Sticking It to Depression

A new lease on life is possible with TMS therapy.

The “dark hole” of depression that Tiffany Caceres wallowed in for more than half her life first began to swallow her up some 17 years ago when a seventh-grade schoolmate launched an incessant teasing and bullying campaign against her.

Photo by Jordan Pysz.

Tiffany (right) and her husband, Rafael, have found their happy place.

With no father at home to turn to for help and an inattentive and often absent mother who blamed Tiffany for a lot of her family’s struggles, that hole quickly grew deeper and darker as Tiffany, now 30, was left to sort out many of life’s problems largely on her own.
“Everything was always my fault, and I felt as if I just wasn’t good enough,” Tiffany remembers. “On top of that, I was home alone all the time, so I never really learned how to communicate with people.”
Tiffany’s mood darkened when, at the age of 18, she became pregnant and found herself trapped in a relationship with a boyfriend who was abusive and controlling. She eventually escaped that toxic relationship, but over time, her depression only deepened.
“Even after I made it out on my own and landed a good job, I’d come home from work, and I’d usually just stay there all by myself,” Tiffany explains. “I didn’t have any friends really and so I didn’t go out. I really just wanted to sleep all the time.”
A slight change came about five years ago after Tiffany met her future husband, Rafael, who soon encouraged her to seek help for her depression. It wasn’t until just recently, however, after Tiffany met Boris Kawliche, MD, at Brandon TMS & Psychiatry, that her life truly began to change for the better.
“I did see a psychiatrist for a while, and I’d tried some medications before here and there, but I still felt pretty much the same,” Tiffany relates. “I was definitely still depressed, and I started to feel like my depression was taking a toll on my marriage.
“I thought to myself, Okay, it’s time for me to go see a psychiatrist because I just don’t want to live in this dark hole any more. I called a couple of doctors, but none of them were accepting new patients. That’s when I called Dr. Kawliche.”
Tiffany first saw Dr. Kawliche within a week of calling his office. She was still taking ZOLOFT® at the time of her first appointment, but Dr. Kawliche could tell immediately the medication wasn’t working for her.
“When I first met Tiffany, she was very down,” Dr. Kawliche explains. “She’s a relatively young woman, and she wasn’t getting pleasure in things. Her self-esteem was very low, and her relationships were being strained as a result of it all.
“Coping with the care of her children had become a burden, too. She just wasn’t at her full capacity, her full potential, and I have seen this before where someone has tried three or four antidepressants, and they’re just not getting the results they want.”

The TMS Revolution

For years, doctors have typically treated patients such as Tiffany by simply prescribing yet another antidepressant or a few more rounds of talk therapy. Dr. Kawliche has found, however, that far better results can be realized through transcranial magnetic stimulation, or TMS therapy.
Approved by the Food and Drug Administration in 2008, TMS first proved effective in treating depression in 1985 when Dr. Mark George a team of University of South Carolina researchers discovered that magnetic pulses can stimulate the parts of the brain that are insufficiently active in people suffering from depression.
The magnetic pulses emitted during TMS therapy are similar to those emitted during an MRI. The difference is that they are delivered through a cup-shaped device that contains a magnetic coil that is much more focused. During treatment, that device is placed on the prefrontal cortex while the patient rests comfortably in a chair that looks a lot like a dentist’s chair.

Stock graphic from

Symptoms of Depression

Each TMS treatment lasts for 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 through the first six weeks of the program, then they are gradually weaned down, coming less often until the ninth and final week.
The most common side effects are some mild scalp discomfort like headache or dizziness stemming from the treatment application. Best of all, Dr. Kawliche declares, TMS therapy is proving to be effective in returning executive function.

Amazing Results

“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 miserable odds. But with TMS, 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.”
Tiffany, who is nearing the end of her treatment cycle, is one of those who have responded favorably to the TMS treatments. She has graduated to the point where she is receiving 20-minute treatments three times a week and will soon be done with her TMS therapy, which she credits for giving her a new and better outlook on life.
“I feel amazing,” she raves. “I actually go out and do stuff now, like go to the park. I get things done instead of procrastinating all the time, and I’m so much more outgoing. I come up with jokes here and there, and I can laugh again because I don’t take things the wrong way anymore.
“My husband likes to joke around a lot, and before I started the TMS treatments, I would always get mad because I would take what he said the wrong way. But now I understand that he’s just joking, he’s just having fun, and we can laugh about it. I know it’s nothing serious, whereas before, I would always blow everything out of proportion.”

“I feel amazing. I get things done now instead of procrastinating all the time, and I’m so much more outgoing.’’ – Tiffany

Rafael says he first noticed a discernable difference in Tiffany’s mood and outlook after only a few weeks of TMS therapy. Dr. Kawliche says that time frame is typical of most patients and adds that in Tiffany’s case, he continued to see improvement as the treatment program progressed.
“To me, she seems to be blossoming,” Dr. Kawliche reports. “Her sense of confidence is up. Just the way she walks is different. There are a lot of these little nuances that you pick up when somebody is feeling good, and I’m seeing a lot of those in Tiffany. She seems to be a lot more enthusiastic and self confident.”
Tiffany says her enthusiasm for the TMS therapy was boosted during her initial visit with Dr. Kawliche. She says he was so enthusiastic about the treatment and the positive effects it’s had on other patients that she felt certain it would help her as well. Dr. Kawliche adds that success stories such as Tiffany’s are the reason he believes so strongly in TMS therapy.
“When I hear our patients say things like, Doctor, you gave me a new lease on life, that’s quite a statement,” Dr. Kawliche confirms. “It has an effect on me, because I’ve been able to do a favor for someone; I’ve been able to restore them in some way. With medication, you don’t hear that quite as much.
“Medication too often seems to be more of a BAND-AID®. Plus, you have to take them daily, and if you miss a dose, you’ll probably wind up having a setback. But with TMS, there’s a possibility you won’t need to take the medication route. You may be able to cut back or not take any more at all. Plus, you don’t have the burden of making the visits to the doctor, the hassles at the pharmacy and the cost. Potentially, it’s a much better way to go.”

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