ABOUT DEPRESSION

We Are Here For You

The darkness of depression descends on the afflicted individual like a thick dark cloud, isolating them from the reality they once knew.

While in the throes of a major depressive event, feelings of despair and hopelessness crowd out the remnants of former joy and pleasure, making the mere thought of happiness seem like a distant memory. The enormous energy needed to even get out of bed in the morning cannot be mustered, so solitude and inactivity become the daily reality of the depressed person.

Depression in America

Depression impacts a staggering number of people; a whopping 16.1 million adults in the U.S. suffer from this debilitating disease. At least one-third of the people who suffer from depression never seek depression treatment or the help they need, believing that it will eventually resolve on its own. Well-meaning efforts by friends and loved ones can fall flat, as they are not equipped to even begin to understand the complexities of a depressive illness. Sometimes, even, their attempts to cheer up their depressed loved one can result in that person pulling further away out of frustration and shame.

Signs of Depression

At the core of most depressive illness is a chemical imbalance in the brain. Thankfully, study after study is demonstrating that transcranial magnetic stimulation (TMS) for depression treatment can help to reset and re-balance the brain’s chemistry, offering hope to those who suffer from this often unbearable condition.

Deep Sadness

Pervasive sense of sadness, hopelessness and/or worthlessness

Low Energy

Fatigue and lethargy, sleep disturbances – either insomnia or sleeping in excess

Small Changes

Changes in eating habits, resulting in weight gain or loss

Lack of Interest

Loss of interest in activities once enjoyed

Mood

Irritability, anger, and agitated states

Suicidal

Suicide ideation and preoccupation with death

Understanding Depression

Knowledge Helps to Heal

Causes of Depression

The exact cause of depression remains a mystery, but many factors have been identified that may contribute to depression.

Depression strikes people of all races, socio-economic groups, gender, ages, and ethnicities. In recent years, teens have been particularly impacted by depression, with suicide now the third leading cause of death among young people aged 15-24. Women are twice as susceptible as men in experiencing a depressive illness. The following are just some of the possible contributors attributed to depression:

Genetic and biological factors. First-degree relatives of people with severe depression are more likely to also suffer from this mental health condition than the general population. Biologically, various areas of the brain are likely involved. Neuroimaging of the brain of a depressed person reveals a smaller or less active amygdala, hypothalamus, and anterior cingulate cortex.
High stress life events. Significant events, both positive and negative, can trigger distress, including starting a new job, moving, marriage or divorce, having children, or retirement, to name a few.
Long-term illness. Although it is a physical illness, being bedridden or having physical activity severely limited can trigger depression.
Traumatic past events. Physical, emotional, or sexual abuse can contribute to a depressive illness, sometimes years after the traumatic event occurred. Being brought up in a dysfunctional home environment where addiction, neglect, or mental illness was present can also cause latent depression.
Being female. The reproductive and hormonal fluctuations that women experience via the menstrual cycle, pregnancy, and childbirth are key contributors to mood shifts.
Age. Hormonal fluctuations are more pronounced in young people, making them more vulnerable to developing a depressive disorder. Seniors may also develop depression due to the ending of their career, loneliness after the loss of a spouse, or deteriorating health.

Symptoms of Depression

Knowing what to look for is half the battle when it comes to diagnosing depression.

A distinct change in the demeanor and habits of a loved one that lasts more than two weeks signals that something is causing them pain and distress. The primary symptoms of a depressive illness include:

Anger and frustration expressed, even over seemingly small matters
Persistent feelings of sadness, hopelessness, and emptiness
Slowed thinking and movements
Agitation, anxiety, and restlessness
Loss of interest in normal activities once enjoyed, such as sports, hobbies, or sex
Sleep disturbances, either sleeping in excess or insomnia
Changes in appetite and eating habits, resulting in weight gain or loss
Feelings of guilt and worthlessness, feeling like a failure
Trouble concentrating, remembering things, or making decisions
Unexplained physical problems, such as headaches or back pain
Obsession with death and dying, or suicide attempts, or suicide

Children and teens may exhibit slightly different symptoms. Common signs of depression among children may include clinginess, worry, refusal to go to school, sadness, irritability, becoming underweight, and complaints of aches and pains. In teens, symptoms may include feeling negative and worthless, feeling misunderstood, extreme sensitivity, angry outbursts, eating or sleeping in excess, self-harm, avoidance of social interaction, and using drugs or alcohol.

Types of Depression

The spectrum of depressive illness includes specific traits that define the type of depression being experienced. These include:

Major Depressive Disorder (MDD)

Major Depressive Disorder is the most common type of depression, and is also referred to as clinical depression. MDD falls within the defined FDA guidelines that allow for insurance to cover TMS for depression treatment. MDD is episodic, with each episode lasting at least two weeks, but can last months or years. MDD is frequently co-occurring with anxiety, which TMS therapy can also help to alleviate.

Persistent Depressive Disorder (PDD)

PDD is also referred to as dysthymia or chronic depression, characterized by a continuous, but usually less severe than MDD, form of depression. Both PDD and MDD share common traits, such as both causing overall low mood and a lack of interest in hobbies and activities once enjoyed. Both can also make normal daily activities and tasks difficult to perform. Because PDD and MDD can be difficult to differentiate, those who have been diagnosed as PDD may actually satisfy the criteria for MDD, thus satisfying the insurance coverage criteria for TMS treatment. Because of this, it is important to pursue a second opinion, if necessary, in order to determine the best depression treatment plan.

Bipolar Disorder

For years, this was more commonly known as manic depression or manic-depressive illness. That’s because it consists of the following two mood states: mania and depression. Symptoms are typically quite severe in both categories and are not to be confused with typical mood swings many people experience on a day to day basis. Bipolar disorder includes extreme lows with difficulty or inability to function, as well as extreme highs with racing thoughts or high-risk behavior. The following are the several different forms of Bipolar Disorder:

Bipolar I Includes manic or mixed states (depression and mania together) lasting at least 7 days and depressive episodes that occur for 2 weeks or more
Bipolar II Consists of what is called hypomania, episodes that are not as extreme as full-blown mania. Also includes depressive episodes
Bipolar Disorder Not Otherwise Specified (BP-NOS)–symptoms include mania and depression but are not as extreme or do not meet the criteria for Bipolar I or II
Cyclothymic Disorder—episodes of hypomania and mild depression that last for at least two years with milder symptoms than those listed above
Rapid-Cycling Bipolar Disorder—typically seen in people who have an earlier onset of bipolar disorder, sometimes mid to late teens, with episodes that quickly switch between mania and depression or both at the same time

Postpartum Depression

Postpartum depression affects 10-15% of new mothers in the 12 months following the birth of a child. Symptoms last more than two weeks and include feelings of sadness, hopelessness, and guilt. Those afflicted may feel irritated and angry, have difficulty sleeping or eating, and have problems concentrating or staying focused. Sometimes these new mothers feel disconnected and can’t seem to bond with their baby. Many who suffer from postpartum depression are reluctant to seek help, out of fear of having their child taken from them. Postpartum depression treatment can be achieved through TMS that can help ease or alleviate depression before and after pregnancy, including through the breastfeeding phase, where antidepressants would not be permitted.

Psychotic Depression

Also called depressive psychosis, it combines a major depressive episode (MDD or bipolar) with psychotic symptoms. The psychotic symptoms consist of delusions and/or hallucinations. Delusions include themes such as guilt, shame, punishment, and low self-esteem. The hallucinations are typically auditory, visual, olfactory, or tactile (involve the sense of touch).

Seasonal Affective Disorder (SAD)

To date, the cause of Seasonal Affective Disorder is unknown. The symptoms of SAD typically begin in the fall and last through the winter months, with the most severe symptoms during the darkest months. SAD is thought to be caused by reduced sunlight, which changes brain chemicals and leads to the depressive symptoms. Factors such as high melatonin levels, low serotonin levels, and low levels of vitamin D are associated with the disorder. Symptoms include fatigue, trouble concentrating, apathy, loss of interest in sex, decreased activity level, overeating, insomnia, anxiety, and crying spells.

Depression Treatment Options

Thankfully, there are several options available for depression treatment. Recognizing the ongoing symptoms and then taking the first step in meeting with a mental health professional for a thorough screening and evaluation is key. The treatment options for managing or curing a depressive illness include:

Medications

Medications such as antidepressants, mood stabilizers, and antipsychotic medications are typically the first line of treatment for depression. Selective serotonin reuptake inhibitors (SSRIs) include Prozac (fluoxetine), Paxil (paroxetine), Lexapro (escitalopram), Celexa (citalopram), and Zoloft (sertraline). Serotonin and norepinephrine reuptake inhibitors (SNRIs) include Cymbalta (duloxetine), Effexor (venlafaxine), and Pristiq or Khedezla (desvenlafaxine). Side effects of these medications can include sleep disturbance, sexual dysfunction, headaches, weight gain, and intestinal problems.

Psychotherapy

Professional psychological therapy can be provided by therapists, counselors, and psychologists as a method of depression treatment. There are various approaches to psychotherapy available, but for treating depressive illnesses it has been found that cognitive behavioral therapy (CBT) is the most effective. In addition, family or systems focused therapy or interpersonal therapy are also effective treatment modalities. A psychiatrist provides minimal actual psychotherapy, but is licensed to prescribe proper medications, as well as to prescribe TMS or ECT therapies.

Electroconvulsive Therapy (ECT)

ECT has been in use since the 1930s, and involves delivering electric currents into the brain with the goal of triggering short seizures. As a result, it can be effective in causing shifts in the brain chemistry that reduce the symptoms of mental illness, including depression. ECT has been found to be successful when other traditional depression treatment methods have failed to provide relief from symptoms. ECT is an invasive procedure that requires sedation with a general anesthesia. Side effects can include confusion and memory loss.

Transcranial Magnetic Stimulation (TMS)

TMS therapy has also been proven to be a highly effective therapeutic depression treatment, but with advantages over ECT. TMS involves the use of a coil to deliver electromagnetic currents through the scalp to the prefrontal cortex. TMS is noninvasive and requires no sedation or medication. The depression treatment procedure itself is easily tolerated with mild, if any, side effects. Patients are alert throughout the session and are able to return to their normal activities immediately following treatment.

Additional Treatments and Therapies

There are various self-management strategies available to help alleviate the symptoms of depression. These include the practice of yoga, meditation, massage, prayer, and physical exercise. Mindfulness training has been found to help control some of the negative self-talk and anxiety related to depression. A nutritious diet is also a key factor in attaining improved mental health.

Depression and Suicide

Depression, anxiety, and suicidal thoughts have no socioeconomic boundaries. Mental illness can affect anyone at any stage of their lives, and the effects can be as devastating as any other disease or disorder.

According to the Centers for Disease Control and Prevention (CDC), “in 2016, suicide was the tenth leading cause of death overall in the United States, claiming the lives of nearly 45,000 people” (2018). Studies have shown that 50% of people who commit suicide suffer from depression.

One may be at risk for suicide if they start talking about:

Being a burden to others
Feeling trapped
Experiencing unbearable pain
Having no reason to live
Killing themselves

At Achieve TMS East, we understand the correlation between depression and the risk of suicide. In order to help those at risk, we believe that it is important to understand the warning signs; therefore, we would like to share The Anxiety and Depression Association of America (2018) guidelines for people at risk for suicide below:

Specific Behaviors to look for:

Increased use of alcohol or drugs
Looking for a way to kill themselves, such as searching online for materials or means
Acting recklessly
Withdrawing from activities
Isolating from family and friends
Sleeping too much or too little
Visiting or calling people to say goodbye
Giving away prized possessions
Aggression

People who are considering suicide often display one or more of the following moods:

If you are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. http://www.suicidepreventionlifeline.org

About Depression and TMS

Approximately half of patients being treated with medications alone to treat a depressive illness do not experience relief in their symptoms.

Thanks to TMS, these patients now have another option for depression treatment, and without the side effects associated with medications. TMS therapy helps to reset and rebalance the neurotransmitters that have become inactive or less active due to depression, restoring healthy brain function.

Because TMS therapy is noninvasive and requires no sedation, it is a safe, holistic depression treatment solution. The daily sessions involve being seated in a comfortable chair, and then having our TMS certified technicians place the helmet at the correct strength level and coordinates for the TMS pulses, as predetermined by an Achieve psychiatrist. Over the course of the 4-6 weeks of treatment (five days per week with a tapering period), the strength of the pulses may be adjusted. If treatment for anxiety is also prescribed, that can be included in the sessions using a different positioning of the coil.

The FDA cleared the use of TMS in 2008 for the treatment of medication-resistant major depressive disorder. For patients who have tried antidepressants without success, insurance will usually cover the cost of TMS treatments. Contact Achieve TMS East for a free consultation today at (877) 297-5816.

Insurance Coverage for TMS

Insurance accepted for treating Depression, specifically TMS therapy, has more than doubled in the last few years, a sign that insurance companies must see cost savings in a treatment method for major depressive disorder (MDD) that works more efficiently than the traditional regimen alone. Patients who continually suffer from the debilitating effects of medication-resistant depression may acquire other health conditions as a result, such as a substance abuse disorder or unhealthy weight gain, to name a few. The fact that more and more insurance companies are providing coverage for TMS indicates a cost benefit to the insurer, thus the broadening of benefits. The following are some of the insurance plans currently working with Achieve TMS East: Aetna, BCBS, BMC, Cigna, Commonwealth Care Alliance, Fallon Health, GIC, Harvard Pilgrim, Husky, Masshealth PCC Plan, Medicare, Neighborhood Health Plan, One Care, Tricare, Tufts Health Plan, and United Health Care. If you don’t see your plan listed, please call and ask us about yours today.