A Bright, New World

TMS therapy erases dark shroud of depression.

Chelsea Engel was still in middle school when depression wrapped itself around her like a heavy, wet blanket and turned her bed into a cocoon, one of the few places in her world where she felt comfortable, safe and secure.

Photo by Fred Bellet.

Chelsea Engel

“There were a lot of days when I couldn’t even get out of bed and walk around the house, much less go to school,” Chelsea, now 21, reveals. “And it was pretty constant, especially when I was in high school, which created a lot of anxiety.
“I was missing a great number of classes and because of that, I worried I was going to fail. That just made my anxiety worse. My heart would race, I’d get shaky and antsy and get this feeling like I couldn’t breathe. It was a cycle that went on for years.”
Those years became even more difficult when, at the age of 15, Chelsea was diagnosed with essential thrombocythemia, a rare, chronic blood cancer that she currently keeps stable through medication. The only drawback is, the medication worsens her depression.
“One of the side effects of the medicine that treats the blood cancer is depression and suicidal thoughts,” Chelsea informs. “When you’re already depressed and you take a medication that causes depression, it just makes things worse. And for me, it did.
“I isolated myself even more, so much that it cost me a few friendships. My friends thought I didn’t want to hang out with them, but it wasn’t like that at all. I wanted to make the effort to be with them, but when you’re depressed, it’s very hard to do sometimes.”
Beginning in high school, which she completed on time, graduating with honors, and all through college, where she is on pace to graduate summa cum laude next spring, Chelsea tried managing her depression through all the standard forms of treatment.
She tried counseling and was prescribed a long list of anti-depressants, none of which worked for her. Then one day in the spring of 2018, she read about a treatment called TMS therapy in Florida Health Care News.

The TMS Era

Sparking a new era in depression treatment, TMS therapy was developed in the 1980s when a researcher at the University of South Carolina learned that magnetic pulses can stimulate the part of the brain that is underactive in people with depression.

Photo courtesy of Chelsea Engel.

Chelsea is enjoying life with her boyfriend Jaron so much more after TMS therapy.

The Food and Drug Administration approved the noninvasive therapy in 2008 for patients who have not responded favorably to traditional treatments such as talk therapy and antidepressants, as well as those who cannot tolerate the side effects of antidepressants.
In the Tampa Bay area, the treatment is offered by Boris Kawliche, MD, at Brandon TMS & Psychiatry. It was Dr. Kawliche whom Chelsea read about in the article and decided to see to determine if TMS treatment might work for her.
“It was my mom who first read the article and suggested it might be a good option for me,” Chelsea explains. “After I read the article, we both started looking into it a bit more, and that’s when I decided, Well, I’ve tried everything else. Why not try this?
Dr. Kawliche determined during his first meeting with Chelsea that she was indeed a good candidate for TMS therapy. Not only did she meet all the clinical criteria required for the treatment, but he was confident she would benefit greatly from it.
“Chelsea is a very vital young person,” Dr. Kawliche relates. “She’s bright, intelligent and full of life. The depression had really been holding her back, affecting her relationships and decreasing her level of energy.
“Before I met her, she was unable to hit life on all cylinders, so to speak. Life had really been a struggle for her, and she wasn’t getting anywhere with the medications she’d been prescribed. In fact, there were times when they were making things worse.
“She was showing all the signs of impairment caused by significant depression, including isolation. When people are significantly depressed, they isolate themselves. They retreat more and more, and managing any kind of stress or demand becomes overwhelming.
“The least demand or conflict can seem like a gigantic mountain to someone in Chelsea’s situation, and they become almost paralyzed. The brain is unable to function properly, and that becomes crippling.”

Life-Changing Treatment

Chelsea says her only concern prior to beginning TMS therapy was that it would be similar to “that electric-shock therapy you see people get in the movies.” She soon learned that TMS is nothing like electroconvulsive therapy (ECT).

Photo courtesy of Chelsea Engel.

Chelsea enjoys a day at the park with her dog Bentley.

For starters, TMS is done in the doctor’s office while the patient is awake. ECT must be done in a hospital or surgery center because the patient must be anesthetized. The biggest difference, however, is in what the two treatments deliver.
ECT causes the patient to go into a seizure. TMS, through electromagnetic induction, emits a magnetic field in short pulses that are delivered intermittently through precise, computer-generated sequences that stimulate the brain. This process is similar to a workout for the brain that is restorative and brings about positive changes.
These short pulses are delivered through a paddle-shaped device that is placed on the prefrontal cortex, which is the part of the brain associated with mood regulation and cognitive function. This is the area that can be underactive in depressed people.
TMS treatments last approximately 30 minutes, and patients typically receive a total of 36 treatments over a period of six to eight weeks. Patients are treated five times per week for the first six weeks and are gradually weaned off the treatment in the final weeks.
“Considering the way I was feeling at the time that I started the therapy, the commitment itself was a big deal for me,” Chelsea says. “I mean, I was at a point where it was an accomplishment for me to get out of bed just one day a week.
“But for me to get out of bed five days a week and go somewhere and do something like this, that was probably the biggest accomplishment that I’ve had in a long time, outside of going to school, because it took a lot for me to do that.
Chelsea Engel says TMS therapy changed her life.“But it was actually really cool because they began by mapping my brain, which starts with them trying to find the spot where it makes your finger twitch. So, they’re doing that and all of a sudden, they said, There it is, her finger twitched.” And I was like, “What? It did?
“After the brain mapping came the treatment itself, and it was very different from what I expected. It was kind of like getting an MRI except someone’s tapping on your head while they’re doing it. It’s like a woodpecker, but it’s not painful at all.
“And one of the great things is, they make sure that you’re very comfortable the whole time you’re there. You sit in this nice, big chair that’s a lot like a dentist’s chair, and they put pillows behind your head and put your legs up so you’re nice and comfy.
“It’s almost like you’re at home lounging in a recliner, but you’re getting a treatment at the same time. And the techs that do the work are amazing. They make you feel very relaxed, which was really great because I was a bit apprehensive at first.
“I wasn’t sure what I was getting in to, but through meeting them and talking to them, I actually developed friendships with them, and I was comfortable going for my treatments because they were right there the whole time, helping me through it.”

Favorable Response

The most common side effects of TMS are mild scalp discomfort, headaches and dizziness, all of which stem from the treatment coil. Dr. Kawliche proudly declares that TMS therapy has proved to be effective in helping patients regain the neurologically based skills that we use throughout the day to organize and manage life’s tasks and achieve specific goals.
“Sadly, after someone has tried three antidepressants, there is only a seven percent chance they will get well by trying a fourth,” Dr. Kawliche educates. “Those are really miserable odds.
“With TMS, however, we get about fifty percent remission rates, where the patients are completely asymptomatic, and about sixty percent response rates, where the person is better but still not at a level where everything is completely where it needs to be.”
Chelsea is among those who responded favorably to the TMS treatments. She says friends and family members saw a difference in her mood and willingness to interact almost immediately after she began the treatments and that she began to notice a discernible difference in herself after a few weeks of treatment.
“Before TMS, I would dread doing anything,” Chelsea says. “I literally didn’t want to get out of bed, so just going for the treatments was a big step for me. But I’m proud of myself for doing that because the treatments have made such a difference in my life.
“It wasn’t long after I started TMS that I actually went to the grocery store. That may not seem like a big deal for most people, but for me, it was. I remember being so proud of that and telling people, I went to the store and bought groceries today. I can’t believe I did that.

More Than a Mood Changer

Since completing TMS therapy, Chelsea has been doing more than just buying groceries. She has a boyfriend now who is very supportive of her and has accompanied her on some of her visits to Brandon TMS, where Chelsea now gets occasional booster treatments.

Photo by Fred Bellet.

Bentley (left) is so excited his mom is feeling so much happier.

But it’s not just Chelsea’s mood that has changed. Since she began receiving TMS treatments, the English-education major’s blood counts have been normal for the first time in nearly a decade.
Dr. Kawliche won’t say TMS is the reason for those improved blood counts, but he won’t rule it out either, noting that prior to beginning TMS therapy, medications prescribed by an oncologist never elicited the blood-count results Chelsea is seeing now.
“Can we make a correlation between TMS and the normal blood counts?”
Dr. Kawliche asks rhetorically. “Well, we can’t prove that. But it is very interesting, and there could actually be some effect there.
“It’s difficult to explain, but we’ve seen things of that nature happen before, which is why I’m very interested in that part of her recovery. I honestly think TMS could one day be a tool in the treatment of cancer and that it can help increase the survivability of cancer.
“The reason I say that is because we have had other cancer patients come in feeling really defeated. They were at the end of their rope, and some of them had very advanced cancers, and within a matter of a few weeks, their energy level was back up.
“After going through TMS therapy, they were once again taking care of their appearance, making sure they looked good and putting on their best face. There was a certain glow about them, a renewed glow of hope.
“Now, to say that TMS treatment can fight cancer, that’s going a long way. But if your mental outlook during that fight is one where you feel like you’re completely defeated, you’re done for.
“If you lose your will to fight, then it’s almost over just by that. I’m hoping that at some point we might connect with an oncology group and perhaps develop a systematic protocol to gauge what kind of influence this treatment might have on those patients.
“Again, I don’t know what kind of effect it will have on the actual results, if it can actually improve the outcomes for these patients, but if nothing else, I suspect it would make a big difference in their overall outlook and improve their quality of life.”
Like Dr. Kawliche, Chelsea finds the link between her improved blood counts and TMS therapy to be a curious coincidence. What she knows for certain is that through TMS therapy, she has regained the youthful vitality that depression robbed from her years ago.
“TMS has changed my life,” Chelsea raves. “The world is definitely a brighter place for me now because not only do I get out of bed every day, I get out of bed and do things. I don’t just sit around. I actually look for things to do and try to meet and talk to people.

“I honestly think TMS could one day be a tool in the treatment of cancer and that it can help increase the survivability of cancer.” – Dr. Kawliche

“That’s why I would recommend TMS therapy to anybody who is struggling with depression or anxiety. And I definitely recommend they go to Brandon TMS and see Dr. Kawliche. He is truly amazing, and he wears the most amazing, colorful shirts!
“Everyone there is incredible. I honestly love them all because they’re like a family, and that’s how they treat you. They treat you like you’re part of their family, and I can’t thank them enough for helping me through a very hard time and changing my life.”

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