i spent nearly two decades of my life severely depressed and suicidal and for so long i believed wholeheartedly that it was my fault. i believed that the reason no medication or therapy had ever worked for my depression was because i wasn’t ACTUALLY depressed— i believed i was just lazy, bad, manipulative, and just using depression as an excuse for the inherent badness i thought was inside me. this was a story that was told to me and reinforced over and over again by treatment providers.
this past summer, i tried my 30th+ psychiatric medication, not expecting to see any results. the day i realized it was working was the day i realized that i was…planning my future???suddenly i no longer wanted to stay in bed all day and never go outside. i no longer wanted to isolate. i wanted to see people, talk to people! i started spending more time with friends and facetiming people and talking on the phone, things that i rarely did in the past. when i had been depressed, the only movies/tv shows i could focus on were super intense, fast paced, and scary or disturbing because that was the only way to hold my attention. after starting this medication, i started enjoying SITCOMS! i no longer felt like i was fighting to just get through every single day of my life.
there was such a clear and measurable difference in the quality of my life that i started to question why i believed that my depression had been my fault. it became very clear to me that a large part of my depression had been biological. i had not been lazy or bad. i had been sick. my brain was sick the same way other organs get sick sometimes. this brought up a lot of grief for me— grief for all the lost time that i’d spent trying to find something that worked, grief for how much pain i had been in for so long. but it also brought up sheer FURY at all of the therapists and psychiatrists who had treated me like i just wasn’t trying hard enough to get better.
i had been labeled treatment resistant, of course, and the only recommendations i had received after being given that label were TMS, Ketamine, and ECT. once i had tried all three with no success, i believed i was just a lost cause. i thought i was out of options. i was made to feel that way by so many treatment professionals. i was told that nothing was working because of my complex trauma and that once i healed from that then i would stop being depressed (as if it’s that easy to just fully recover from CPTSD!) i was told that i just needed to do more DBT, i just needed to live and breathe DBT skills and then i would get better, even though i’d done intensive DBT programs for years with no improvement to my depression. (yes, it helped me to change my behavior and quit self harm, but behavior change isn’t necessarily indicative of a change in mood. i could do all the right things all the time and still be in excruciating mental pain.)
i was told that i just wasn’t trying hard enough, or that i must have a personality disorder, or that i just needed to exercise more, or eat less, or eat MORE, or eat differently, or get a job, or get a dog, or do yoga, or acupuncture, or biofeedback, or find purpose in my life— psychiatrist after psychiatrist looked for something to blame everywhere but in the mirror. instead of admitting that they weren’t equipped to help me, they made me believe that it was MY fault i wasn’t getting better. and i believed them. for SO long, i believed them.
and now after finding a medication that works for me, i see everything so much more clearly. psychiatrists need to put their enormous egos aside and actually treat patients with treatment resistant depression instead of blaming us for suffering from a (partially at least) biological illness. if you’re a doctor and you know that a patients illness is outside of the scope of your abilities, either do more research and get more training to help them or refer them to someone who specializes in what they need. don’t keep them around letting them pay you thousands of dollars while you make them try the same thing over and over and over again and expect to get a different result. people act like things like ECT are a last resort option, and in doing so make people believe that if it doesn’t help then you’re out of options. but nobody ever tried me on tricyclics. nobody tried me on MAOIs. nobody told me about how some dopamine agonists like Pramipexole have had some success in treating treatment resident depression. instead i was made to feel like asking to not be suicidal daily was asking for too much. if you’re a clinician who thinks that’s asking for too much, you’re in the wrong profession. we can do better than that. we NEED to do better than that.
in my experience, out of every profession, doctors have some of the biggest egos i’ve ever seen. i say this as someone who is both mentally ill as well as physically disabled. many doctors HATE it when you do your own research. they HATE it when you have suggestions, or when you ask for what you need. it’s almost as if they feel threatened by it, like they need to believe that they are superior to their patients because of how much time and money and energy they put into going to med school— they need to believe they hate their hard work was worth it so they have a tendency to dismiss any ideas their patients might have. i don’t care how many years you’ve been in school. you do not get to tell your sick patients that it’s their fault they’re sick to justify your laziness and refusal to learn new things. put away your god complex and actually listen to your patients.
and the strangest part to me is that the longer you have been suicidal for, the less seriously they take it. the same way that the more chronically ill you are the less people believe you. it’s bizarre— when people see pain that is beyond what they can fathom, instead of feeling empathy, they tell you you must be faking it or that you must be looking for attention. i’ll never understand this. it’s as if they think that suicidality doesn’t need to be taken seriously unless the patient has successfully completed suicide. and i think it’s very clear how that logic is flawed. i was treated like i just wanted attention whenever i asked for help with my chronic suicidality and it made me terrified to ask for help with ANYTHING. i still constantly am afraid that if i’m too honest with clinicians then they’ll think i just want attention. attention isn’t a bad thing to want, all human beings need some degree of attention, but regardless that doesn’t negate the severity of a person’s suicidality. i wasn’t attention seeking by asking for help. i was STRONG. i was really fucking strong, far stronger than i should’ve had to be. i fought for my life every single day and i am lucky to still be here but it’s not luck that got me here. it’s ME that got me here.
i don’t want to make it sound like i speak for everyone who has suffered from TRD, because i don’t think that would be fair. i can’t tell you if there’s a med out there that’ll work for you. all i can tell you is that most psychiatrists prematurely tell chronically suicidal patients that there is nothing they can do to help them or that they’re out of medication options. if you’re a psychiatrist or doctor and you feel yourself getting defensive while reading this, i invite you to get curious about where that activation is coming from.
and if you are someone with treatment resident depression or chronic suicidality reading this, i am telling you now: your illness is not your fault. i don’t know if it’s going to get better or not, but i can promise you— it is not your fault and it never has been.
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ok i wouldn't normally make a post about mental health in the tags for people to actually see, but if you're considering TMS (transcranial magnetic stimulation) because you're at the end of your rope, do it.
(obviously consult with your psych, ****I am not your doctor****)
very long commentary + procedure explanation below.
cw for bad mental health, depression, suicidal ideation, eating disorder mention (no details, as triggering as this cw tag)
for background, I have had extremely severe depression my entire life, hand-in-hand with suicidal ideation, a severe lifelong eating disorder, ocd, adhd, anxiety, the works. depression, anxiety, and ocd runs in my family, and my family life has historically been incredibly toxic if not outright abusive, as well as having been in abusive romantic/sexual relationships.
i have been on a number of different medications (from SSRIs, SNRIs, anti-psychotics, etc.) with very little success. i have been in various higher levels of care for months at a time. i have tried (medically administered) ketamine. nothing has made a dent.
very recently, i had a severe episode where i was basically bed ridden for six months. it got to the point where my two different therapists, psych, and dietician were all separately recommending a higher level of care. if you're anything like me, you can't afford that shit, let alone taking weeks at a time off from work.
all that to say, ya girl has Been Depressed.
tms was basically a last ditch effort before I would have to do residential, and i didn't want to do that again, only in part because of the aforementioned reasons.
it's not magic. i'm going to say that right away. it's absolutely not going to magically make you happy.
i've been going 5x a week for 6 weeks (none on weekends), and it takes about 30 minutes to do two different stimulations — depression (20 minutes) and ocd (10 minutes). this is my specific regimen, yours might be different. after the 6 weeks and weekly evaluations, I'm tapering down to 3x a week, then 2x a week for 2 weeks (total of 37 sessions). my provider would like me to do 44 sessions total (as opposed to standard 37) but i guess health insurance doesn't always cover the additional sessions, so we're waiting to hear back.
when i started, my evaluation levels were in the 60s. now they're in the 30s. they think they can get me to the teens. i'm already feeling so much relief, i don't know how they think I can feel any better, honestly. my provider used the Beck Depression Inventory, which I just looked up — I am still considered to have severe depression with my score in the 30s, but by god, cutting in half from the 60s? genuinely life changing.
basically, they test your brain regions (and you can get a brain scan for an additional cost and more accurate treatment, but I opted not to) by lightly zapping different regions of your brain to see how your toes and then your fingers twitch. i don't know how it works, but it's how they determine what voltage to use and what areas need stimulation. you're wearing a personal cloth cap with a grid on it to guide them, and the machine itself basically looks like one of those old fashioned hair driers.
it's not painful, but it can be uncomfortable. it feels a little bit like a woodpecker tapping on your skull. if it is painful, tell them. i was feeling a sharp pain in one of my teeth, and they adjusted the positioning. my right hand fingers still twitch when I'm getting the depression zaps, but not the ocd. honestly, I have almost fallen asleep, because it's kind of meditative, and i'm on a very high level. if i'm remembering correctly, it's like 2 seconds on, 10 seconds off? or 5 seconds off? it's not constant.
i read during the depression one, and have to "lightly" trigger myself with the ocd (if you've ever done an ERP/ERP therapy, a gentle version of that so your anxiety is at a 5-7, not a 10 but also not a 3) so I can't read during that one. I listen to music, and my provider has offered to put on netflix or hulu.
during the depression one, the only thing you're really encouraged to do is something mentally positive — don't listen to your Sad Girl TM music, or anything like that. listen/read/watch something that you find pleasant and enjoyable and something that generally makes you happy.
they don't start you at your specific max voltage — they start you low and you build up in increments the first week or so. the first few times are the most uncomfortable, and you might get a headache afterwards, but i never did. after a few sessions, you stop really noticing it.
****there is a VERY (<1%) slight chance of seizures, but i believe only in people who are already epileptic, heavy drinkers, or on specific medications. there is no chance of you going home and having a seizure, it would happen while receiving the treatment.*****
i can not tell you how much my mood has improved since starting this treatment a month and a half ago.
I was really dubious, and didn't have high hopes. I have a friend I met when we were both in a higher level of care who is similarly resistant to depression treatments — she did tms before me and didn't experience much relief. however, ketamine seems to be helping her and it didn't help me! so, remember, every single person is different. what works for me, may not work for you. but i do think it's worth trying.
it doesn't happen right away, and they tell you this upfront. I think I really only started feeling noticeably better around week 3 or 4?
honestly, I think a huge part was just being forced out of the house 5x a week (I was working from home exclusively atp, which was getting me in slight trouble at work despite having permission) forced to interact with other humans, if only briefly/professionally. I scheduled mine at 08:30, right when they open, so I had to force myself to get up at a reasonable time to make the train, get there, etc. and so I didn't have to go on my lunch break or after work.
(a slight disclaimer: at this point in my depressive episode I was using weed to numb out. I wasn't using a lot (at least, by the standards of my former friend group?) but I was smoking a bowl each night. this wasn't a problem for my providers, especially because I'm in a state where it's legal, but do make sure to let them know if you use weed or any other substances, as it will impact the voltages or something. i was told it isn't a problem, so long as i'm not coming to the appointments high. I've been trying to cut down to only a few times a week, and i've been really successful without really any problems, which I'm taking as another sign of my improved mental health.)
I didn't really need the reminder, but the practitioner did remind me a few times that tms does not cure your depression, and it doesn't make you happy.
the way she put it, is it kind of brings the "levels" (of.... what I'm not sure, sorry. google.) of your brain to a more neutral state, which then makes it easier for you to experience happiness or enjoyment, cutting through the fog of depression and anhedonia. this has absolutely been my experience.
like, i'm not going to lie to you and say this has cured me. according to my scores, i'm still severely depressed. but i can not stress how much relief I feel.
I've never been able to get out of bed in the morning, not even when I was a kid, and while I'm still snoozing my alarm until the last possible second, once I'm up? I feel awake. I feel fine. I'm smiling at fucking birds and flowers on my way to the train. I'm not crying over every little thing, and even better? I'm not numb, or trying to be numb because I feel overwhelmed. I feel, god, cheerful waiting for the train to take me to my very boring job. i'm actually looking to make friends and date again, and making creative goals again after months and months of nothing.
no, it hasn't really helped my severely unmedicated adhd — however, I don't really feel the overwhelming feeling of dread at approaching a project that I've procrastinated on for work. i'm honestly still just as distractable, but I'm also finding that cheap sources of dopamine (tiktok doomscrolling, scrolling tumblr) aren't as appealing, and I eventually come back to the task I have to do. do I hate the task less? no, but like, it's more of a necessary evil, as opposed to a crushing despair.
i'll also say it hasn't really helped me progress in my ed recovery. without details on that, i'm at a relatively healthy place after some higher level treatment, and working on maintenance, which everyone tends to agree is much harder than the recovery period. i've done this rodeo a few times, and generally agree. however I can only assume that making progress on that will be infinitely easier when I'm not laying in bed for 20 hours a day.
honestly, the funniest part of this is I've started noticing how much my very incompetent roommate pisses me off. before, I was so depressed I either didn't notice or have the capacity to process how irritating they are (they are the definition of weaponized incompetence, but that's for a different post) because I was so in my head and hopeless, and now? now i'm annoyed, and while that's not, like, an ideal emotion to have towards someone you live with, it's vastly preferable to feeling just nothing. i just roll my eyes to myself, take a deep breath, and move on.
something that was stressed upon me was that, in order for tms to work, you have to put in the work to help it along. like, if your brain is getting set to a neutral baseline, you have to work to keep it from slipping back into depressive habits.
semi-regular exercise like going for a walk on your lunch hour, eating reasonably well, sleeping regularly and enough but not too much, not doomscrolling too much, finding a stimulating hobby like idk crochet or painting or book club — anything that you derive actual enjoyment from. all those really annoying things you hear from people who say things like "have you tried yoga?"
those were so far out of reach for me before. like i've said, i've been quite literally bed ridden all of this year, and not much better in the past. those things actually feel somewhat attainable to me now, for the first time in my life.
honestly, if this is even half as well as how non-mentally ill people feel all the time, I'm a bit furious lol i knew I was starting from a lower rung on the ladder, I didn't realize that rung was literally underground and covered in ice and slime and that most people are miles above me wearing grippy boots. i don't know if this analogy works. whatever.
all of this to say: if you're thinking about tms, and aren't sure because it sounds kind of woo-woo or scary, i'd give it a try.
it's not cheap — my insurance covers everything except my copay, which is $50 per session. that is steep and it adds up. when the alternative was somehow finding the time and money to drop $10k+ on a month+ of residential or php again because I wasn't safe, knowing it honestly may not help much, as it hasn't in the past? it was a pretty clear choice. at least where I go, all insurances were accepted and cover the treatments in some capacity, and I believe a lot also have sliding scales. I'm unfortunately not sure about medicaid/care.
in terms of continuing treatment post-tms, i'm obviously going to continue my medication regimen, and meeting weekly with my outpatient mental health team. many people do maintenance sessions every few months, depending on their mood. we'll see what I need to do.
this post is already a mile long, so if you made it this far, um, gold star! i hope this was at least mildly informative. I know I've used tumblr and reddit to see anecdotal experiences for various medications and therapies, so I'm hoping this reaches at least one person who needs it. I may edit this post at a later date if I think of anything. feel free to ask me questions (within reason, and please with trigger warnings) and I will try to answer them to the best of my abilities, but again, I am one person, with one person's unique experiences, and I am not a doctor. :)
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