Back in the Swing of Things

TMS offers a better outcome for patients with treatment-resistant depression.

Doug McCrea was used to being “a very active, involved” person, playing tournament tennis; working in advertising, sales and marketing; managing employees and helping develop various businesses over the years.

Photo by Jordan Pysz.

Doug McCrea

But depression robbed him of his zest for life and his drive to achieve. While he still exercised, Doug says he wasn’t as effective at work and often languished at home.
“The only time I felt better was when I was on the tennis court,” he shares. “I was always the guy driving things, and all of a sudden, I was sitting there like a vegetable. When I started something, I would only go so far instead of completing the task. I put things aside. Tomorrow was better than today.
“The engaging nature of what I am as a person went away as well, the social engagement,” Doug continues. Finally, he received an ultimatum. “My wife said, You’re going to see a psychiatrist, or you’re going to be kicked out.”
Doug’s wife, Irene, is a nurse practitioner in geropsychology, a branch of psychology that addresses the concerns of older adults. She and Doug have been married for 46 years, during which time Irene has been an active advocate for her husband’s mental health care.
Doug tried the anti-depressant Wellbutrin® while living in California 20 years ago but wasn’t satisfied with how it affected his performance on the tennis court. So, he quit taking the pills.
“I was always trying to find something that would enable me to have a better reaction time,” Doug recalls. “The only thing that did it was stopping the medication. I was okay for a while, and then the symptoms arose again.”
Doug tried other treatments over the years, including eye movement desensitization therapy, which uses rapid eye movements in an effort to weaken the effect of negative emotions and memories. But nothing worked well enough for him.
Finally, about two years after the couple moved to Florida, Irene again urged Doug to seek help for his depression. Doug began researching options and found Robert Pollack, MD, of Fort Myers-based Psychiatric Associates of Southwest Florida.
“Credentials were important to us,” Doug emphasizes. “His background spoke a thousand words in what he could provide. My wife and I were extremely impressed with him – his educational background, his demeanor, his approach, the no-nonsense attitude of Let’s try and test these things and find out which one works.”

Safe, Innovative Therapies

Dr. Pollack embraces emerging therapies for treating depression based on pioneering discoveries about the brain. Those include genomic testing to determine which antidepressant might be most effective according to the patient’s genetic profile, as well as transcranial magnetic stimulation (TMS) and theta-burst stimulation (TBS). Both use magnetic pulses to rouse areas of the brain and relieve depression.
Dr. Pollack also uses ketamine, an anesthesia drug introduced in the 1960s that can alleviate suicidal thoughts and act more quickly than many antidepressants.
“Doug has a sensitivity to different medications, so I thought ketamine would be a bad choice,” Dr. Pollack reasons. “Also, his genomic testing did not reflect somebody who would do well with ketamine. He had a tremendous amount of anxiety, and TMS tends to have better results for anxiety.
“I don’t think Doug trusts medications,” Dr. Pollack adds. “He prefers treatments he can control. Even with TMS, he wanted to control his position in the chair. He’d say, When I put my head over here, I rolled my eyes over here, and that gives us a better response. Chances of that being true are not great, but if he needed to have control, my feeling is that’s fine.

“It worked for me very well, very quickly, probably within four or five sessions. It’s like night and day.” -Doug

“The more people talk, and the more they function during a course of TMS, the better they do,” Dr. Pollack asserts. “It increases brain activity. We had someone who ran a board meeting during TMS, and it was their best treatment.”
A noninvasive therapy, TMS was approved by the US Food and Drug Administration in 2008 for people such as Doug with treatment-resistant depression, as well as those who can’t tolerate the side effects of antidepressants.
TMS is also used to treat chronic pain, anxiety, migraines, obsessive-compulsive disorder, fibromyalgia, bipolar disorder and other illnesses for which medication has not had the desired outcome.
Dr. Pollack administered TMS to Doug over 36 sessions at the Psychiatric Associates of Southwest Florida office. All Doug had to do was sit in a chair and relax.
“They put this device on top of your head, and the first session is spent trying to identify the exact spot within your brain that affects depression,” he describes. “There’s no pain whatsoever. It’s like a little woodpecker tapping you very lightly. Once they find that small spot on the left side of your brain, your right thumb starts to twitch, which is sort of funny.”
Unlike medication, nothing involved with TMS entered Doug’s bloodstream or clouded his thinking. But the therapy did leave him tired.
“I’m not a nap person, but I found myself napping early in the evening,” he recounts. “The other thing that happened, which was fascinating, is that after the first three sessions, I told the technician, I’ve noticed that digital signs along the street seem brighter. And she said, That’s good because it normally takes a while. Some people have said that’s one of the things that happen when the TMS is working.
“It’s been almost a year since I completed it, and I still look at the digital signs to see how I’m doing, and they’re bright,” Doug assures.
Dr. Pollack believes that “treatment of depression is a family affair,” so he made sure Irene had all the information she needed to understand and evaluate her husband’s TMS treatments. She also served as his motivator.
“When he would say, Maybe I don’t need to do this, she pushed and she was strong,” Dr. Pollack states.

“It’s Like Night and Day”

As with any patient, treating Doug involved becoming familiar with his history and his personality, then evaluating how those impacted his emotional well-being.

Photo by Jordan Pysz.

Doug is back playing tournament tennis.

“Doug tends to look back at things for cause and effect, rather than accepting reality,” Dr. Pollack points out.
For instance, Doug wondered whether his past alcohol abuse (he’s been sober for 41 years) and the seven or eight concussions he suffered while growing up, mostly playing football and other sports, contributed to his depression.
Dr. Pollack isn’t convinced they did. He believes Doug “most probably” struggled with “an underlying biological depression” aggravated by situations at work and his frustration with the inevitable effects of aging, which diminished his ability to play tennis as well as he once did.
“He’s not happy with being seventy-two,” Dr. Pollack states. “Now, he’s able to sit and joke about it, which he wasn’t before.”
Thanks to TMS, Doug is also more outgoing, Dr. Pollack reports, and is eager to spread the word about the benefits of magnetic-pulse therapy.
“It worked for me very well, very quickly, probably within four or five sessions,” Doug marvels. “It’s like night and day. I’m more rested, more sociable. I’m teaching tennis part-time, and I’m volunteering with SCORE, a group of former business executives who help entrepreneurs.
“I’m back playing tournaments again,” he adds. “That’s the best result of the TMS treatments. It’s got me back to being me.”

Print This Article