Lifting the Dark Cloud of Depression

Combination of therapies sparks sunny outlook on life.

It’s not hard to see why Anne-Marie* grew into adulthood thinking a dark cloud followed her wherever she went. She was born in London, England after all, and after living there for 16 years, she and her family moved to Seattle, Washington.

“I just happened to spend the first thirty or so years of my life living in what can sometimes be two of the rainiest, dreariest places in the world,” Anne-Marie says. “Now don’t get me wrong; London and Seattle are beautiful in their own ways.

“But it rains a lot in London, and in the fall and winter, not only does it rain a lot in Seattle, but there aren’t that many hours of daylight on the nice days. That’s one of the reasons why I moved to Florida. I felt like I needed some sunshine in my life.”

She did, but the move came too late to save Anne-Marie from the throes of depression, a condition she’s wrestled with since she was 14. She knows better than to lay the blame for that on where she lived, but she’s convinced it didn’t help her much either.

“I definitely suffered from seasonal affective disorder, where you feel worse when the weather gets bad,” says the 38-year-old violin teacher. “But depression is something I’ve had to fight even on the brightest and sunniest of days.

“It’s something I’ve gotten a lot of help for over the years. I’ve been to lots of doctors and taken more antidepressants than I can remember, but unfortunately, nothing really helped me until I got to Florida and found Dr. Pollack.”

Robert Pollack, MD, is the founder of Psychiatric Associates of Southwest Florida, where he embraces the use of many emerging therapies in his treatment of depression, which he describes as a legitimate major illness.

“Depression Is an Illness”

“Depression is a brain disease,” Dr. Pollack informs. “It’s not an adjustment disorder. It’s not somebody who’s feeling sad. In the same way that cancer and diabetes are illnesses, depression is an illness, and it’s treatable with a multitude of therapies.”

Those therapies include genomic testing, which can determine which antidepressant will work best for a patient, and intravenous infusions of an anesthetic agent called ketamine that can alleviate suicidal thoughts, and acts more quickly than many antidepressants.

Dr. Pollack is also one of an ever-growing number of mental health professionals who have begun offering treatment for major depression through the use of transcranial magnetic stimulation (TMS) and theta-burst stimulation (TBS).

“I was really fortunate to find [Dr. Pollack], because he’s really compassionate. He’s someone who really cares about what he’s doing.” – Anne-Marie

Discovered by a team of researchers at the Medical University of South Carolina in the 1980s, TMS uses short, 10Hz magnetic pulses while TBS uses 50Hz pulses to rouse the part of the brain that is underactive in people who suffer with depression.

These magnetic pulses are similar to those used in MRI stimulation, and they’re delivered through a paddle-shaped device with a magnetic coil that is placed on the prefrontal cortex while the patient rests in a comfortable chair similar to a dentist’s chair.

In the United States, TMS gained approval from the Food and Drug Administration for use in people with treatment-resistant depression and those who can’t tolerate the side effects of antidepressants in 2008. TBS was approved for use ten years later.

The biggest difference between the two noninvasive treatments is the amount of time required for each treatment session and the number of sessions prescribed during a typical treatment period.

TMS treatment sessions last approximately 19 minutes, with patients typically receiving a total of 36 treatments over a period of six to eight weeks. TBS treatment sessions last only three to six minutes and are typically administered daily over the course of two weeks or as the doctor deems necessary.

What the two treatments do have in common is their effectiveness. Studies show that about 40 percent of patients receiving these treatments become completely asymptomatic, while about 60 percent “feel better” but do not consider themselves to be free of symptoms.

Combo Package

Those numbers didn’t quite hold up with Anne-Marie, who first visited Dr. Pollack last summer and initially scored a 21 on a personal health evaluation test in which zero means you’re elated and 27 means you are severely depressed.

Based on that score and his evaluation of her condition, Dr. Pollack began his treatment of Anne-Marie in June by administering TBS treatments. After ten such treatments, however, Anne-Marie said she felt only “a little better,” not significantly better.

A TBS booster shot administered a month later didn’t do her any good either, as Anne-Marie’s mental health score fell all the way to 27. That prompted Dr. Pollack to try ketamine infusions. Like the TBS treatments, though, the ketamine infusions had little effect.

“After that, I sat down and did some head-scratching and said, Let’s see what happens if we pair TBS and ketamine,” Dr. Pollack relates. “The first time we did that was on August 12, and by August 28, her mental health score had dropped to eleven.

“We continued those treatments, combining TBS with ketamine, and by October, her mental health score was six. I’ve seen her a couple of times since then, and her mental health scores have consistently been in the six, seven or eight range.”

This wasn’t the first time Dr. Pollack succeeded in helping a struggling patient by combining therapies. He did it once before by combining TMS, TBS and ketamine in a patient who now only requires ketamine infusions to feel good.

“Most people who do poorly with ketamine tend to do well with TBS,” Dr. Pollack reports, “and most people who do poorly with TBS tend to do well with ketamine. In Anne-Marie’s case, she didn’t do well with either one by itself.

“The thing about TBS and ketamine is that they have an interesting relationship. So what I did was give her TBS as a kick starter and the ketamine to help push it a little further. After just one session, you could already see a difference.”

Anne-Marie felt that difference. After years of “pretending” to feel good around others and more or less plodding through each day, she now has a real energy and vitality that inspires her and carries her through the day.

“My approach to each day used to be, If I fake it, I’ll make it,” Anne-Marie confesses. “And that took a lot of effort because I couldn’t sleep, I couldn’t eat, and I really just didn’t want to do anything. I was always going through the motions.

“That was how I felt when I first went to see Dr. Pollack, but now, since I started the TBS and ketamine treatments, I feel completely different. I actually feel sort of normal in a way that I haven’t felt in a really long time.

“I’m a lot more chatty now, and I have this desire to do things I’ve always wanted to do but never did, like yoga. I’m a lot more outgoing, which is something I really haven’t been since I was in my early teens.

“I don’t think I would feel this way were it not for Dr. Pollack. I was really fortunate to find him, because he’s really compassionate. He’s someone who really cares about what he’s doing. He has a lot of empathy, and my experience with him has been nothing short of great.”

*Patient’s name withheld at her request.
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