Zap Kat: Information Sheets

Zap Kat: The Interview

I called CAMH and they set up a meeting within a few days.  For the first time in a while I found myself downtown again, fighting off my sleepyness and anxiety while I holed up in the library across the street.  Eventually the appointment time came and I met up with one of the research analysts.  It was fairly straightforward, she checked some questions like:

• Are you right or left handed?  (They're using right-handed individuals for this study.)
• Have you ever had a seizure?  (TMS does involve some increased risk of seizure for people who have already had one)
• Is there anything implanted in your body, especially your brain?
• Have you tried other methods for relieving your depression without satisfactory results?

I filled out an information sheet and consent form and she proceeded to the HAM-D. 

The Hamilton Depression Rating Scale is a widely used questionnaire to determine the level of pathology and existence of depressive disorders.  It is used in a great majority of the TMS literature I've read, so I consider it somewhat like using standard units of measurement.  This way data from various studies can be correlated because they use the same measurement scale for depression. 

Check out a sample HAM-D form by clicking here.

As with most intake sessions, it was a little awkward to answer such personal questions with a total stranger, but you gotta do what you gotta do.

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.