Depression: When the fog returns

In December of 2014, I wrote an article, Out of the Fog, which could be my most widely read piece for the Los Angeles Post-Examiner.  In it, I wrote to commemorate the one-year anniversary of my head finally clearing itself from a lifelong battle with depression. A year earlier, I began a new antidepressant, Cymbalta, that allowed me to experience life with a clarity never felt before.

Depression is an ugly disease. It comes in so many forms and no two people react the same to the drugs used to knock it out. All my previous attempts failed. At their best, they left me feeling flat and without any emotions, good or bad. At their worst, they left me feeling like a zombie.

By the time I began Cymbalta, I knew there would never be any more of the lows I was just coming out of. I could not put the people I loved through another one and I could not drum up the energy to fake my way through life.

One of the ugly things about depression is it comes with other problems. Anxiety, chronic pain, PTSD are just some. The complexities of all these problems makes it difficult to know which issue came first and which one needs the greatest attention.

I hit a trifecta when it comes to depression. Through talk therapy, I learned I was born depressed. While I was an easy baby for my mom to care for, it was pointed out it is not common for a baby to want to be left alone in a crib when he has five older siblings. Apparently, I was one of those babies. In fact, by the time there were ten people living in our family, I was well aware of my desire to just want to be left alone.

Another type of depression I suffer from is situational depression. I am bothered by the events that go on in the world and have a hard time letting go of them. It can be triggered by major things like a pandemic or riots, lesser things like issues at work or home, and seemingly minor things like being laid up with a small injury and being unable to work out.

My third type of depression is Seasonal Affect Disorder, SAD, and hits when the daylight hours get shorter. By the time I hit rock bottom in the fall of 2013, I was getting slammed by all three forms. On top of my depression was the incessant pain I experienced all day long from surviving an accident I was told I had no business surviving. With that came the PTSD, often in the form of nightmares where I was left to relive it night after night. Topping it all off was a job that was no longer enjoyable and a marriage on the brink of ending.

Cymbalta brought me more than just relief. It gave me clarity over the events of my life and how I had arrived to where I was.  I was finally able to understand my disease and no longer ashamed of it. Not only did I know myself better, I knew what I wanted down the road.

One of the problems with an antidepressant is like many other drugs, you build up a tolerance to it and it loses its effectiveness.  A couple of years ago my dose was increased when I mentioned to my doctor I felt I was feeling a bit flat inside.  Then last fall, the flatness returned and I noticed it was slowly increasing.  Along with the drug’s increasing ineffectiveness, I was struggling with my chronic pain and its accompanying fatigue.  My upper body strength was disappearing from the nerve damage I have and none of my non drug treatments were working. I relied more on my pain medications just to maintain some level of comfort and by the end of November, I was no longer able to work.

By the time COVID-19 hit and we began sheltering at home, I was already doing so for three months. When the order to shelter in place came down, I was forced to stop some new treatments that were helping my pain, especially acupuncture. I also decided to put on hold a revolutionary new treatment plan until I felt more comfortable being in public every day.

Two weeks ago, I began this new treatment. It is called Transcranial Magnetic Stimulation, TMS, and it requires I receive daily treatments five days a week for two months. It is the first real non drug treatment for depression to come along and if it works to its fullest, I may be able to stop taking an antidepressant. At the very least, it will help the one I use to become more effective.

Each day, I put a cap on my head that has been specially fitted to me and marked with specific locations for parts of my brain. Once it is in place and measured three times for fit, I am reclined in a chair while a large magnet is placed on my head and aimed at the specific brain locations. The machine is then turned on and I receive twenty magnetic pulses, each lasting two seconds with about a five second break in between. With each pulse comes a feeling of a small electrical zap that runs from just above my left eyebrow and up about three inches past the top of my forehead.

Each pulse is stimulating the part of my brain that fails to release the dopamine people without depression get from day to day activities. After each session, the portion stimulated has been done so between three and five thousand times. When my eight weeks are up, it will have received close to 150,000 stimulations which will result in new nerve growth that should lead to the brain remembering how to release normal amounts of dopamine, something it has long forgotten how to do.

The entire process is less than five minutes and from the time I get out of my car to the time I am back in it is usually less than ten minutes. It is entirely painless and carries no side effects (30 percent of TMS patients will feel a slight headache for the first week or two and nothing else). Compared to the long list of potential side effects from antidepressants, TMS offers people like me a non-drug treatment option to help us overcome an illness no one used to want to talk about.

TMS is also used to treat other problems like anxiety, PTSD, chronic pain, autism, Asperger’s, and Parkinson’s. It may even help slow the progress of Alzheimer’s and other forms of dementia.

For someone like me who struggled to find the right drug only to build up a resistance to it, TMS offers hope. The fog that comes with depression can suck the life out of sufferers. It results in too many suicides, drug abuse, and prevents individuals from maximizing their lives. TMS is not a cure all and doctors will tell you there are no guarantees with it. However, the one thing that is certain is the thought of falling back into a life that cycles between limited ups and far too many downs scares the crap out of folks like me. TMS is worth the gamble.

There should be noticeable improvement in how I feel in another week or two. Perhaps if my brain starts releasing normal amounts of dopamine the pain will decrease. Maybe then there will be a return of energy that lets me go back to working again and feeling as if I have a road in front of me worth traveling down instead of one that requires I hold back and patiently wait for things to improve.

This is a strange time we are all living in. Hope seems to have been replaced by chaos and uncertainty. In that sense, welcome to the world of the depressed. However, for most people, this has been a new feeling and one that is only a few months old. It will end and we will rise as a nation to a better life.

However, for those with depression, if not properly treated, their lives will not improve. Life is a battle, one where the depressed are left to look in the rear view mirror at all times. TMS gives us the hope we can put the past behind us once and for all and join the rest of you and look forward to what lies ahead.

Top photo by Tim Forkes