“I wonder if TMS could help my daughter Sarah, who is dismally depressed. My sister emailed me an article about TMS and I wonder if it would help Sarah. She just graduated from high school in May. Sarah still lives at home, so I know that just about all she did this summer was lay around, tablet in hand. She has no energy and rarely went out with friends – which is just not like her. It was a real struggle to get her to enroll at the community college this fall. It’s a great school with excellent programs, but she is SO ‘down’. Sarah doesn’t want to do much of anything. She cries a lot and says, “I just want to feel like ME again!” Even though it’s frustrating at times, my heart goes out to her. I wish that this would be an exciting time for her, because she really has the whole world in front of her. We’ve tried counselling, but that didn’t seem to help. She doesn’t want to talk about it. Do you think TMS could help Sarah? Who qualifies for TMS treatment?”
– Jeanni (Sarah’s mother)
IF Sarah qualifies for TMS treatment, my first reaction is that the odds of successfully helping her with TMS are in her favor. In order to find out if she qualifies, a physician who is knowledgeable about TMS needs to evaluate her situation, symptoms, and medical history. But not everyone qualifies, and I’ll go into that in more detail a little later on.
Please keep in mind that both depression symptoms and TMS treatment are different for everyone. I’ve never met Sarah, but many of my patients have had experiences similar to Sarah’s. So we can discuss it from that perspective.
Let’s look at TMS first. At Nashville TMS, we feel confident that we’ve had enough treatment experience to discuss what we’ve seen, and what has worked. At the date of this writing, we’ve treated more than 220 patients over the last five years. That’s about 5500 individual treatments. So now we know from experience that TMS treatment has an excellent success rate.
Over 75% of our patients have responded to their course of TMS treatment. Meaning, their major depressive symptoms have either dramatically improved or they no longer experience those feelings of depression. To determine whether or not TMS can help your daughter Sarah, we’ll first consider a few basics.
What are the guidelines to ‘qualify’ for TMS treatment?
Three fundamentals must be met in order to qualify for TMS treatment:
- Patients must be at least 18 years old. While FDA clinical trials and research on patients under the age of 18 have reported positive results, there is no study on the long term effects of ‘TMS and the developing brain’. Most physicians recommend that qualifying patients be over the age of 18.
- Patients must be diagnosed with Major Depressive Disorder (MDD). Because the FDA protocols have cleared only patients with MDD, the clinical guidelines to qualify for TMS treatment include only those patients with MDD. ‘Major Depressive Disorder’ is also called ‘Depression’, and is a severe form.
- Patients must be ‘treatment resistant’. This means that the patient has unsuccessfully tried other treatments for their MDD, but those treatments were determined ineffective; they did not achieve satisfactory improvement, and/or the patient could not tolerate the side effects. Many insurance policy coverage definitions of ‘treatment resistance’ vary widely, so pay close attention to their definition if you are relying on your coverage to pay for TMS treatment.
Sarah is 18, so she meets that guideline, but what is a ‘Major Depressive Disorder’?
As I mentioned earlier, it’s up to Sarah’s physician to establish her diagnosis. However, the FDA offers this description of Depression; “Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness.”
The FDA also offers this description of ‘Major Depression’; “…severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.”
How will Sarah’s physician determine whether or not it’s a serious, or ‘Major’ Depressive Disorder, and make that diagnosis?
Consider this list of signs and symptoms of a Major Depressive Disorder. Someone who might qualify does not necessarily have all of them. A diagnosis may be made when the patient experiences several of them that persist and/or are particularly distressing:
- Persistent sad, anxious, or “empty” feelings
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Irritability, restlessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Fatigue and decreased energy
- Difficulty concentrating, remembering details, and making decisions
- Insomnia, early-morning wakefulness, or excessive sleeping
- Overeating, or appetite loss
- Thoughts of suicide, suicide attempts
- Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.
This list looks a bit overwhelming. But the success rates you mentioned are very encouraging. What are the next steps?
The good news is this quote from the (very conservative) FDA; “Depression, even the most severe cases, can be effectively treated. The earlier that treatment can begin, the more effective it is.”
Consider taking Sarah to her pediatrician, if that is the physician who knows her best. With this list of signs and symptoms, she may find it easier to talk about her current difficulties. You can request a diagnosis, and discuss the steps that will help Sarah get back onto the road to greater happiness. It’s also important to ask about your physician’s experience with, or understanding of TMS.
Have you shared articles about depression (or TMS) with a family member or a friend? If so, tell us about your experience. Was it positive? Was it difficult? What did you learn?