TMS (transcranial magnetic stimulation) is a treatment that takes a serious time and financial commitment. By the time patients get to it, they are quite desperate to start feeling better. There are some things you can do to help the process along.
1. DO NOT STOP TAKING YOUR MEDICATIONS DURING TREATMENT
TMS can be used instead of medication, in certain circumstances. This makes it an attractive option when, for example, medication side effects are intolerable, or if a pregnant mother has concerns about the impact of medications on the unborn baby.
However, if you are suffering from treatment resistant depression (TRD), you have been feeling crappy for a long time. Now is not the time to take away the scaffolding which medication provides. Now is the time to build on what works, and optimise what does not. To this end, I give regular feedback to your psychiatrist. Your job is to work with your team, to get you stronger. Take your meds. Keep your appointments.
2. LIMIT ALCOHOL CONSUMPTION
Sometimes when you have been depressed for awhile, bad habits start forming. Many of my depressed patients tell me that they can’t wait for their evening wine (or bottle), just so that they can start numbing the constant pain away. It’s well known that alcohol can help you relax.
What is less well known, is that alcohol does not stop with relaxing, and numbing out. Alcohol is also a depressant.
Since alcohol is a depressant, if you are going through TMS therapy, it may be counteractive to drink. A glass of wine or a beer now and then won’t hurt, but excessive drinking should be avoided.
Fortunately, my patients tell me that cravings do get reduced whilst getting TMS. In fact, there are treatment protocols using this effect of TMS in the treatment of addictions.
Some of the neuroscience behind TMS is that it encourages a process called neuroplasticity. In other words, it tries to give the part of the brain which is hypoactive in depression (the DLPFC) a “workout”, so that new connections can grow.
In order to effectively do this, the brain needs proper building blocks in the form of healthy nutrition. My experience with depressed patients is that their nutrition has not been great for some time. For this reason, I recommend a “top up” of certain supplements.
Vitamins and supplements of proven benefit include:
B vitamins are a group of eight different nutrients that work together to manage many processes in the body. Vitamin B2 and B12 are found in animal products, so if supplementing with B’s is essential if you are vegetarian.
Folate (vit b9) may well be a secret weapon in the management of depression. Folic acid is used in many neurological processes, including neurotransmitter formation.
Taking B complex supplements can help a person get enough of all the B vitamins. Even better, take methylated b complex, like Methyl Care. It is a bit more expensive, but your body absorbs it better.
–Zinc: Zinc is an essential micronutrient for many physiological processes. Deficits are implicated in depression. Our modern processed diets are often low in zinc. You will need about 25mg of zinc per day supplementation, and the odd oyster meal top up.
–Omega 3 Fatty Acids: Omega 3 Fatty Acids are found in fish and plant oils (like avo or flaxseed).
A 2018 systematic review and meta-analysis looked at the results of 19 clinical trials and concludes that taking an omega-3 supplement such as fish oil could be helpful for people with anxiety. You will need about 1-2 gram per day (or an equivalent of salmon sushi three times a week)
–Vitamin D: Vitamin D plays an important role in mood regulation, as well as nerve and brain health.
Supplement by taking 1000U per day, and be sure to spend some time outside every day. Vit D is the sunshine drug, something depressed patients often forget!
4. JOURNAL YOUR JOURNEY
The changes during TMS are subtle. When you have been depressed for a long time, your brain and body are in the habit of feeling depressed. We want to take note of improvements. The act of simply noticing that energy is a bit up, or that you are singing again, means that you are nurturing the part of the brain which is trying to heal again. “Energy flows where focus goes”.
Before each session, the TMS tech will do a brief meditation with you. This is mainly there to help you relax, but also serves as a mindfulness exercise. It will help you track your thoughts, so that you can notice when you are ruminating and can then choose to try to be a bit more present. Dissociation (zoning out) is common with depression. We want to “redirect” your brain. If you manage to do moments of focussing on your breath, or scanning your body, outside the TMS chair- even better!
Similarly, try to stop obsessing about everything that is still wrong. We formally access your depression and anxiety levels every so often. In between your formal assessments, it does not serve you to ruminate on your symptoms.
5. TRY TO STAY ACTIVE
When you are depressed, there is no motivation or energy for exercise.
However, the benefits of exercise for depression is well documented. Adding any form of physical activity which you can manage will be to your benefit.
With TMS therapy, you can remain active and even go to the gym or complete a workout right after treatment.
By starting TMS you have told yourself, enough! This cannot go on!
The above recommendations are not easy for someone who is depressed. Do what you can.