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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