certain task, I never understood why prayers couldn't simply be accepted in stripped down versions bereft of pomp and restrictions. Why isn't a pure emotional outpouring as valid as a robotic, recurring routine?
The created crying out to the Creator.
Over the decades I have pleaded, begged, reasoned, pondered, questioned, and cried a million and one tears during prayer. I'd always try to start a prayer by giving thanks for what I already have fully aware that it's not about asking for favors or bargaining. All I've ever really needed was a bit of help to get my head above water or a lightening of the load. A divine boost or a some sort of "wink" from God reassuring me that I'm doing just fine and things will be alright. On the contrary, I cannot remember ever feeling better after praying. I have come away from each attempt at reaching out in much worse shape then when I began. I have found prayer to be emotionally draining and an exercise in futility. It's been an extremely slow realization. God of course works on His own time clock. I have read that prayer is not for God because God needs nothing. Prayer is for the benefit of the one praying...but I have never experienced benefit.
There are many a Christian whose default response would be akin to 'just give your life to Jesus and you'll live happily ever after.'
(Long pause for effect)
Sorry, but at the risk of offending many — I've never been able to swallow that pill. Not just because I'm Jewish but because I've seen with my own eyes that God really chooses not to intervene. Millions in concentration camps, Soviet gulags, prisoners of war, kidnapping victims, and the people in the airliners on 9/11 surely prayed for their very lives but their prayers fell on a deaf ear. This is clear evidence that prayers are not always answered. Of course people will adamantly disagree claiming God has in fact answered their prayers on many occasions. That's all well and good for them but this has forever eluded me. It's simply never happened.
He has already provided us with a planet to live on, air to breath, water to drink, food to eat, and brains to reason with. The rest is up to us.
One conclusion I've come to is maybe He has in fact answered me...by not answering me at all. That's the answer. Silence. The "answer" is — you're on your own. You have been provided the tools to solve your own problems.
Now go.
I guess I've been too dense or stubborn to understand the lack of response as the response itself. I continue to struggle with this theory but maybe there's validity to it. Maybe not. It's all very perplexing and taxing so I've just stopped. There was no real conscious decision. No formal announcement with fanfare. One day when I had the desperate urge to pray, I simply decided I did not have the energy and chose to abstain. I gave up. In a way it was a restful decision. I spared myself an emotional episode.
By no means am I at ease with any of this. It's now one less source to turn to and yet another hope for help that's evaporated. In fact, I feel a slight upsurge of loneliness since refraining from prayer. I will most likely return to God and prayer in my quirky little way although I don't know when. I can only hope, in His infinite mercy, that He will accept me as I am with warm open arms.
Inspirational quotes
The following are thoughts, observations, and quotes I have pondered on over the years from people much wiser than I.
"Don't take life too seriously; you'll never get out of it alive."
-- Elbert Hubbard
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"Home is one's wife." -- Jewish proverb
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"Life is ever since man was born, licking honey from a thorn."
-- Louis Ginsberg
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“Character is doing the right thing when nobody's looking."
-- J.C. Watts
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"Nobody's seen where I've been. Nobody feels what I've done.
Nada one." -- Nancy Wilson
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"Depression is not a sin; but what depression does, no sin can do."
-- Chassidic saying
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"The mass of men lead lives of quiet desperation." -- Henry David Thoreau
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"It's just a game, and all I can do is play." -- Rik Emmett
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"If you want to be happy, be." -- Leo Tolstoy
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"The pain of the mind is worse than the pain of the body." -- Syrus
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"If God lived on earth, people would break His windows."
-- Jewish proverb
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"A sad soul can kill quicker than a germ." -- John Steinbeck
Dr. H.
As a general rule for me there's a criteria for selecting a doctor, dentist or any other service that requires recurring appointments. One is that they be in the vicinity of my work or home so I don't have to drive for miles and miles. I prefer someone who has a good command of the English language. Communication is extremely important especially when therapy or meds are involved. Another, of course, is they accept my insurance. I'm fortunate to have a health plan. It's not great but it's something. Lastly, that they can accommodate a late afternoon or evening appointment to least impact my work schedule.
More often than not I have NOT sought help for depression. I'll do what I can to muster the energy to get through the day without doctors, treatments or therapy. I've gone years at a time without therapy. Some medications that were prescribed to me by a psych I'd just have my general practitioner refill for me. I took Zoloft for 12 years in this fashion. It really never lifted my depression. It just numbed me. Every so often I'll descend back into a dark valley that will require seeking help once again. I've really never responded positively to therapies or drugs. That's not meant as a slam to the individuals involved or the industry itself although it's far from perfect. I mostly blame myself for not putting out a concerted effort into "homework" assignments or implement the tools these folks give me to improve my situation. However, there was one doctor I encountered that reinforced my disdain for the psychiatric community. He'll be known here as Dr. H.
I found Dr. H. on my health plan's website. He fit all the criteria. My insurance covered his services, close to home, took late afternoon appointments, etc. I called and naturally got a voicemail message. My call was returned a couple of days later. It took a few weeks but I managed to land an appointment right after work.
As with many doctors in my area his office was a large, converted old house shared with several other doctors. A white, two level "double gallery" structure with a second floor balcony reminiscent of homes in New Orleans circa 1800s though it wasn't that old. Its architecture didn't match the neighboring houses but it was slightly hidden by large trees and brush so it blended in.
The arrival and check-in was scarcely memorable. Approached the window. Spoke to the girl behind the counter. Filled in all the mundane paperwork. Sat and waited. I was the only one in the waiting room on this day. It wasn't too long a wait before the doctor emerged from a door and summoned me in.
Dr. H. was an older male. Tall, grey, glasses, shirt and tie. A professional appearance at first sight. I sat on a small sofa gathering my thoughts and preparing my delivery of the same tale I've told countless times. Instead of sitting in a chair, Dr. H. straddled the corner of his desk which was positioned perpendicular to the sofa on the opposite wall. His arms were folded and he towered over me in part because of his height, because he was half standing/half sitting on a desk, and because I was sunken into a mushy couch. His office was in a bit of disarray. Books and papers scattered about. The desk unorganized. I take note but it doesn't bother me.
Instead of enquiring about me or the reason I was there, Dr. H. launched into his own biography. He has been in the business for 30 plus years or some such number. He has an excellent success rate with his patients. He threw out some percentage — 80 or 90%. He boasted about his uncanny ability to prescribe just the right med at just the right dosage. At this early stage in the session I'm trying to be a patient patient and allow him to ramble on about how terrific he is.
Finally we got down to the business of me. He reached for a notepad and sat in a chair opposite me. He asked the typical questions and I replied with typical answers. I explained all the past therapy and drug failures and spoke of my desperation to find help.
We discussed the drugs that I have experimented with in the past and then he caught me off guard with an odd question. He wanted to know if I had any leftover meds lying around that I didn't have any intention of taking anymore. I replied that I believed I did. Why? As with most M.D.s he gave out samples to patients. Only thing was, many of the samples he would give out were leftover prescriptions from other patients. He touted how this was a way of helping less fortunate patients who couldn't afford medications. Now all I can see is red flags. This guy actually dispenses prescribed meds to other people without a prescription. Noble but highly illegal, not to mention stupid. I had a fleeting thought of entrapment. What if I agreed to bring in my unused pills? Was this a test? Would I be arrested? This stunk. Is he for real?
Just when it seemed we were achieving a rhythm Dr. H.'s cell phone rang. He reached down to his belt clip and answered it not even excusing himself. It was a lady who was calling about another patient of his who was currently having a rough time. I had no choice but to eavesdrop seeing as he had no qualms about talking about another patient in my presence. The call went on for maybe ten minutes. I was irritated but tried to be understanding. After all, he was helping a patient in need and that could some day be me on the other end.
Though the pace of the session was disrupted, he hung up and droned on and on about who that person was and why she was calling. We then continued the consultation with hopes of coming to some conclusions and a plan of action. A few minutes later the phone rings again. Same lady. Now I'm getting irritated. Why does this guy even have his cell turned on during a session...especially an initial consultation? I'm subjected to listening to this call for a couple of minutes and then the good doctor proceeds to stand up, walk across the room, and disappear into an adjacent office. What has begun as confusion is now disbelief. I can still hear the conversation through the wall. The call goes on for another ten to fifteen minutes as I stare at the carpeting. The appointment is now running long and I have to get home soon. Ironically I always feel psychiatrists spend way too little time with their patients but in this case we have to wrap things up soon. I can't sit here all evening and listen in on one side of a phone conversation.
Without apology he strides back into the room as if it's business as usual. I'm not even sure where we left off this time and I'm getting very disgruntled with this character. We continued further, though I can't even remember what we discussed at this point. A few more minutes pass and yes, the phone rings once again. This time it's the troubled patient himself calling. Dr. H. thinks nothing of getting up to leave the room again. Now I'm livid. Does this guy have any professional common sense? Taking cell phone calls during consultations? Are you kidding me? I'm sitting there dazed and distraught. My mind starts to wander. I fantasize about scrawling a big F-U letter on his chair. Or even bursting into the other room and smashing his damned phone against the wall. Maybe I should just quietly trash his office and slip out unnoticed.
I sit.
I wait.
I fester.
I'm feeling anxiety now. I glance at my own cell phone to see the time and it's now gone on way too long. I've had it. I deserve better. It's all unacceptable. I resisted all the retaliatory fantasies and quietly scooped up my jacket and walked out the door — past the receptionist and into evening air as he continued to devote my session time to another patient in another room. I'm rattled. Humiliated. My time was wasted and my hopes shot down yet again. How is it a pompous, arrogant jerk like that can actually be a long-time, established psychiatrist? If he treated me like that during my first appointment then how has he treated others? I was completely baffled by the ignorance of this so-called professional. Luckily the receptionist hadn't asked for copay before the session so he got nothing out of my pocket.
When I arrived home — late for dinner — my wife could see the rage in my face. I told her I had just done something I'd never done before...walk out of a doctor's office. After dinner the phone rang but I intentionally let the machine answer suspecting the doctor would be calling. It was his receptionist wondering if I was "okay" and wondering why I abruptly left. I waited a while afterwards to collect my thoughts and call the doctor's office knowing they would be done for the day so I could leave a few select words of my own on his machine. I don't remember exactly what I said but I do remember mentioning how he had unprofessionally spent a goodly amount of MY time on his cell and that he won't receive a dime from me nor will he be paid by the insurance company after I contact them.
The next day the doctor himself left a message apologizing and offering to find another doctor to meet my needs if I chose not to return to him. Needless to say he never heard from me again. I was so enraged I left scathing feedback on a few doctor review websites and even noticed a couple other complaints from other patients regarding this clown.
Fred writes: "This doctor confuses his lack of boundaries as a sign of care for his patients. He is very demanding and invades other people's space."
Bonnie says: "He is an impatient, rude, insensitive man, the last thing a person seeking mental health would require. My last visit, as usual, I waited to see the doctor for over an hour, when i finally did see the doctor, i thought i was on punked or some sort of candid camera show. he proceeded to accuse me of withholding information, he became extremly irritated with my lack of knowlege about the six or so drugs he had perscribed, he did calm down a bit when I checked him and informed him 'I am not a pharmacist.' what a joke i left out of there frustrated and feeling abused. stay away from Dr. H."
I wished I had seen these comments beforehand. Incidentally there were no positive reviews to be found.
In hindsight, I should have reported this imbecile to some authority for at least the illegal drug dispensing part but I have little energy as it is and it would be better spent searching for someone else. I did manage to contact my insurance company to tell them what happened and to suggest they refuse to pay him. Now I had to go back to square one and find another "professional" to help me pick up the pieces. Episodes such as this only add to the problem. I left his office worse then when I had arrived. The process repeats itself over and over as each time I try to improve my situation it somehow backfires and it's two steps back. I can't seem to get off this hellish psychiatric/drug prescribing merry-go-round.
Laughter
I was maybe 17 or 18. The timeframe is a bit fuzzy. There was a group of "friends" that I hung out with for a small chapter of my life. Most of them went to my school. Some lived in my neighborhood. Some right on my street. There was a constant base of about a half a dozen of us with various other friends of friends rotating in and out at any given time.
One weekend night I found myself yet again in a park drinking beer and generally wasting my youth away with this group. We stood around in a makeshift circle discussing absolutely nothing of substance. It was general goofing off and a way to kill a night.
Cassie was a small, animated, ditzy blonde that lived a few blocks from me. I didn't really know her very well but would see her from time to time at gatherings such as this one.
During the conversation, for some reason Cassie took note of everyone's particular type of laugh and decided to go around the group and impersonate each person's distinct laugh. After about four or five impressions she came around to me and stopped short. She then said something to the effect—"Wait, you don't have a laugh." I probably denied it claiming that of course everyone has a laugh. Or maybe I demonstrated a fake laugh. I honestly don't remember how I reacted outwardly. Regardless, she quickly dismissed me and continued on around the circle and nobody gave it another thought.
Except me of course.
In her little oblivious, all-in-fun experiment, Cassie caused me to come to a painful realization—that I, in fact, did not have a laugh. It was not something that I had ever given thought to but she was spot on. I was capable of a small chuckle or giggle or whatever it's referred to but I didn't possess a grand belly laugh that comes naturally to most people and I still don't to this day. I believe I did when I was a small child. I remember laughing hard when being tickled by an adult or laughing uncontrollably with my fellow peers. That seemed to disappear in my teen years. Now, some thirty years later, the memory of Cassie's revelation still haunts me. I don't laugh. I don't have a laugh.
I do find humor in things. I've been told I have a dry sense of humor many times. I appreciate clever standup comedy or a well written comedic movie. But she was right. I don't laugh. It's a small, silly observation but one that is very telling. They say laughter is the best medicine. When I reflect on all the drugs I've taken to feel 'happy,' the one medicine missing has been laughter. I hope to find a prescription for it some day.
Blessings and Curses
There is an awareness that's ever present. An awareness that adds further discomfort to my reality. One only has to glance at the Internet, read a newspaper, or a history book to be reminded of the immense human suffering that occurs daily. Suffering that I have never experienced and cannot comprehend. Suffering that's existed since biblical times.
I will often dwell on things such as the Holocaust or the Depression. Victims of terminal diseases or random acts of crime. Natural disasters that instantly erase whole villages, whole families, whole cities. The plight of the homeless or the latest African famine. Casualties of war be it a soldier whose lost a limb or a civilian that's lost his wife and only child. The list is endless. The proverbial glass that's half empty.
When I ponder these thoughts I often feel that I have absolutely no right to be this sad person I've become.
One look around me and I see a nice home, two healthy daughters, and a beautiful, patient wife of over 20 years. I have always had a meal on the table; clothes in my closet; heat in my furnace; comfort from the elements; a bed; a toothbrush; a hot shower; family; a few friends. I've always been gainfully employed and able-bodied. I am the most physically healthy person I know. I may get a cold once every three years. With the exception of some chronic back pain and a couple kidney stones I have been truly blessed with physical health. I can walk. I can run. I can jump. I can swim. I can still pick up my teenage girls and spin them around in circles...though they wish I wouldn't do that.
I can see.
I can hear.
Despite what appears to be an exemplary life, one filled with happy, healthy times and rich experiences...absent is the ability to feel them. To feel them deep in my soul. I can observe a stunning sunset. I can see its beauty—but I cannot feel it. The mechanism required to FEEL even the smallest, positive emotion simply does not exist within me. It seemed present when I was a small child but vanished during adolescence. It's relentless, puzzling and heartbreaking.
There is a lady I work with who lost her adult son to an auto accident and her longtime husband to cancer. Despite these unthinkable tragedies, she still manages to smile and laugh and function....at least this is her outward appearance. I cannot fathom the pain and heartache that she has endured but I admire her tenacity and love for life that keeps her going. She has told me it's her faith that keeps her afloat. She is one of my heroes though I don't think she realizes it. I plan on telling her some day.
There are so many lives that experience unconscionable tragedies that make my depression pale in comparison. I realize that. I really have no right to complain about anything. Guilt often overcomes me at times when I hear of immense burdens that people face. Burdens that would crush me. I have discussed this with several therapists over the years. They unanimously try and explain that it's all relative. Everyone has their own private hell. I find little comfort in this. As bizarre as it sounds, I sometimes think I'd rather be a happy paraplegic bound to a wheelchair than this miserable healthy person.
Acupuncture
We have a little home town newspaper that we subscribe to. As I was perusing the classifieds I came across a small ad for an acupuncturist. The ad listed a few of the conditions she treats, one of which was depression. I had tried acupuncture on two separate occasions for chronic low back pain but had no luck with it. I'd never tried or considered it for depression but it intrigued me. Acupuncture is more than 4,000 years old so something that's been around for such a long time must have some credibility. Again, another promising, drug free possibility. I called the number and left a voice message. A day or two later she contacted me and we agreed on a time to meet and discuss what she might be able to do for me.
She set up shop in an old converted Victorian house that she shared with a chiropractor. I knew that from the chiropractor sign above the door. I entered into what used to be the living room that now served as a lobby. Directly across the creaky wooden floor was a large fireplace. The interior of the house had a distinct, old, musty, wooden smell. Very characteristic. She called out from a hallway that she'd be with me shortly. She was apparently still with a patient. I took a seat in an old chair that was next to a rack with assorted brochures and pamphlets. Not long after she was done with her patient she sat down opposite me with a notepad to take notes. She was not Asian by any means. Petite, caucasian, short brunette hair, a bit bohemian. She had had several years of education and training in Eastern medicine and was very devoted to it.
I did the best I could to explain my situation and all the failed treatments of the past. I asked if she had any past success in treating depression with acupuncture. She assured me she had. Towards the end of this consultation she told me she was confident she could help me in at least a month's worth of treatments. One treatment per week including Chinese herbs. Her pricing seemed reasonable and I was comfortable with her overall so we set up a time table to get started. She was able to see me on certain days of the week after work. I was hopeful yet skeptical.
The first half of the first appointment was more of an assessment and exam. We went into what used to be a small bedroom but now was a treatment room. After removing my shoes I lied back on an exam table. She had me stick out my tongue. Apparently the tongue is very telling and can be used as an indicator of many problems. She also took my pulse on both wrists simultaneously apparently gathering additional information. I had no choice but to be open-minded. She lifted my shirt slightly and gently felt around my abdomen. She explained all about "chi"—the energy force we all have running through our system. I learned about the 12 main meridians or energy channels that relate to the internal organs. I learned about "cupping"—the scraping of skin to increase circulation. I also learned that I apparently have a clogged chi.
The procedure was comfortable and relatively painless. She put on relaxing Native-American music akin to "new wave" for lack of a better term. She determined the specific locations for each needle and placed them accordingly. A few on my feet, mid section, forearms, the bridge of my nose and forehead. She then applied a substance called "moxa" which is an herb that's burned over the acupuncture point. The burning of the moxa was done by a lit incense stick which added an additional "new agey" fragrance to the experience.
As best as I can remember, I was in the initial throes of an unusual onset of anxiety that I was hoping could be alleviated. I mentioned this to her and she felt that this was actually a good thing as it could be a "shifting" or actual positive change. It felt anything but positive. I described the physical sensations of the anxiety I was experiencing—most notably a strange adrenalin-like feeling in the chest's center. She added a few needles to that general area for good measure. After a bit of time passed she would remove those needles and have me flip over to my stomach so she could apply needles to my back and neck.
During these sessions we would chat about acupuncture in general and all its benefits. She told me of her experiences with it and her studies. She was passionate about Eastern medicine and I admired and respected that. She was sweet, gentle and caring. A question that I always pose to purveyors of these "alternative" treatments is does it matter if I'm skeptical of this approach? Can my initial negative attitude toward artsy-fartsy methods jinx it to fail? She replied absolutely not. The chi is independent of the mind and it matters not your attitude. I wanted this answer to be reassuring but it somehow wasn't. Though she was intelligent and meticulous, this process seemed almost silly to me but I had to give it a chance.
After the treatment she gave me a container of Chinese herbs. It was in powder form to be added to hot water and taken a couple times a day. The concoction was custom mixed for my needs. The appointments were relaxing and informative but I am the eternal skeptic and felt unsure about what I was even doing there. Three more appointments were scheduled for that month along with different mixes of the herbs. Some of them had an ungodly taste but I managed to gag them down nonetheless. At the conclusion of the month's treatments there was absolutely no change. On the contrary, the anxiety seemed to be increasing but she was convinced it was a good thing. We mutually agreed to go another month's worth of sessions since there were no results thus far. The subsequent treatments were relatively the same with varying locations for the needles. Now into the sixth week, still no change and I'm feeling very disappointed. She is still very encouraging and tries an additional approach of using tiny magnets that adhere to the skin. She placed larger ones on each of the bottom of my feet and smaller ones inside the exterior of each ear just below where the top of the ear curves. The concept being the magnetic fields would draw out the negative energy and also benefit the chi at the pressure points they were placed on. Willing to try anything I wore these magnets but as with every other treatment of the past they did nothing for me.
It's week eight. I arrive for my final treatment. She asks how I'm doing and I reply not well. No better than when we started. She's disappointed. She asks if I even want to proceed with the last treatment. I replied yes. I'm here, we might as well give it one more go. There was less chat during this session. It was apparent that it wasn't working and the end had come.
When finished, I put my shoes back on and met her in the lobby. She suggested some other types of alternative treatments such as biofeedback. My eyes may have welled up at that point and I asked for a hug. We said our goodbyes and wished each other luck. As I walked out of the door for the last time it felt like a small gust of wind could topple me at any moment. Somehow I suppressed an outburst of tears. I now had no choice but to cross this hope off the list. The days following were particularly somber.
Depression's henchman
They're referred to as anxiety or panic "attacks." One definition of attack reads "to set upon in a forceful, violent, hostile, or aggressive way." An attack is usually from an external source. An unwelcome incoming.
A few years ago I had an unexpected spell of anxiety. It manifested itself in several different ways. Most of them were physical in nature. My life is basically an 8 to 5 routine bookended by weekends occupied mostly by yard work or something the family has planned. Each day and each week—a clone of the next. As this feeling of anxiousness slowly crept into my existence, I was baffled as to what could possibly be triggering it. There was no more stress than usual. Nothing different was happening. The soul-sucking, daily routine plodded on and on as it always does.
At first it would begin with the heart jumping. The feeling you get the instant you realize you forgot to do something very important—that flopping sensation the heart seems to do or at least what it feels like it's doing. This would continue and increase in frequency as the days bore on. Again, triggered by nothing. The overactive heart beating was soon accompanied by the sensation of a whirlpool of adrenaline swirling about in the center of the chest. This became almost constant. These awful, combined attributes were reminiscent of the physical effects of a very lengthy roller coaster ride. Butterflies. Heart jumps. Adrenaline spikes.
More days come and go. Now breathing has become affected. Have to keep taking deep breaths. Can't seem to "catch it." Borderline hyperventilation. All the physical symptoms invariably impact the mind. Waves of fear overcome me though there's nothing I'm actually fearful of. Just a pure feeling of fear. This continues for weeks. Lack of sleep worsens. The moment I awaken, my heart is pounding and I'm taking huge breaths. I find if I jog, then the gasping for air isn't as severe. Jogging, of course, causes the heart rate to increase so my desperate hope is to somehow mask these unhealthy physical sensations with matching healthy ones. Several early mornings I found myself running around the block trying to drown out this new affliction. It's all bizarre and confusing. What is happening? What is causing this? What's next?
It was yet another Saturday afternoon. This one in April. It was unusually hot for that time of year. I was home with the family. Nothing planned for the day. Just home. Familiar surroundings. A stressless environment. By mid-afternoon I became voraciously thirsty. My thirst could not be quenched. My breathing was erratic. My heart was in overdrive. I'm overcome with fear. I have no control. It genuinely feels like an attack from the outside. I have this terrible urge to get out. To run. To flee. To breakaway. I grab a bottle of water and quickly leave the house and just run, run to nowhere. Just run. The run quickly erodes to a swift walk. Can't catch my breath. Can't quench my thirst.
A thirtysomething guy is walking in the opposite direction toward me. We acknowledge each other as we pass. An odd thought occurs to me that this guy has no concept of the internal crisis I'm experiencing at this very moment. I'm just a stranger walking down the street. No reason to think anything of me. For some reason I can't forget that moment whereas his memory of that instant most likely ceased to exist before it even began. I continue walking briskly—aware of how beautiful the day actually is but at the same time—under siege and the day is a horror.
I made my way back to the house but could not bear seeing my family and I didn't want them to see me. In a few weeks it will be my wife's birthday. She had asked for a beach cruiser bike. I had ordered it online and it sat boxed and unassembled in the garage. Upon entering the garage I saw it and immediately tore open the box with every intention of putting this thing together come hell or high water. I had to keep busy. I had to be distracted. During a full-blown panic attack I completely assembled a full sized adult beach cruiser bike. Drenched with sweat, I then went into the house to seek my wife where I told her what was happening to me. I was breathless and on the verge of tears and I'm sure I sounded like a crazy person to her. It was most likely very alarming for her. She wisely remembered I had a prescription for Xanax that a doctor had given me for sleep. I had no interest. She wanted me to take two. I compromised and took one. She sat me down in the back yard on a reclining chair and told me to relax, close my eyes. She had to leave for an errand but would be back shortly. In time, I eventually settled down and actually dozed a bit.
I would not wish this on my worst enemy. It was one of the worst states of mind I had ever experienced.
The anxiety has leveled off. Sometimes it returns briefly but not at the intensity it did that day. If I had to choose between depression and anxiety, I would choose depression without blinking. Anxiety is most likely a by product of depression. An evil henchman. I pray it never visits me again.
TMS
It sounded promising. A new treatment. A drug free treatment.
Recently approved by the FDA.
My psychiatrist handed me a mailer—addressed to her—from a local hospital. The photo showed a patient sitting in what looked like a dentist's chair. The header read: "For patients trapped by depression and its treatment side effects...Introducing the new way back to the true you™"
The true me.
The manufacturer of this 21st century marvel is Neurostar. Catchy.
Transcranial Magnetic Stimulation (TMS). An outpatient procedure that uses short electromagnetic pulses to stimulate the neurotransmitters in the area of the brain that controls moods, emotions and depression. The frontal left area to be more specific. An MRI scan is similar technology as it uses electromagnetic pulses that have a jackhammer-like quality.
TMS is a distant cousin to electroconvulsive therapy.
ECT.
Shock therapy lite.
The typical regimen is five sessions per week over a four to six week period. Each session is a little over half an hour. I skimmed the card she handed me and almost immediately dismissed its premise. I told her I'd consider it on down the road but wanted to look into it further. She admitted not knowing much about it herself but thought it might be a good option and I appreciated anything drug free.
Knowing that treatments like this are inexplicably expensive and also having experienced the hoop-jumping bureaucracy of insurance companies, I set it aside somewhere dreading the process this would entail and didn't even give it another thought. Not until my incident with a prescription drug she first gave me. (See "My sad, stupid Emsam story").
During my recovery from that drug I went back to that card she handed me. I looked up the website and ventured into the world of TMS. I watched YouTube videos, read blogs and newspaper articles both pro and con, etc. There were two facilities sort of nearby that offered this treatment. The mailer was promoting a high profile hospital to the east. The other was a smaller facility to the west. I randomly called the location to the west to get more information and to find out what sort of insurance nightmare I would have to endure to possibly "qualify" for this new treatment. I spoke to a nice lady, possibly a nurse who gleefully sang the praises of this wonderful new treatment. She told me she has gotten lumps in her throat and tears in her eyes from witnessing the amazing results. Of course my deflector shields immediately deploy when I hear such platitudes but at the same time a voice inside says maybe this is what you've been looking for. Maybe this is it. I then called the other facility and left a voicemail. The doctor that actually administers the treatment returned my call a couple of days later. He too told me of excellent results from a large percentage of patients. It made sense. Maybe my brain just needs a good ass-kicking. Maybe this is it.
The next step was to contact my medical insurance company to see if they even knew if this magical chair existed. As expected, I was ping ponged back and forth between departments, associates, supervisors and separate companies "carved out" of the main insurance company. Initially I was told there was no coverage. I continued to call knowing I would get a different person on the other end every time and was finally referred to the proper "carved out" service that was willing to take my "case." I came to find out later that I was the first patient that this insurance company attempted to cover for this newfangled treatment. No pressure. Each treatment was over $300. The initial consultation—over $600. Luckily my copay was $20 though that adds up quickly. Do the math. $20 x 5 days x 4-6 weeks plus the additional monies for gas to get there and back. Still not cheap.
The drive to the hospital was an average of 30-45 minutes depending on traffic. I went for the consultation and the doctor seemed confident that I would be a good candidate. There were several "authorizations" that had to be sorted through that took forever so treatments didn't start until weeks after the consultation. The waiting is the worst. Finally, months after I initiated everything, all the paperwork seemed to be in order and I was given the green light. I was quite surprised.
I'm a private person and don't choose to advertise that I'm clinically miserable to people that know me. Nobody at work knows I see shrinks and take meds though I'm sure they see a sad sack slumped in his chair daily and suspect he needs to be medicated. I put on my poker face every day hoping to disguise my anguish but I've been affectionately referred to as Eeyore at various times in my life so I'm not fooling anyone but myself.
In order to undergo this treatment I have no choice but to work half days for what could be a span of six weeks. Sorry, no nighttime appointments. I sat down with my bosses and concocted some half-truths about needing lots of time off for dental and doctor appointments because of my mishap. Told them my doctor wants me to attend a clinical trial on blood pressure at the hospital that could take weeks. My employers are great and I'm very grateful. They told me to do whatever I needed to do. I'm sorry I couldn't be more forthright with them.
From a handwritten log during treatment:
Day 1:
Pre-treatment apprehension. Irritable. Not thrilled with the impending daily inconvenience. Hopeful for relief soon. The waiting is cruel. During treatment doctor and assistant seem inexperienced with equipment. A bit bothersome. The first session involves customizing machine's settings and measuring my motor reflexes. The chair reclines into various positions for comfort. My head is nestled in a head rest and a strip of paper adhesive is applied around my forehead and affixed to the head rest to keep my head stable. Another cushion of some kind is positioned on the right side of my head for added stability. I'm offered earplugs in case the sound is too loud or disturbing. The chair is backed up to a wheeled console that has a vertical pole extending upward. On the rear of the pole is a pivoting arm that supports a large computer display. At the top is where the magnetic coil resides. The coil is a clamshell shaped apparatus that's applied to the left prefrontal cortex of the head. The supposed culprit area of my malady. Armrests provide added comfort. Some brief testing is done to pinpoint the exact positioning of the coil. I'm given several individual pulses to cause movement in my right thumb. After several tries, it does in fact twitch. All systems are go apparently. Intermittent jackhammering pulses that last around 10 seconds and recur every minute or so. On this first occasion I find the actual treatment itself to be physically uncomfortable, almost painful but bearable. I become headachy and foggy well into the session. The RN assistant seems caring and helpful. The doctor is soft spoken and professional although it's very apparent that this is all relatively new to them. To me too. Post treatment headache continues but dissipates during the drive home. I feel absolutely NO benefit but realize it's way too early to expect any positive change following one treatment but disappointed nonetheless. Headache returns in the evening. Feel restless and low. Hope for possible better results in subsequent treatments. Afraid this won't help.
Day 2:
Less nervous. Determining routine. No doctor this time. Different RN assistant. Very nice, helpful and informative. Procedure is less discomforting and less painful. No headache during or immediately after however a dull headache emerges around 10:00 pm and carries over into the next day. Gets worse as the day goes on.
Day 3:
Falling into routine now. Getting used to the treatment sensation. The original RN that worked with me on the first appointment is talkative and encouraging. No headache following this treatment. The RN tells me that the average time until possible benefits can be as little as two weeks. Two weeks. Seems impossible that decades of darkness can be suddenly illuminated in a two week period. I start to do ridiculous simple math in my head. Let's see......two weeks equals seven more treatments. Can that be? I'm hopeful but guarded. No improvement yet.
Day 4:
Getting comfortable with the routine. The goal is to reach and maintain the highest setting. Trying to be patient with the length of time this is going to take.
Day 5:
More routine. The machine is acting up but there's no interruption. Maxing out at the "120" setting. Hopeful that the maximum strength early on will hasten relief sooner. No benefit yet.
Day 6:
Appointment cut short because of machine malfunction. Irritated and disappointed. Headache from treatment that lasts all night. Just wanted to sleep. Feeling like a guinea pig. Technology is new and staff seem green with the protocol.
Day 7:
Appointment canceled due to machine being down. Becoming disenchanted. Delays drag the treatment time out even further. Wondering if interruptions are setting back any minor benefits back to square one. Depressed and irritable. The waiting game is so cruel. Just need elusive relief. Beginning to not care.
Day 8:
Drove all the way to the clinic only to find the appointment was canceled because machine was still down. Nobody notified me. Each thought the other had informed me. I knew this would happen. I should have called to verify. Felt numb. Disappointed. Angry. Afraid the delays are impeding any possible progress. Not a good day.
Day 9:
Machine fixed. Appointment is lengthy because of reconfiguring. Annoyed but glad it's up and running again. Trying so hard to be patient. The supposed two-week mark is the magic point when people detect positive change. My two-week point has been delayed.
Day 10:
Back to routine. Machine working fine. Back to maximum intensity setting. No benefit. No change. The normally stoic, business as usual receptionist in the lobby suddenly broke form and asked how long my treatment has been. Said she's noticed positive changes in people in two weeks—"big time." Nice to hear but so far not working for me in the least. I was surprised at the interest she seemed to have in me. I would watch her interaction with other patients— or lack thereof and was puzzled. She seemed to have a selective niceness to her.
Day 11:
Routine visit. Maximum intensity. Headache after treatment. Not much to report. Feeling futility. Long, daily trek there getting tiresome and costly. Very depressed and irritable in the evening. It's now the two-week mark. I'm doing yard work on a Sunday and feeling anger. Why have others reported relief at this point but not me? Maybe another week. Maybe not. I'm not sure I care.
Day 12:
Another routine visit. Receptionist asks if I'm feeling better but I shake my head. Maintaining that "120" maximum intensity. No post treatment headache this time. When will the positive results kick in? Several times I ask specifically what patients report who have found relief from TMS. Some say food tastes better. Music sounds better. Some say they feel a lifting of the depression itself. A liberating feeling. I long for all of this but wonder if it's even in my grasp. Only one patient had no success but he missed many appointments and had a bad attitude to begin with. I'm at least here everyday though my attitude is less than positive about this whole game I have to play.
Day 13-24:
Nothing to report. Going through the motions. Appointments are uneventful. It's quite obvious now it's not going to happen.
Day 25:
Sit down with the doctor discussing options. Says I'm a "late responder" but further treatments could still work for me as he's seen it happen with other patients. It's been five weeks now. They will request an additional week's authorization from the insurance company so I can go the full six week span. Today is Thursday. I have two more authorized appointments left unless I can get an additional week. I've gone this far, maybe one last week will do the trick. He also talks of trying different meds and of course he touts shock therapy which he is an advocate of. I take a wait-and-see stance. There are no words for my disillusionment.
Day 26:
It's a Friday. Another typical session. The RN informs me that the insurance company has declined any further treatments due to my lack of response. I have one more appointment on Monday but I've already decided it's over. The RN has disappointment in her eye and in her words. She is however extremely positive and tells me not to give up. Over the course of these treatments this nurse has given me "homework" assignments, recommended books to read and told me of her own battles with depression and the meds she's taken. She really wants me to go back on some sort of med even if it's just a low dose. At times I've felt she's decided she's my doctor and I'm her patient. She gives me one last pep talk and tells me to promise her that I'll show up Monday. I nod but we both know. I ask for a hug and it's done. On my way out I stop by the receptionist's window and thank her for her kind words and support. I can see she's slightly taken aback. That I would take the time to do such a thing. She wishes me luck and hopes I find something. I drive back home in a suspended state of numbness.
TMS has failed me. The realization in the following days causes me to tailspin even further. The irony. Now I'm worse. I may have to return to drugs. Tears every day. My wife tries to understand but is affected too much by my downtrodden behavior. A couple weeks after the final treatment she tells me that I'm not the same person she met 26 years ago and she's resentful. Feels ripped off. We both deserve a relationship that no longer exists. I have no answers for her. I'm at a complete loss for words or thoughts. I cannot control the tears. I want her to hold me. I want to hold her. But that's not how things play out. I tell her I have to go walk. I exit the house into the night and aimlessly wander into a nearby park where I collapse into a heap in the cool grass. I am completely and utterly gripped by pure despair.
So tired
The latter part of my childhood and all of my adulthood has been draped in a heavy, wet towel of sadness. I truly don't know why. Not a day goes by that I don't devote a thought to it.
A pity party that goes on and on and on.
Most of the therapists I've visited with have delivered the same message. YOU have to work to get out of this. But the reality is—I'm too tired. A certain amount of mental energy must be exerted to do battle. In depression's arsenal, its most effective strategy is to wear down its subject. This can only be accomplished with large amounts of time.
Months.
Years.
Decades.
I do realize the answer is within. It can only come from myself. But this heaviness has taken its toll and I find it daunting to muster the energy to fight. Each day, I'm just that more tired.
My sad, stupid Emsam story
What is Emsam? An antidepressant medication delivered via skin patch. The acronym Emsam is derived from the names Emily and Samuel. They are the children of Mel Sharoky, M.D., CEO of Emsam's manufacturer, Somerset Pharmaceuticals, Inc.
Cute huh?
It's a newer product on the market and at this point I'm willing to try most anything.
Over the years I've sought a wide variety of sources of treatment ranging from counseling to medications to "alternatives." I've been on the antidepressant roller coaster for decades. Each prescription only resulted in side effects and then withdrawal symptoms when switching to yet another med. Combinations and add-ons were tried as well but no benefit. Most of these antidepressants were of the SSRI family. My newest doctor decided to try the Emsam patch because I had never tried an MAOI inhibitor before. I was placed on the lowest dosage patch first (6mg). After about 8 weeks there was absolutely no effect, side or otherwise. The doctor and I mutually agreed to have me try the 12mg patch—the maximum dosage. There are dietary restrictions on this dosage but I was willing to work around them and it turned out not to be much of an issue. Unfortunately the problems began about 4 days into the higher dosage.
As a veteran of taking antidepressants, I am well familiar with coping with side effects and letting them run their course. I had no reason to feel Emsam's side effects should be treated any differently so I chose to ride them out just like all the previous meds. These side effects included slight dizziness, dull headaches, dry mouth and the main character of the story—head rushes.
On December 18, just days before Christmas, I stopped at a gas station on my way to work. I was leaning back against my SUV while waiting for the gas pump to finish. At that moment an intense head rush came over me. I could see white splotches of light, felt dizziness, etc. I instinctively put my head back and closed my eyes to ride it out.
Mistake.
I blacked out, rolled to my left and plunged off the end of the vehicle like a rag doll to the greasy concrete below—chin first. The impact immediately awoke me. As odd as it sounds I had a full awareness of what had just happened and knew just what to do. I got up quickly while spitting out pieces of broken teeth into my hand. There was nobody around so nobody came to my aid which was fine by me. I quickly replaced the gas nozzle and jumped in the vehicle. I reached for the pile of napkins I keep in my glove box and covered my mouth trying to minimize the bloody mess.
Dazed, shaken, yet surreally lucid at the same time, I managed to get myself to a nearby emergency room. I approached the lady behind the window with a wad of bloody napkins and gauze. I then uttered the following brilliant words— "I fell." Startled, she handed me paperwork to sign and I was quickly whisked off to an exam room. My blood pressure was taken and showed a perfectly normal reading. An x-ray revealed a fractured right jaw bone. I took three stitches to the chin. My front lower teeth were extremely loose and two top teeth were broken.
The cause of the head rush and subsequent blackout was due to an apparent sudden blood pressure PLUNGE that made me lose consciousness. Ironically the dietary restrictions of this drug are meant to prevent sudden blood pressure SPIKES caused by certain foods. Ironically I found myself on a different diet of soft foods for 4 to 6 weeks since I could not bite or chew. An oral surgeon had to grind the tops of the bottom teeth down so they wouldn't hit the top teeth when I closed my mouth and also bonded a wire to them to keep them stable. Further x-rays revealed another fracture in the lower jaw beneath those bottom teeth. Fortunately he felt my jaw would heal on its own without wiring me shut provided I don't bite or chew. If the jaw didn't heal properly it would have to be rebroken and consequently wired shut for an additional 6 weeks or even more. On top of everything else, ten days after the accident I began experiencing dizziness and vertigo. Yet another doctor said it may be an inner ear disturbance caused by the head injury.
This was all due to a side effect of the drug known as Emsam. An ANTI depressant. An expensive medication that's supposed to help one feel better.
Along with my struggle with depression and anxiety, I found myself facing a long haul of doctor, dental and oral surgeon appointments. The vertigo seems to be gone now but it may resurface in the future. My jaw and teeth, though healed, have not been the same since. My bite is misaligned and the only thing that can correct it is a minimum 18 months of wearing braces. This is not a financially feasible at this stage....so I wait. The load has now become that much more burdensome.
Somehow I managed to get through the holidays with a broken jaw and a limited menu of soft and liquid foods. As I look back on my long experience with antidepressants I have come to realize that they have never ever helped me out of this darkness. Ever. As a matter of fact, with their accompanying side effects, withdrawal symptoms, cost, dashed hopes, and this unfortunate Emsam induced accident, they have pushed me further into despair. A literal kick in the teeth.
The List
The following is a listing of antidepressants, homeopathic supplements, and alternative treatments that have failed to put a dent in this thing called depression.
1970s
Tricyclics (don't recall the names)
1980s
No prescription meds
1990s
Prozac
Zoloft (12 years)
Wellbutrin
Paxil
2005-present
Effexor
Lithium
Lamictal
Cymbalta
Trileptal
Risperdal
Ambien
Xanax
Seroquel
Klonopin
Deplin
Abilify
Lexapro
Emsam
Ritalin
Remeron
Cytomel (T3-thyroid hormone)
Aplenzin
Nuvigil
Viibryd
Pristique
Saphris
Ketamine
Brintillix
Fetzima
Trazadone
Homeopathic supplements
St. John's Wort
SAMe
5-HTP
DHEA
Melatonin
Valerian root
Amoryn
Fish oils (omega 3, 6, 9)
Magnesium
Selenium
L-tyrosine
Kava
Flaxseed
Chinese herbs
Vitamin B
Vitamin D
Vitamin E
GABA Complex
Tumeric
Niacin
"Alternative" treatments
Acupuncture
Meditation
Self help books
Magnetic therapy
Alpha-Stim
Exercise
Prayer
Neurofeedback (aka Biofeedback)
Hypnosis
EFT (Emotional Freedom Technique)
TMS (Transcranial Magnetic Stimulation)
TNS (Trigeminal Nerve Stimulation)
Massage
Therapy
One on one counseling
Group therapy
Cognitive therapy
Psychologists
Psychiatrists
A Marriage Counselor
Two Rabbis
A Pastor
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