Hope for Depression

Rebecca Coupe moved to Florida from Ohio in 1996 to escape the harsh Midwest winters. She planned to spend her days basking in the warm sunshine.
But, chronic back issues found Rebecca unable to enjoy the subtropical lifestyle. Constant pain forced her to quit her job. She didn’t want to see or talk to anyone and suddenly found herself confined to her home.

Patient photo courtesy of Rebecca Coupe.

Rebecca has her life back
after treatment.

“When I say I am retired, I was kind of forced into it,” she admits. “I physically couldn’t do anything. I couldn’t work because I was in constant pain, so I had to retire. My back hurt almost every day. I cut myself off from people. I was irritable all the time. I just had no ambition or desire to do anything.”
Unable to afford surgery, Rebecca struggled through the pain most days.
“I finally found something I loved to do to get my mind off the pain and ease the depression,” she describes. “I started volunteering for the American Veterans [AMVETS] service organization. My son is in the US Army, and I enjoyed spending my time giving back to those who served so selflessly.”
In 2013, Rebecca says, her daily life began to unravel when she came down with double pneumonia. That, coupled with her ongoing back issues, left her weak and fragile most days.
“I started to get depressed,” Rebecca recalls, “because I was on oxygen all the time, and I had a portable tank I had to drag behind me everywhere. I never left the house. It was easier that way. I was cooped up. I was forced to stop volunteering because I was so sick.”
Rebecca sought help from Boris Kawliche, MD, at Brandon TMS & Psychiatry.
“Dr. Kawliche prescribed antidepressants, and they did work for a while. I felt better some days – good enough to at least be able to function with some normalcy day-to-day.”
But when her back pain magnified, Rebecca says she was forced to undergo surgery. That was when things took a turn for the worse.
“It was my fourth back surgery,” Rebecca recalls. “Afterward, I felt about as low as a person could get mentally. I would get up at eleven in the morning, stay up until about two in the afternoon and then go back to bed. Then, I would get back up later and make dinner, crochet a little bit or read a book, and stay awake watching television until eleven at night and just repeat the same thing the next day.
“I used to be so active. Suddenly, all of that was gone and I felt useless.”
During her recovery period following back surgery, Rebecca says she was not taking any medication for her depression because of its potential interference with pain medications. One day, when she was at her pain management doctor for a follow-up visit, Rebecca was advised to go back to see Dr. Kawliche.
“My pain management doctor could see I was struggling mentally,” Rebecca shares. “That’s when I went back to see Dr. Kawliche, and he told me I was a strong candidate for transcranial magnetic stimulation, or TMS,” Rebecca confirms. “I discussed it with my husband, and he was on board with it.”

The TMS Era

A new chapter in depression treatment, TMS began in the 1980s when a researcher at the University of South Carolina discovered how magnetic pulses could stimulate part of the brain that is underactive in people with depression.
Quote from Rebecca CoupeThe Food and Drug Administration approved the noninvasive therapy in 2008 for people with treatment-resistant depression and those who can’t tolerate the side effects of antidepressants.
Once the patient is settled into a comfortable chair, a paddle-shaped device with a magnetic coil is placed on the prefrontal cortex. It emits a magnetic field, similar to that of an MRI, in short pulses to stimulate the brain. These magnetic pulses are delivered intermittently in a precise sequence that is computer-generated.
The magnetic pulses are precisely targeted to the prefrontal cortex, which is the part of the brain associated with mood regulation and cognitive functions. Research studies have shown this area can be underactive in depressed people.
“I had TMS treatments five days a week for six weeks,” Rebecca remembers. “There is no pain involved whatsoever. It was a huge commitment, but I followed through with the entire treatment plan to the end.”
“Usually, people start to notice changes within two or three weeks of treatment,” notes Dr. Kawliche. “They say, I have more energy. I’m thinking a little clearer. My motivation is better. I feel like doing things. Feeling better doesn’t happen immediately after the first day of treatment, but occurs over time. The brain gets used to maintaining a higher level of functioning through repetition of treatments. This helps create muscle memory and oxygen flow to parts of the brain that may have been weakened by the depression. This treatment not only helps alleviate symptoms of depression, it also regulates sleep and helps stimulate blood flow to the brain.”
Rebecca confirms she was feeling better about two weeks into her treatment regimen.
“I felt like I could get up and get moving every day, not like I used to feel,” she reiterates. “I was slowly getting my life back. I felt rejuvenated.”

The Prefrontal Cortex

Major depression is the most common mental illness in the United States, according to the National Institute for Mental Health. In 2015, an estimated 16 million adults in America had experienced at least one episode of major depression the previous year.

Photo by Jordan Pysz.

Dr. Kawliche says the TMS machine is a safe and effective way for treating chronic depression.

Its effects can range from mild to debilitating, and they go beyond feelings of sadness. People with major depression can experience the inability to concentrate, sleep disturbances, fatigue and changes in eating habits. Their favorite activities are no longer enjoyable, and there is a sense of hopelessness about the future. In worst cases, major depression can lead to attempts of suicide.
The exact cause of the complex disorder isn’t known, but research has shown that genetics, brain chemistry and function, stress levels, other medical issues and a host of other factors can contribute.

Getting Her Life Back

Rebecca says TMS was a life-changing treatment for her.
“I am back to my old self again,” she says. “I am doing yard work again, volunteering again and enjoying all of the daily activities I had shelved for so long.”
Rebecca says she still sees Dr. Kawliche once every six weeks for follow-up care.
“I used to look like a zombie because I was on so much medication for pain and depression,” Rebecca says. “Now, I am slowly weaning my way off antidepressants, and I hope to be completely off of them very soon.”
In the past three decades, antidepressant medications have become a common treatment. However, a large percentage of people with depression are like Rebecca. They don’t respond to the medications, or the drugs stop working after being on them a while. Statistics have shown that by the time an individual has tried three antidepressants (in a lifetime) and they have not worked or have stopped being effective, this is when they move on to a fourth medication and the likelihood of that medication being effective is just seven percent.
“About twenty-five percent of people treated for depression for the first time don’t respond to the standard treatment of talk therapy plus antidepressants,” notes
Dr. Kawliche. “They are unable to regain the function and enjoyment in life that they had prior to the depressive episode. TMS can really be life-changing for these kinds of patients.”
“I owe a lot to Dr. Kawliche,” Rebecca emphasizes. “TMS was a lifesaver for me because I had exhausted the use of antidepressant medications. This was kind of a last resort effort, and it worked! I finally have my life back, and I could not be happier. I feel great!”

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