Relieving a Lifetime of Suffering

New therapies like TBS bring better results.

Melissa Banks says she struggled with depression “on and off, but mostly on” since the age of ten. She traces the cause to early life experiences, and while she doesn’t have a personal recollection of the details, her mother has helped fill the gaps in her memory.Stock photo from istockphoto.com.
“My twin brothers were born when I was not quite two,” Melissa shares. “My life until that point had been great. I was part of a young family, was the first daughter and everything was wonderful. Then, when my brothers were born, my mom suffered from postpartum depression. She now had three kids under two. One had food allergies, which they didn’t know anything about in 1974.
“My physical needs got met, but attention and affection were pretty much withdrawn at that age,” Melissa continues. “And then my parents split up when I was nine and divorced when I was ten.”
Melissa’s mother was busy with a full-time job 30 miles from home, and then with her pursuit of a Master’s degree at a college 120 miles away. Melissa took care of her brothers and kept house.
“I was a stay-at-home mom when I got home from school,” she remarks. “I never really felt like a kid. If I needed something, I was adding to the problem. The only way I got positive feedback was to fix other people’s problems.”
When she was 14, her mother remarried – and Melissa’s life became more challenging.
“My stepfather was extremely emotionally abusive to me and very jealous of my relationship with my mom,” Melissa discloses. “I was suddenly displaced from their family.”
They later moved to a town where Melissa knew no one, leaving her even more isolated. She wanted to live with her father, but he declined.
“The way I dealt with it was by excelling academically,” she remembers, “and I skipped a year of school so I could get out of that house.”
When Melissa left for Spain as an exchange student at 17, her mother and stepfather basically told her, “You don’t have a home to come back to. Have a good life alone.”
In Melissa’s absence, however, her mother saw the family dynamics from a new perspective.
“She realized I wasn’t making all that stuff up about my stepfather because he picked new people to abuse,” Melissa reports.
She and her mother eventually repaired their relationship, and Melissa has learned to coexist with her stepfather.
While that emotional burden has been lifted, physical misery still plagues her. Melissa has fibromyalgia, characterized by chronic muscle pain, fatigue and issues with sleep, memory and mood.
“I’m on a lot of medications to treat it,” she informs. “It’s hard to tell how severe it is because I don’t know what it’s like anymore to feel anything else. Everything hurts all the time.”
As if that wasn’t enough, Melissa’s shoulder ached from a torn ligament and rotator cuff, bursitis and a bone spur, which ended up requiring surgery.
Her struggle with depression also continued, although Melissa didn’t recognize the symptoms because they coincided with her physical ailments, and antidepressants hadn’t helped much in the past.
“There were days I couldn’t get out of bed,” Melissa acknowledges. “I thought about suicide. I didn’t think about it like maybe I should do it, but it was in the back of my mind. What stopped those thoughts from becoming more real was, Who would take care of my two cats?
Her mother lives four hours away, and the rest of the family is up north. Melissa does have close friends but didn’t share her feelings of hopelessness with them.
“How do you express something so overwhelming – that there’s no point in me being alive anymore?” she asks. “That’s not a story you tell someone because there is nothing they can do to fix it.”
Then Melissa’s mother stayed with her after her shoulder surgery, witnessed her behavior and informed her it wasn’t healthy.

21st Century Treatments

In August 2016, the two women came across an article written by Robert Pollack, MD, whose Fort Myers-based practice, Psychiatric Associates of Southwest Florida, embraces emerging therapies for treating depression based on pioneering discoveries about the brain.
“I called them that night, he called me back and we set up an appointment,” Melissa says. “Dr. Pollack got me in that week to do an evaluation.”
He decided her best option for getting well was six infusions of ketamine, an anesthesia drug introduced in the 1960s that acts more quickly than many antidepressants.
While the results aren’t always predictable, Dr. Pollack has found that 72 to 75 percent of his patients with treatment-resistant depression, PTSD, obsessive-compulsive disorder, and bipolar and postpartum depression have a positive response to ketamine.
Unfortunately, a disappointed Melissa wasn’t among them.
Dr. Pollack then suggested theta-burst stimulation (TBS), which uses magnetic pulses to mimic the natural rhythms of activity in the neurons of the brain. He not only hoped to alleviate Melissa’s depression but also to relieve her discomfort from fibromyalgia, which he sees as a related disorder.
“Absolutely there’s a direct connection between the degree of depression and pain perception,” he asserts, “so we really do need to go after both aspects.”
The prescribed TBS regimen was five straight days for two weeks. But after Melissa’s third treatment, Hurricane Irma interrupted that schedule and forced her to evacuate when she lost power at her Naples home. She finally resumed therapy after about three weeks.

No “Magic Bullet”

Despite that gap in her treatment, Melissa reports that her depression is virtually in remission and she no longer feels hopeless or thinks about ending her life.
Her results from a recent PHQ-9 screening questionnaire support her assessment. The PHQ-9 rates the frequency of various symptoms in order to measure the level of a patient’s depression, from minimal (zero to four) to severe (20 to 27). Melissa’s test score was a one,
Dr. Pollack confirms.
“Melissa came to us at a point where she couldn’t get out of bed, couldn’t go to work, couldn’t function,” he notes. “Now, she’s going to work and has a significant degree of relief. We were able to get her off a lot of antidepressants.”
While Melissa is enjoying dramatic results from her therapy, Dr. Pollack cautions that treatment of depression and other mental health issues is not an exact science and that there are no “magic bullet” solutions.
“We don’t have all the answers yet,” he expounds. “Eventually, we’re looking at a different direction in the treatment of depression. It’s based more on knowing the patient’s genetics and neurochemistry. We’re going to see gene sequencing approaches to these illnesses very, very soon. What we did two years ago won’t be recognizable two years from now.”
That means mental health professionals must keep up with the ever-changing science by tapping into information available online and from peers.
“This age of psychiatry is truly a collaborative science,” Dr. Pollack emphasizes. “What we all want is to make patients better.”
Melissa is proof that life-changing outcomes are possible for patients and practitioners willing to try innovative therapies until they find what works best.
“Let’s use the tools that we have,” she concludes. “I’m all about being focused on the results.”

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