First Day of Treatment - rTMS

It is finally July 8th, 2019 and I attended my first rTMS session today. It feels like I have been waiting for this my whole life but really it has been only about 9 months since I learned about rTMS. I really do not feel that the other non-drug treatments (forms of electroconvulsive therapy (ECT/Shock Therapy) are a good option for me due to the memory loss and other effects - I carry both markers for Alzheimers and I do not need anything potentially adding to that. If this rTMS does not work, I think that my only options for treatment/a cure/a remission would be the Ketamine therapy that is proving so promising in PTSD sufferers. Other than that, there is nothing in terms of new drugs or treatments for depression. So, for me, this is pretty much the end of the road in terms of treatment options.

I am trying not to put pressure on myself because I sense the urgency and the fact that the rTMS is the only proven treatment I have left at this point in my life. I am wanting to try to keep my mindset as positive as possible during my treatment because I really believe that will be the key to whether it is successful or not. I realize and am excited by the fact that this could be potentially life changing in such a positive way. I try to daydream of who I am without depression or anxiety. I try to imagine what my interests might be, if I can be passionate about any one pastime or if I have a thicker skin. Usually by that time I fall asleep and do not get to the actual visualization of that. Ah, such is life.

My first appointment at the clinic was at 11:00 for my motor threshold testing. They placed a swim cap like hat on my head and took measurements marking them on the cap to find my motor centre of the brain. They place the coil onto the motor centre of your brain. They use magnetic pulses that are just strong enough to cause your hand to twitch. This is considered your motor threshold. They use that figure to determine the dose of the magnetic pulses to give you during treatment. It is usually calculated at motor threshold + 20%. It felt like being snapped on the head with an elastic band. It wasn't painful or startling.

At 12:30 I presented myself for my first treatment. Out came my "swim cap". It was positioned on my head and the position was verified by the technician, checking the measurements. My protocol was that I was to start at 50% of my treatment dose and work up. My session would only last about 3 minutes but during that three minutes I would have 600 pulses. The coil was held against my head with a metal arm so that it could be held in exactly the right spot for the duration. The technician pulled out a sharpie and marked the exact outline of the coil/wand on my cap for future treatments. The technician started with my treatment but I found the 50% was very jarring for me (I am sensitive). So, she backed it off to 30% and over the course of the three minutes I was able to get her to up it to 44%.

The sensation was a bit different than the motor threshold test. The pulses were stronger and more "zappy". It felt a lot stronger than a rubber band but not like a hammer or anything scary. It was startling at first as some of the muscles in my face twitched (which is normal).

After the treatment I had a very mild/low grade headache with very mild nausea and my head was a little sore where the coil had been placed (from all the pulses). The soreness went away within minutes, the nausea which was probably mostly nerves subsided shortly thereafter and the headache was gone within 15 minutes. I felt tired, but I am not sure if that was from the treatment or the anticipation of it. I guess I will find out as time goes on.

I feel positive about today even though I could not work up to the max strength of treatment but my hope is that tomorrow starting at 44% I will get there quickly. The rest of my day was long so hitting the hay as quickly as possible so that I am in my best shape for treatment tomorrow.

My advice for anyone on their first day of treatment is to be kind to yourself. Wake up after getting a good 8 hours sleep, eat breakfast, try to stay positive, and try to relax. It seems like a big thing and getting treatment is, but it is big in a good way - don't set expectations or let yourself get too anxious. The treatments go faster and easier. Even though you can drive and go back to work right after, if you want to treat yourself take the day off and rest and marvel in the fact that you are able to do something about depression that might actually work. Give yourself kudos for giving yourself this opportunity and for taking the steps and doing the work to get to this point. 1 down and 19 more session to go.