Repetitive Transcranial Magnetic Stimulation or rTMS for short, has been around for quite a while. It is a mental health treatment that was developed in 1985. It hasn’t entered into mainstream practice in a lot of places just yet, but it is gaining popularity. Up until 2 years ago, I hadn’t heard of it either.
So what is rTMS and what does it claim to do?
Here’s my rather informal explanation. rTMS is a magnetic pulse that quickly zaps your brain which in turn stimulates specific brain nerves that are thought to be involved in mood control. The idea is that this stimulation might “wake up” parts of the brain that are stuck in “off mode” due to depression or other conditions. If you want a more technical description check out this Mayo Clinic article here.
Right now it’s mostly used for depression, and there have been good research results on other mental health concerns, particularly PTSD. rTMS involves very little risk and has minimal side effects. The main limitations are that you can’t do the treatment if you have metal in your head, you are pregnant, or if you have seizures. It can also be quite expensive, luckily here in Canada, it is fully covered by our healthcare system.
How did I get here?
My road to learning about rTMS was about on par with my unusual life. A new clinic opened up in my city, and I was commissioned by their office to make some social media graphics. I had no idea what they did, so I had to research it all before I could do any creating. I found it interesting but for some reason, I didn’t put it together that it could be an option for me.
Long story short, about a year after this encounter, I was going through a rough time. I have depression and CPTSD, and both were especially activated. After attempting a few medication adjustments, without a lot of success, it dawned on me that I should ask if I could try rTMS for myself- so I did exactly that.
I had my initial assessment with the psychiatrist and it was decided that yes I was a good candidate. After that, the first step was to do what is called mapping. This is where they determine the specific strength of pulse that meets your threshold and your unique spot on your head. They have you wear a funny cap, they mark down your placement, and you wear it each visit.
What’s it like?
In the past, it used to be a longer appointment, about 40 minutes, but newer machines have been sped up a lot. Now, most people do a treatment that takes 3 minutes, or if you are one of the unlucky ones who need a high strength zap, then treatments take 20 minutes. I’m in the 3-minute group, and I’m usually in and out in less than 15 minutes. As far as time is concerned, the biggest commitment is that you go in every weekday for about 6 weeks. They start you on a lower pulse than needed and work their way up to your strength over a few days.
It’s hard to explain what it feels like, and I’m sure each person comes up with their own clever description. I’d say it’s a bit like a robotic pen being clicked inside my head. It certainly doesn’t hurt, it just feels bizarre, but eventually, it gets to the point where it barely feels like anything. Another thing to know is that they have you wear earplugs each time, I wouldn’t call the machine loud so much as noisy.
I had almost no side effects, and most of them only lasted for the first few days. I experienced something that was not quite a headache, but rather a little more like feeling “fuzzy”. I also felt some mild tenderness at the spot of treatment. The only side effect that lasted longer was that on some days I’d feel some heavy tiredness, I really noticed this on Mondays after my weekends “off”.
And while this wasn’t a direct side-effect, in those first few weeks I had several appointments during or after, and my nervous system was particularly annoyed.
Did you feel better?
I didn’t notice anything much until around 3 weeks in. It was then that I noticed my “get-up -and-go-ability” was markedly better. When I’m not doing well, there is no such thing as having an idea and then just doing it. It’s more so a drawn-out process of me convincing myself through the various steps which can take hours or days. All of a sudden I found myself in situations where I’d have a thought like “I need milk” and 5 minutes later I’d be driving to the grocery store. Woah this is new.
I also noticed an improvement in my ability to be curious and compassionate when I had negative emotions, rather than being immobilized by them. In some schools of therapy, this is referred to as “riding the wave”.
I also have to insert a bit of honesty here. At this 3 week mark I (no word of a lie)- landed my dream job that I’d been plotting to get for about 5 years. And I also want to point out that going somewhere supportive for 15 minutes a day for an entire month and a half, is likely to have some positive effect on your well-being.
So what was it that really helped me, I’d say in all likelihood it was a mixture. I also know that there have been other times when I’ve been unwell, exciting things have happened, and my symptoms remained regardless.
What’s the plan now?
How folks go about maintenance treatments is unique to each individual. Typically you do go through a period of tapering that may be 2 weeks of every other day, 2 weeks of 2 times a week, weekly, and then whatever seems to work. Some folks continue on a schedule of every other week or maybe once every 6 months.
After a few weeks of trying just once a week, I was feeling overly emotional and easily triggered. We decided to stick with twice a week for a while and lower it again later on. It’s now been nearly a year and I’m still going the same amount, my personal schedule is pretty flexible and I decided if it seems to work for me why fix what isn’t broken? Though I would like to lower it eventually I’ll wait for when it feels right.
So what about your CPTSD?
When I first was going to my appointments, I was in a very activated state, due to having gone through some pretty extreme triggers. This tends to make a lot of things more difficult for me, which regularly includes medical appointments. My nervous system goes on high alert and it attempts to warn me of what it perceives as danger, even though there rarely is any. When my nervous system is cranky this often means high anxiety and a lot of crying.
Pretty early on the tears arrived in my appointments. All the techs were kind and upheld a shame and judgment-free environment. We worked it out that sometimes it’s helpful for me to have 2 minutes before we get anything started just to chat about dumb stuff. I told them I often like it if someone can hold my hand if I request it, which was agreed. They discovered I like juice boxes and cookies (who doesn’t) and magically one is left out for me at each appointment. They don’t have to do that, but little things like that signal to my brain that I’m safe and cared about. And there was probably other stuff that I’d forgotten about already.
I still get my two-minute chat and my tasty treats, and I no longer need the other support but I’m happy to know I could ask again if needed.
They also embraced my quirky need to make everything a celebration which often results in taking photos and videos for social media.
I do think rTMS helps me, I certainly wouldn’t continue going regularly if I didn’t. Specifically how much it impacts my brain is up for debate. It’s not a replacement for my other treatments, I still take a large handful of medications and go to regular therapy. Now I’ve added this into the mix and I feel it improves things by about 10-20%.
If you have difficulties similar to mine, whether or not rTMS would be helpful for you is unknown. You can only find out by giving it a try. I’m glad that I did, and you may be too!
If you’d like to follow along with my journey, you can find me on Instagram as @mentalhealthyxe
If you’re a visual person here is a video of the process, which I think shows nicely that it isn’t painful and pretty laid back experience.
Heidi Fischer is a mental health advocate who lives in Saskatoon, Canada. Heidi enjoys writing about her personal experience with C-PTSD, Depression, and Anxiety. Heidi is the creator of a popular mental health Instagram called @mentalhealthyxe and can also be found on her website mentalhealthyxe.com.