Three Cheers for TMS

Alternative to antidepressants shows promise for eating disorders.

Many kids grow up wanting to be doctors, teachers or professional athletes. Not Samantha Wynimko. For the longest time, she says, she has wanted to be an autopsy technician. A recent trip to the morgue only strengthened her conviction.

Alternative to antidepressants shows promise for eating disorders

Samantha Wynimko

“I was able to observe six autopsies at the Pinellas County Morgue, and that really confirmed to me that this is what I want to do,” the 25-year-old Riverview resident says. “I know it’s not for everyone, but it’s something I’m excited about.

“And I’m almost there. I already have my Bachelor’s degree in Health Science from the University of South Florida, and I have just one more class to complete before I can take the state exam and get certified.”

If all goes as planned, Samantha will be working in a morgue sometime in the very near future, which is now very promising. It wasn’t long ago that Samantha’s future was quite uncertain because of a bout with depression, anxiety and an eating disorder.

“The problems all started when I was in high school,” Samantha relates. “I was a varsity cheerleader, and there’s this belief among a lot of people that cheerleaders are all supposed to be small or a certain size. Well, I wasn’t.

“I was probably the biggest girl on my team. I’m five foot ten, and I weighed around two hundred twenty pounds back then. Because of that, I was bullied and tortured just about every day about my weight, by one person in particular.

“One day, I finally said, Enough, and decided to do something about it. I started off dieting, but it turned into purging and over-exercising. I would work out at the gym for three hours or more and then not eat. I was obsessed with my weight.”

Samantha carried that obsession for more than two years, during which time she dropped approximately 130 pounds. But it was not a healthy weight loss. By the time her 19th birthday rolled around, Samantha had become anorexic.

Fortunately, a friend noticed and took Samantha to the hospital. Samantha stayed there for four weeks, then moved to a treatment center, where she spent three months. During that time, she was diagnosed with depression and anxiety and prescribed medications.

The medications never really worked. In fact, it wasn’t until a few months ago, after she began seeing Boris Kawliche, MD, at Brandon TMS & Psychiatry, that Samantha found a treatment that really worked for her. That treatment is transcranial magnetic stimulation, or TMS.

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 who suffer with depression.

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 area can be underactive in those who are depressed.

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.

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.

“This form of treatment does require a commitment on the part of the patient, because at the beginning you do have to come every day, five days a week, and spend about a half hour with us,” Dr. Kawliche notes.

“If you’re in school or working, those are factors that can be hard to surmount. In that way TMS treatment can be a little complicated, but it is effective. And for those who fear it may be like electroconvulsive therapy, which some refer to as shock therapy, I can assure you it is not. This is totally different.”

One of the biggest differences between electroconvulsive therapy (ECT) and TMS is that 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. There is also a difference 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 in 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.

The most common side effects of TMS are mild scalp discomfort, headaches and dizziness, all of which stem from the treatment coil. And Dr. Kawliche proudly declares that TMS therapy often proves to be more effective in helping patients than antidepressants.

“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, we get about forty 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.”

A Difference Maker

Samantha went to see Dr. Kawliche thinking he would continue treating her with antidepressants. It wasn’t long before he suggested she try TMS therapy. Now, Samantha is glad he did because it has changed her life.

“After more than five years of trying so many different antidepressants, I was at a point where I was willing to try anything that was different,” Samantha concedes. “So I figured, Why not give it a shot.  Almost immediately I noticed a difference.

Alternative to antidepressants shows promise for eating disorders

Samantha is living a happier and healthier lifestyle since receiving TMS treatments

“After my very first TMS session the things I was struggling with the most – the depression and anxiety – really just disappeared to a point where I was able to decrease my medications. I stopped the binging and purging and just started feeling a lot better.”

Samantha was the first patient with eating disorders that
Dr. Kawliche has treated with TMS therapy. She is not, however, the first person with a disorder other than severe depression who found relief from TMS treatments.

“We’ve encountered a lot of different people experiencing anything from pseudo seizures to real seizures and even people suffering from post-traumatic stress disorder that we have observed improvement in,” Dr. Kawliche says.

“In Samantha’s case it was an eating disorder. She was binging and purging on a regular basis pretty much daily and sometimes several times a day. But gradually, after we began the TMS treatments, that behavior went away, and she did very well.”

She did well for a while. Samantha completed her initial round of TMS treatments this past summer. After a couple of months, however, she suffered a relapse that resulted in her falling back into some old habits.

“I started slipping back into old behaviors again,” she says. “It started with me restricting what I was eating during the day and being very focused on my calorie intake, my fat intake and my carb intake.

“And just like I did before, I began obsessing over my body image the way I did when I first got out of high school and in college, and I didn’t want to eat. And when I did eat, I’d make myself throw up, so I was purging again.”

The relapse prompted Samantha to go back to Dr. Kawliche, who recommended a second round of TMS treatments. Just as they did the first time, the treatments had the desired effect on Samantha’s depression, anxiety and obsession.

“After only a few days of treatment the second time around, I started feeling a whole lot better,” Samantha says. “My anxiety went away almost immediately, and I noticed I had a lot more energy. I was no longer just sitting around by myself all the time.

“And after a couple of weeks, I was no longer restricting my diet and worrying about what I was eating. I stopped the purging, and now my weight is back to what is normal for a woman my height, and I’m happy with that.

“TMS has made a huge difference in my life. I’m so glad I did this. It has helped me more than I could have ever imagined. I probably never would have done it had I not found Dr. Kawliche.

“He’s just great. And so is everybody in the office. Everyone is nice and welcoming. The atmosphere there is so relaxing and comforting that I actually enjoy my appointments, and I used to hate going to doctors.

“I don’t know where I’d be had I not found Dr. Kawliche. I recommend him and everyone else at Brandon TMS one hundred and fifty percent. They’re the best. They helped me get my life back, and I can’t thank them enough for that.”

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