It is difficult to describe, and for others to understand, what life is like when managing with depression. The thought of facing yet another day can be daunting. Mundane tasks seem impossible, and activities that were once enjoyable lose all appeal when you are depressed. Making the treacherous journey from the bed to the floor in the morning, or the afternoon becomes the most monumental task of the day.
Depression affects almost 15 million adults in the United States, a third of whom don’t receive treatment. Some lack insurance. Others don’t recognize depression as a mental disorder, thinking it’s a weakness or that it will simply go away. Friends and family sometimes make it worse while trying to help. ‘Cheer up. Life is good.’ Unfortunately, life is not very good for people who struggle with depressive illness. They can’t just cheer up. Fortunately, it’s often caused by a chemical imbalance in the brain that can be corrected. And, that’s where Transcranial Magnetic Stimulation comes in, stimulating neurons to help the brain naturally correct that chemical imbalance.
It’s normal to feel down once in a while, but if you are consistently sad and it affects your daily life, you may suffer from depression.
- Major Depressive Disorder (MDD) is episodic in nature, lasting at least two weeks and can include a single episode or multiple events.
- Persistent Depressive Disorder is a continuous depression that varies in severity.
- Bipolar Disorder consists of severe depressive lows, and extreme manic highs that can include anxiety, racing thoughts, and high-risk behavior.
Other forms of depression also include Psychotic Depression (combined with psychosis, can include delusions and hallucinations), Postpartum Depression (occurs after women give birth and severely affects 10-15% of mothers) and Seasonal Affective Disorder (SAD) which typically occurs in winter.
If you think you might suffer from depression, or are having difficulty managing depression, check with your doctor or give us a call for a consultation at 877-447-6503.
If you need immediate help, please call 911. To talk with a crisis worker now, call the National Suicide Prevention Lifeline at 800-273-8255.
There are many different factors that contribute to depression. Women are nearly twice as likely as men to be depressed.
This may be due, in part, to the fact that men are typically more reluctant to report depression in the first place. The illness strikes people of all races, ethnicities, income levels and age. Teens have become especially susceptible, as suicide is now the third-leading cause of death for people between the ages of 15 and 24 years.
Distressing past events that may contribute to depression and anxiety include past physical, sexual, and/or emotional abuse as well as other traumatic events. Long-term difficulties contribute, such as family conflict or being raised in a home where there was an addiction, mental or physical illness and/or neglect.
Life-changing events, both positive and negative, can cause distress. Changes like starting a new job, moving, marriage, having children and retirement can sometimes be disruptive and make it difficult to adjust. Losses such as death, divorce or isolation are very trying.
Ongoing illnesses which may seem strictly physical can easily cause depression, especially if someone is bedridden for a length of time.
Certain medications unrelated to mood disorders may include depression as a side effect. Even antidepressants can occasionally make matters worse, sometimes contributing to suicidal thoughts, especially with teenagers.
Genetic and biological factors also contribute. Several areas of the brain are likely involved, including the misfiring of some neurotransmitters linked to mood. We know that mental distress sometimes runs in families. Children, siblings, and parents of people with severe depression are more likely to suffer from depression than members of the general population.
For women, reproduction and hormonal changes are key factors in mood shifts. During the menstrual cycle, changes can include depressed feelings and emotional disruption. Pregnancy creates many hormonal changes that can affect mood.
Age is another contributor. Children and teens all have mood swings, but for some, they can be severe. Getting professional help is important, especially since suicide is becoming a greater threat. Seniors are also prone to depression, which proper treatment can often alleviate.
- Pervasive sense of sadness and hopelessness
- Sleep disturbances- either insomnia or sleeping in excess
- Changes in eating habits, resulting in weight gain or loss
- Fatigue and lethargy
- Loss of interest in activities once enjoyed
- Irritability, anger, and agitated states
- Suicide ideation and preoccupation with death
Below is a more detailed description of the types of depression people struggle with:
Major Depressive Disorder (MDD)
Also known as clinical depression, this is the most common type. MDD can occur in episodes that last at least two weeks or much longer – months or even years, and it is frequently accompanied by anxiety. Fortunately, TMS therapy is able to help alleviate both anxiety and depression.
Persistent Depressive Disorder (PDD)
PDD is also called dysthymia or chronic depression. Rather than being episodic in nature, it is continuous but usually less severe than episodes of MDD. However, these two types are not always distinguishable. Many people suffer from an overall low mood and lack of interest in activities that were once enjoyed. Many tasks, including daily work assignments, can become difficult to perform and complete. Since PDD and MDD can be difficult to distinguish, some people previously diagnosed with PDD can, later on, be diagnosed with MDD. It is important to check with your doctor, or to seek a second opinion, to determine the best course of treatment for your type of depression.
For years, this was more commonly known as manic depression or manic depressive illness. That’s because it consists of two mood states, mania, and depression. Symptoms are typically quite severe in both categories and are not to be confused with typical mood swings many people experience. Bipolar disorder includes extreme lows with difficulty or inability to function, as well as extreme highs with racing thoughts or high-risk behavior. There are different forms of Bipolar Disorder:
- Bipolar I—includes manic or mixed states (depression and mania together) lasting at least 7 days, and depressive episodes that occur for 2 weeks or more.
- Bipolar II—consists of what is called hypomania, episodes that are not as extreme as full-blown mania. Also, includes depressive episodes
- Bipolar Disorder Not Otherwise Specified (BP-NOS)–symptoms include mania and depression but are not as extreme or do not meet the criteria for Bipolar I or II
- Cyclothymic Disorder—episodes of hypomania and mild depression that last for at least two years, with milder symptoms than those listed above
- Rapid-Cycling Bipolar Disorder—typically seen in people who have an earlier onset of bipolar disorder, sometimes mid to late teens, with episodes that quickly switch between mania and depression or both at the same time
Much more is being discovered with regard to postpartum depression. It affects between 10 and 15% of new mothers, after they give birth, and can be quite severe. Sometimes this problem is compounded by the fact that they were on antidepressants and needed to quit taking them before getting pregnant. Prior depression combined with the hormonal changes during and after pregnancy, the stress involved, and the lack of sleep create a difficult scenario. This is one of the great benefits of TMS. If a woman already struggles with depression and wishes to have a child, she can undergo TMS therapy to ease or alleviate her depression before, during, and after pregnancy, including through breastfeeding when medications are not safe.
Also called depressive psychosis, it combines a major depressive episode (MDD or bipolar) with psychotic symptoms. The psychotic symptoms consist of delusions and/or hallucinations. Delusions include themes such as guilt, shame, punishment, and low self-esteem. The hallucinations are typically auditory, visual, olfactory, or tactile (involve the sense of touch).
Seasonal Affective Disorder (SAD)
SAD typically occurs during the winter months when there is less sunlight. A less common form of SAD starts in late spring or early summer and dissipates in the fall. People are affected during this same time of the year, each year. The causes of this are still uncertain.
Depressive illness can be devastating. Thankfully, it is also treatable. Recognizing it is the first step, and it is important to have an evaluation performed by a trained psychologist or psychiatrist. A variety of treatment options are available.
These include antidepressants, mood stabilizers, and antipsychotic medications. Antidepressants are most commonly used and include two different classes—SSRIs and SNRIs. Selective serotonin reuptake inhibitors (SSRIs) include medications such as Paxil (paroxetine), Prozac (fluoxetine), Lexapro ( escitalopram), Zoloft (sertraline) and Celexa (citalopram). Side effects often include intestinal troubles, sexual problems, weight gain, and headaches. Serotonin and norepinephrine reuptake inhibitors (SNRIs) include Effexor (venlafaxine), Cymbalta (duloxetine), and Pristiq or Khedezla (desvenlafaxine). Side effects are similar to those of SSRIs.
Professional therapy and counseling are offered by a variety of people including counselors, therapists, and psychologists. The most common forms of therapy for depressive illness are cognitive behavioral, family or systems focused, and interpersonal therapy. A psychiatrist can offer some psychotherapy but specializes in prescribing proper medications and treatment plans such as TMS or ECT.
Electroconvulsive Therapy (ECT)
ECT sends electric currents through the brain in order to trigger short seizures. It causes changes in brain chemistry that help alleviate mental illnesses. Like TMS, it often works when other treatments have failed. However, unlike TMS, it is invasive. General anesthesia must be used, along with electrodes attached to the scalp. In most cases, there is confusion and memory loss. Treatment is typically administered three times a week for two to four weeks.
Transcranial Magnetic Therapy (TMS)
Similar to ECT with regard to effectiveness, but nothing like it when it comes to side effects, TMS therapy for depression is much milder and performed in the doctor’s office. Anesthesia is not needed because very little discomfort is involved. The gentle magnetic pulses are similar in strength to an MRI, and unlike ECT, TMS does not trigger short seizures.
Additional Treatments and Therapies
Self-management strategies are important to implement when possible. Exercise and proper nutrition are key factors in overall mental as well as physical health. Also, mind/body/spirit approaches such as meditation, faith, and prayer can be important. Acupuncture and holistic treatment are helpful for some.
The future for the treatment of depressive illness is much more positive, thanks to TMS.
For the more than 4 million people who have not found relief through medication, they can now turn to TMS as a safe, effective solution.
The mild magnetic pulses are thought to increase the levels of neurotransmitters in areas of the brain that are dormant during depression. So, rather than adding medication to a problem with brain functioning, TMS helps restore the functioning itself. Hence, it is a more natural solution than most.
TMS therapy is not only effective but also the least intrusive treatment for depression with the fewest side effects. TMS is performed on an outpatient basis in a comfortable setting. After the doctor determines the proper position and strength for the TMS pulses, called mapping, a technician takes over and monitors the treatment. Each session delivers the same number and strength of pulses and is sometimes increased later on. If you are being treated for depression and anxiety, the position of the apparatus is different. You can receive treatment for both in each therapy session, within an hour. There are 5 sessions per week for 6 weeks.
The FDA has cleared TMS treatment for patients suffering from Major Depression who have not been helped by antidepressants. Insurance will often cover therapy for those patients who have tried 4 different antidepressants and 3 augmentations without success.
Within California* and Oregon, Transcranial Magnetic Stimulation has been approved for use with treatment resistant depression by several insurance providers. Insurances that we’re in network with include Optum, Magellan, Anthem Blue Cross, Cigna, Aetna, Regence and Tricare. We also have single case agreements with MHN. Please call us for a full list of providers. We would be happy to help check with your insurance regarding pre-approval.
*Unfortunately, Medi-cal currently does not cover TMS treatment in California. Please contact your Medi-cal provider to inquire further.