TMS: Bringing joy back into your life

Eventually, things got much worse. Soon word spread, and Esty’s extended family became involved. They had plenty of ideas: get more rest, take some help, go on vacation… but none of these ‘solutions’ made a dent. She was stuck in a bleak, endless fog of pain and confusion, a sense of ‘nothing matters,’ not even her own precious children. The three older ones, at eight, six, and four, were bewildered and confused. Baby Chaim didn’t know his ‘normal’ Mommy, but he sensed the tension in the home and wouldn’t stop crying.

 

“Mommy, why are you so sad all the time?” sweet Faigy asked, but Esty was too enveloped in her own fog to comprehend the question that should have broken her heart.

 

“Shh…don’t bother Mommy; she’s resting,” Toby, her eldest, warned the others. “Let me give you a snack.” At the tender age of eight, she had become a ‘little Mommy.’ But the children needed their real mother and began to show signs of neglect.

 

Yanky, Esty’s husband, tried to help as much as he could, but he had a demanding job, and his boss was losing patience with his frequent absences. At first, he hoped Esty would snap out of her moods, but as time went by, it was replaced by despair.

 

An afternoon housekeeper-cum-nanny was hired to take care of the kids and do some laundry. But Esty remained depressed, unable to stay out of bed for more than a few minutes at a time. People began to whisper, chesed organizations were contacted, and Esty’s family became a ‘case.’ Her husband begged her to snap out of it, to go to a doctor and fix what was wrong with her.

 

“I can’t just ‘snap out of it,’ “ Esty whispered, her face contorted in anguish. “I don’t think I’ll ever be normal again.”

 

Eventually, after three months of torture, Esty agreed to see a doctor, who would ‘figure out what was wrong.’ She was seen by a well known psychologist, who promptly diagnosed a severe case of postpartum depression. He prescribed Zoloft, a common antidepressant, and recommended a therapist to help Esty deal with what she described as a ‘blackness and emptiness in my heart.’

 

Esty began the medication two days later, hoping to finally be free of the pain and anxiety that plagued her, the bothersome thoughts that wouldn’t go away. She was forced to wean her baby, and the medication made her insomnia worse. Yet the anticipation of relief, of finally being a normal person again, was the only ray of hope during this difficult time.

 

“The medication may take four to six weeks to take effect,” the doctor had warned. Two weeks went by, and there was only a slight improvement.

 

In the meantime, Esty’s weight dropped drastically. Though she’d been slim to begin with, she began to appear skeletal. She was sleeping only twenty minutes at a time, and couldn’t concentrate on a conversation for more than a few moments. The doctor was called, but he airily assured Yanky that his wife would improve in another two weeks.

 

A month went by. A long, slow, arduous month of little progress. The medication was destroying Esty’s appetite and what little sleep she had. Finally, Yanky had enough. “You’re going off the medicine!” he declared. “We were much better off without it!”

 

Esty threw the bottle of pills in the garbage, and headed off to bed. She remained there for over a week, sleeping most of the day.

 

The next week brought another doctor, another medication, a higher dose. Esty would improve for a few days, and then slip back into depression. Her children were farmed out to relatives, as she was no longer able to care for them at all.

 

In desperation, her husband called askanim, professionals, anyone who could help her. Finally, someone mentioned TMS.

 

“What’s that?” Yanky asked warily, hoping it wasn’t yet another medication or panacea.

 

“It’s a magnetic treatment that is supposed to cure depression,” he was told. “Find out more about it.”

 

After hours of research, Yanky, who lives in Brooklyn, heard that a TMS center was recently opened in Monsey, NY, under the auspices of Bikur Cholim Partners in Health, founded by Rabbi Shimshon Lauber. He called, hesitation in his voice, to ask about the program. What he learned about this cutting-edge technology, which has cured countless sufferers of depression, convinced him to give it a try.

 

Two weeks later, Yanky and Esty traveled to Monsey for their initial treatment, administered by Rockland TMS Director Rabbi Dr. Rehavya Price.

 

“I didn’t know what to expect,” said Yanky. “We’d been through so many ups and downs, so many disappointments over the last six months. I thought this was another hoax.”

 

Dr. Price, dedicated director of the TMS program, was polite and efficient, as he explained how the TMS machine, which looks like an oversized dentist’s chair, works. Esty was wary but aloof, lost in her own world, following directions like a robot. She sat down in the chair, her mind a million miles away.

 

Dr. Price’s voice was soothing. “Now, Esty, we’re going to focus this magnet on the part of your brain called the left prefrontal cortex. You’ll feel a slight pressure, and hear a clicking sound for about four seconds, followed by thirty seconds of silence. It’ll go on again for four seconds, off for thirty. It might bother you at first, but soon you’ll get used to it. Shall we start?”

 

For the next 37 minutes, as Esty sat in the chair, tense and coiled, the magnet rested on the area of her brain that housed the prefrontal cortex. At first, the noise gave her a headache, and all she wanted to do was jump off the chair. With Dr. Price’s encouragement, she remained seated for the entire session, a vacant look in her eye.

 

At last, the session was over. Esty got off the chair, put on her coat, and left. All the way home she sat in silence, too exhausted to speak. Yanky was discouraged. Had they gone all the way to Monsey for nothing? Was this just a quack cure?

 

“I don’t know what to make of this treatment,” he later said to Esty’s parents. “The machine looked sophisticated, and the doctor had great credentials, but it didn’t look like anything was happening. I don’t understand how a fancy magnet can really change anything in Esty’s brain. I’ll give it a chance, but I don’t think this is doing to work.”

 

The following day, the couple returned for the treatment, which must be administered continuously for several weeks in order to be effective. Again, there was no response. It was only after the fourth treatment that Yanky realized something amazing: Esty had begun sleeping through the night!

 

That Shabbos, for the first time since Chaim was born, Esty smiled at her precious baby, whose birth she had so eagerly anticipated. “Hi, sweetie,” she cooed, and then caught herself, startled at the gesture.

 

The changes began happening slowly, creeping up on her, unawares. After only two weeks of treatment, Esty expressed an interest in seeing her children, whom she had cared for only mechanically.

 

Toby, Faigy and Shmully were brought home from their various relatives, where they’d been staying, to ‘say hello to Mommy.’ Esty was sitting up in bed, smiling, and extended her arms to her precious children.

 

At first, the girls were suspicious, and wary of approaching her. Four year old Shmully had no such compunctions. He bounded into his mother’s arms with a gleeful shout.

 

“Mommy, why are you crying?” asked Toby fearfully, drawing away. Esty touched her cheeks. Was she crying? She hadn’t shed a tear since the day Chaim was born. Depression had deadened her senses. Slowly, her emotions were returning.

 

Four weeks later….

 

Esty sat on the floor, building a Lego tower with Shmully. In the infant seat, Chaim squealed, waving his pudgy arms. Toby and Faigy were ‘playing house’ with their collection of dolls.

 

“You be the Totty this time, and I’ll be the Mommy,” said Toby.

 

“No, I wanna be the Mommy,” Faigy protested.

 

“Fine. Be the Mommy. Go into bed and pull the blanket over your head.”

 

Esty shuddered, remembering those long, dark days and lonely nights.

 

And then she heard Faigy’s sweet voice, “No, I’m the Mommy who feels all better now. I’ll wash the dishes, and then I’ll make supper, chicken and potatoes, like Mommy made last night.”

 

Shmully reached for another Lego, and Esty’s heart soared with happiness. “Thank you, Hashem, for giving me my life back,” she whispered.

 

**

 

Depression affects over 14 million American adults every year. Often, depression is caused by an imbalance of the brain’s neurotransmitters, or chemical messengers that send signals between brain cells. The symptoms are most often treated with antidepressant medications, which increase the levels of these neurotransmitters.

 

Transcranial magnetic stimulation therapy (TMS Therapy) is based on knowledge of physical principles dating back nearly two centuries. In 1831, Michael Faraday discovered that a magnetic field could be converted into an electrical current. That discovery has been applied to create a powerful and focused magnetic treatment coil which can be used to stimulate the brain.

 

Since the 1980s, transcranial magnetic stimulation has been used to study the nerve fibers that carry information from the brain to the spinal cord and muscles. In the late 1990s, physicians began to explore transcranial magnetic stimulation for the treatment of depression. Since then, 30 trials studying transcranial magnetic stimulation as a treatment for depression have been published.

 

Transcranial Magnetic Stimulation uses short pulses of magnetic fields to stimulate nerve cells in the area of the brain thought to control mood. TMS Therapy is performed in a psychiatrist’s office under their supervision– while the patient remains awake and alert.

 

The treating clinician positions a treatment coil over the left prefrontal cortex, the part of the brain involved with mood regulation. The NeuroStar TMS Therapy system generates a highly concentrated, magnetic field which turns on and off rapidly. This magnetic field is the same type and strength as that of a magnetic resonance imaging (MRI) machine.

 

NeuroStar TMS Therapy is an outpatient procedure. The typical treatment course consists of 5 treatments per week over a 4-6 week period, for 20-30 treatments. Each depression treatment session lasts approximately 37 minutes. It does not require any anesthesia or sedation.

 

According to Rabbi Dr. Rehavya Price, M.D. professor at Cornell Medical School/New York Presbyterian Hospital and Medical Director of Bikur Cholim of Rockland County Department of Clinical Services, “TMS can help the body heal itself through energy without necessarily having to take medication and without the side effects. There is a lot of resistance and stigma around medication due to shidduchim, and other concerns, where TMS would be a safer alternative. TMS is currently FDA approved for Depression, but studies are currently in progress to apply it to many other conditions such as ADHD, Anxiety, Trauma, Bipolar and Schizophrenia.”

 

In a controlled clinical trial, patients treated with active NeuroStar TMS Therapy experienced a 22.1% average reduction of their depression symptoms. Patients also experienced significant improvement in anxiety and physical symptoms, such as appetite changes, aches and pains, and lack of energy.

 

In another study, approximately half of the patients treated with NeuroStar TMS Therapy experienced significant improvement in their depression symptoms. About a third of the patients treated with NeuroStar TMS Therapy experienced complete symptom relief at the end of six weeks. For more information, call Rockland TMS at (845) 678-6070.