Introducing Zap Kat: An Ongoing Peek into the rTMS Protocol

After my recent relapse in August I went through the usual "tweaking" of my medications.  Up a bit on this, down on that, try a combination of this and that. 

This and that is not sufficient when one has encountered increasingly intense hyper-somnolence, paralyzing anxiety, depression sinking to the bottom of the barrel, not to mention a very promising new start at school going down the drain.    

It was a while after my worker and doctor came back before I was able to start looking at other options.  I had spiraled pretty far down.  Eventually I started looking up the recruiting pages of all the local research hospitals.  At the same time, I compiled a list of all the psych meds I could find.  The Centre for Addiction and Mental Health is Canada's largest psychiatric research hospital, so I was not surprised to find them recruiting participants for a study in rTMS.

What is rTMS?
rTMS is an acronym for repetitive transcranial magnetic stimulation.  It is a (relatively) new treatment for treatment resistant depression.  After carefully mapping your brain and marking the targeted area a magnetic coil is positioned over it to fire.  The coil has a strong magnetic field that creates an electrical current in the brain.  It's transcranial nature means that your skull and hair stay intact throughout the process.  Repetitive TMS uses multiple pulses over a longer period of time, (several weeks plus maintenance treatment) than just TMS.
rTMS, ECT, DBT, what's the difference?
ECT is electroconvulsive therapy, widely viewed as a dangerous, violent procedure.  In truth it is well regulated, patients receive sedation before the treatment and it is highly effective in treating refractory depression, but there is still a significant chance of memory loss.  DBT is a new procedure that involves threading wires into the brain and implanting a pack into the patients chest to provide constant electrical stimulation.  rTMS, and TMS are by far the least invasive of these treatments as they require no sedation or surgery however like DBS it is still in the testing phase.
rTMS Basics
In this study, rTMS is applied once a day, every weekday for three to nine weeks.  (Nine weeks if you should get the placebo first and not respond to it.)  If it is beneficial with you, they will provide a years worth of weekly maintenance treatments.  The treatments take about 30 minutes, where you lie in a fully reclined squooshy chair with the magnetic coil positioned carefully over your head.  You can read or sleep or even knit during the treatment.  With each pulse is a loud snap, like a large rubber band or a stick of wood snapping.  You feel something similar on your head, like the rubber band is snapping against your skull or at worst, like a drummer is using your skull to replace their snare drum.  They offered me earplugs, but it makes me feel like I`m an in an underwater sea world so I think I`ll skip them.
What are we learning?
The study I'm in seeks to explore three variables:
1.  Whether one-sided or two-sided rTMS is more effective
2.  To find out if using a more precise method of finding the stimulation area is more effective
3.  To understand the brain mechanisms involved in treatment depressive symptoms
I'm getting bilateral, (two sided) treatment.  One side has a steady pulse for about 140 beats and then a rest, the other is a much quicker firecracker-like group of pulses with much longer rests in between.

Fighting the Relapse Beast

Part of why it's so difficult for me when people say that I'll get better and I'll be so close to remission again is because I was so close. I was about to rock a college certificate, I had proved to myself that I was ready for university, but it all came crashing down two weeks before I would have finished that achievement. It just makes me think that there's no point to moving forward from this because I'll have another relapse and become completely capable of anything again. And when that's over, I'll have to start all over again.

Life isn't linear, it's not like once you've failed college you can't go back and try, but it does go on despite whatever is happening in your life. I can work so hard and not really get significantly better and time is going to keep on passing. I'm never going to catch up to my age mates in the rat race and that's something I think I'll feel badly about for a long time. They have had so many different experiences while I am having a completely different one that really gets me nowhere in the calculation of success. I haven't completed any level of education past grade 10, I haven't lived away from home, I haven't dated, all because of this damn illness that's going to dog me forever. There is no cure for depression. I can deal, I deal with my anxieties and my OCD, but to be completely honest that's not the life I want. I don't want to deal, I don't want to be afraid that the next week somethings going to conk out and my life is going to grind to a halt again for reasons that I can't really explain. This summer everything stopped because I was exhausted, and that led to a million other things. Next time maybe it'll be the anxiety which will lead to the other things. The uncertainty of not knowing when or if a relapse is going to strike bothers me quite a bit.

My urgency to find something now is because I know with my history it's most likely that I'll have more relapses throughout my life. I've been so close to the edge this time that if I were to get that close again I don't think I would have the strength to fight it, and with that experiences I`ve gathered of the adult mental health system there are strong barriers to seeking help for it. You don't know...even when you've experienced it, once you're healthy and you're part of the world again you always think it's not going to be that bad. Next time you'll be stronger because you have the perspective of having been healthy. It doesn't work like that. Once it's back, you're in it. It's all consuming, overwhelming, there is no thought that doesn't lead back to it. If I don't find something that will work now and in the future, I'll die because that's just how strong my episodes are. I truly don`t know if I can face more jagged edges like that and come back from it. It`s taken a lot to be at a place where I want to come back. Even now I`m extremely hesitant, I can`t see a future for me that I want to live through.

Depression and Work

I'm not at work today. I'm not picking up Pau's fantastic wrappingness, I'm not serving customers, I'm not filling box cards.

I can't.

And my parents, and Janice, don't believe this is real. I know it's frustrating to have calls coming about me saying I can't work, usually with less than 24h notice. Or even 1h notice. But this is the face of my illness. This is the compromise you make by hiring me, someone who is dedicated even with a job I hate, who will keep on answering, "Are you charging Canadian or American prices?" without swearing at customers, who will spend her break working because there's only one girl on the floor and it's busy.

I know, I know I shouldn't say this, but I wish this had been an illness that people could see, or measure. Something that didn't come with stigma attached.