Bipolar 2 From Inside and Out

Posts tagged ‘treatments’

Is TMS Right for You?

On Tuesday, when I went to my psychiatrist’s office, I noticed a large display of brochures for Transcranial Magnetic Stimulation (TMS). My husband, who was with me, asked about it, so I told him what little I knew about what it is and what it’s supposed to do. But I realized that I’ve never investigated it thoroughly. When I was considering ECT, TMS was rather new and not an option offered to me. Then a change in medication alleviated my treatment-resistant depression at last. When we got home from my appointment, I thought I’d look into TMS further.

What Is TMS?

TMS, sometimes called rTMS (for repetitive TMS), is a non-invasive treatment for long-term depression (and perhaps a few other conditions such as OCD, PTSD, migraines, epilepsy, and even nicotine addiction). It differs from vagus nerve stimulation and deep brain stimulation because it doesn’t require surgery or cutting the skin.

TMS involves placing electromagnetic coils on the patient’s scalp and moving them around until they have the desired effect. The procedure targets areas of the brain that show decreased activity in patients with depression and is thought to activate those areas.

Calibrating the magnetic coils and determining their placement happens at the initial appointment. For subsequent appointments, the coils are simply placed at the effective points already determined. TMS only affects areas of the brain that are close to the surface. Sessions are required five days per week for several weeks. Each session lasts approximately 20 minutes or sometimes less.

TMS doesn’t require anesthesia and can be performed as an outpatient procedure in a provider’s office or a clinic. You don’t have to have someone to drive you home afterward, though you may want to for your first session until you know how TMS will affect you. Symptom relief can occur after several weeks of treatment.

TMS is FDA-approved, and most insurance plans cover it if you meet certain criteria, like having no effect from several antidepressant medications. Many also cover repeated treatments if the effects wear off. Deep TMS, in which the electromagnetic pulse reaches deeper into the brain, is FDA-approved for OCD and nicotine addiction when standard treatments have failed, but is off-label for other conditions.

Outcomes

Approximately one-third of people who undergo TMS experience full remission of their depression. Fifty to sixty percent report improvement of their symptoms. Most patients, however, experience remission lasting for months after the treatment, with positive outcomes averaging somewhat more than a year. But the results are not permanent; there is a high rate of recurrence. Patients can engage in multiple rounds of treatment after the effects wear off. For patients who don’t respond to TMS, ECT is often considered.

Side Effects

One of the first things I learned about TMS was that I wouldn’t have been a good candidate for it. My illness is bipolar disorder, which has a mania component, and one of the possible side effects of TMS is mania. And I might not qualify for it now, as I have metal implants in my body, which is sometimes a contraindication. Although TMS is sometimes recommended for bipolar depression, I’m not sure I would like to risk it. I would have talked it over with my psychiatrist.

TMS has other potential side effects as well, though not the memory loss that can accompany ECT. In addition to possible mania, TMS carries the risk of seizures, as well as hearing loss if the ears aren’t properly protected. More common side effects include headaches, scalp pain, lightheadedness, and twitching facial muscles.

Pros and Cons

The relatively high success rate is certainly a selling point. Even better outcomes are expected for TMS guided by fMRI for more precise placement of the magnetic coils. Although seizures can occur, the rate is approximately 1 in 10,000 sessions. In addition to alleviating depression, TMS may also reduce suicidal ideation. If you’re taking medications for depression, they will not interact negatively with TMS. Many clinics offer the procedure.

On the other hand, TMS is not for everyone. The treatments can be time-consuming. And some practitioners don’t treat patients under the age of 18 or over 65. If you’re not insured, the procedure can cost $6,000 to $15,000. Advanced equipment and the costs of added therapies can boost the total to $30,000.

Only you and your doctor can determine whether TMS is worth trying. But if you have longstanding, treatment-resistant depression, you may want to explore the possibility.

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Living With a Bipolar Family Member

Let’s start with this: A bipolar family is like any other family. They have good times and bad. They live with each other; they fight with each other; they care about one another. They deal with each other’s differences and problems. But they have the added stressor that one or more members of the family have bipolar disorder.

What does this mean for a family? It does mean that there are likely to be difficulties that other families don’t face. Depending on how severe the disorder is, whether the family supports their relative in getting treatment, and the resources available to them, their lives will look quite different.

My Family

My family was unprepared for me to develop bipolar disorder. They knew that I was different, and often didn’t know what to do with me, particularly when I went into depressive episodes and retreated from the world, crying hopelessly. I remember this happening in seventh grade in particular. I had been publicly humiliated at a birthday party and spent days curled up in a bean bag chair, sobbing uncontrollably. My parents knew that something was very wrong.

Nothing happened for quite a while. When I was in high school, my behavior had gotten so off-kilter that it was recommended I go see the district psychologist. My parents left the choice up to me, and I didn’t go, for reasons that now seem completely ridiculous. I should have taken the opportunity.

Later still, when I was diagnosed and medicated with Prozac, my family was encouraging, but had some issues. My mother, who got a lot of her information from TV talk shows, said she had heard that Prozac was a “ticking time bomb.” My father had no objection to my therapy as long as he didn’t have to go (which no one had ever mentioned). But they continued to give me love and emotional support throughout, though they never really understood my condition or what I was going through. I don’t think they ever did, but they never gave up on me.

Other Families

I think it’s vitally important for family members of someone with bipolar disorder to learn all they can about the disorder. This will require bravery and openness on their part. But learning all you can about bipolar disorder will help you help your family member in the best possible way.

Of course, the kind of support a person with bipolar needs will differ greatly depending on how severe their symptoms and their disorder are. If they are subject to mild to moderate depressive phases, don’t try to “cheer them up.” It won’t work. Instead, talk therapy and/or medication, or, if they’re in a more severe depressive phase, an alternative therapy like TMS or ECT may be called for. Hospitalization is definitely an option if the family member has suicidal ideation.

If they’re in a manic phase, don’t just tell them to “calm down.” That won’t work either. Instead, help them be more grounded and keep potentially harmful behaviors in check. How you do this will vary depending on how their mania manifests. If they are given to reckless driving, for example, you keep the car keys and drive them where they need to go. If they’re an overspender, keep the credit cards and PIN numbers out of reach.

Help your bipolar family member in specific ways. Encourage them to seek therapy. If needed, drive them to their therapist appointments. Pick up refills of their medications for them. Get them a pill caddy to make it easier to take their medications as prescribed.

If your family member is experiencing delusions or psychosis, don’t argue with them about hallucinations, which are very real to them. They may also be suffering from anosognosia, which means they don’t even recognize that they are ill. You may have to intervene more directly, whether that means taking them to the emergency room or admitting them to a psychiatric facility. Do all you can while keeping yourself and the rest of your family members safe. If you or your loved one is in immediate danger, don’t wait—take action!

Kinds of Support

It may seem that you are taking agency away from your family member, and that is to some extent true. But until they’re more stable and able to demonstrate agency over their own condition, helping them negotiate the practicalities of their illness is likely the best thing you can do. You can’t change your family member’s disorder or change them; in most cases, all you can do is support them.

Remember there’s help available. In addition to your local or county National Alliance on Mental Illness (NAMI) chapter, you can get in touch with Depression & Bipolar Support Alliance (DBSA), the Bipolar Caregivers website, or bphope.com, which has online support groups. That last link will take you to a page that lists other organizations and resources that may be available to help you.

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I Don’t Care If They Discover the Cause of Bipolar

Recently there have been several so-called “breakthroughs” in discovering the cause of bipolar disorder.

And I really don’t care.

Whatever they decide the cause is, I still have bipolar disorder. No matter if it’s toxoplasmosis, gut bacteria, or faulty synapses that are behind it, I still get to experience the lows and (sometimes) highs, the apathy and psychological pain, the weeping and despair, the irritability and touchiness, the anxiety and the gloom.

Knowing the cause will not alleviate my symptoms one bit.

I know that people believe that discovering the cause will bring us that much closer to a cure.

But will it really?

If the cause is genetic, how am I supposed to go back and change my genes? Or does anyone really believe that gene therapy will be available to the mentally ill when even hospital beds are denied them?

If the cause is viral, does that mean that a cure is right around the corner? We now know what virus causes AIDS – HIV was discovered in 1983 – but nearly 35 years later, a cure is still far away. Yes, there are treatments that improve health and extend life, but there are also treatments that alleviate some of the symptoms of bipolar disorder. Will any advances be orders of magnitude greater, or merely incremental? And how much money will be devoted to finding those treatments when Huntington’s disease, multiple sclerosis, and a host of other conditions are still without a cause, a cure, or sometimes even minimal treatments?

With most bipolar sufferers being treated (if at all) in community mental health centers, via EAPs, or through six-weeks-and-out insurance programs, what are the odds that any new breakthroughs and any new treatments that result will be available to the bipolar-on-the-street (or in the group home or even at home or at work)? Will someone really arrange MRIs or TMS or brain implants for the homeless?

With bipolar disorder once again considered a pre-existing condition and not given parity with physical ailments for insurance purposes, will any advances trickle down to us at all?

What do you want to bet that any breakthroughs regarding the causes of bipolar disorder will lead to more pharmaceutical research and yet another pill that costs more than the average person can pay or the average insurance will reimburse? And how long will that treatment take to get through the FDA pipeline to reach the people who need it?

Nor is knowing the cause of a disorder necessary to cure it. Isaac Semmelweis didn’t need to know the cause of childbed fever, a disease that killed thousands – perhaps millions – of new mothers. Germ theory wasn’t even developed until decades later by Lister and Pasteur. But Semmelweis knew that if only doctors washed their hands between conducting autopsies and putting their hands in pregnant women’s vaginas, the death rate would decrease.

So when I hear that there’s a new theory on the cause of bipolar disorder – and they seem to be coming with increasing frequency – I say, “Where’s the treatment? Where’s the cure? Who will be able to access it? Who will be able to afford it? When will it produce positive results for me and those like me?”

Get back to me when you’ve found something that will help. Until then, keep splicing your genes and culturing your bacteria and stimulating your synapses. I’m getting pretty good results with what you’ve already discovered. For now.

Don’t keep raising my hopes until you have something more than “mights” and “some days.”

 

 

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