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Greenbrook TMS Care Team Spotlight: A Conversation with Dr. Darlene Ifill-Taylor, M.S
Daniel Hageman
How did you first learn about TMS Therapy?
I’d been curious about it but never had the time to explore it until after years in private practice in Washington, D.C., I came to North Carolina. That’s where I first saw TMS Therapy firsthand. Once I completed Intensive training in TMS at the Medical University of South Carolina with Dr. Mark George, an early pioneer of TMS Therapy, I was on fire about TMS because of the great results seen in this course of treatment for patients struggling with medication-resistant depression.
So when I came back to my work, I went gangbusters on the TMS program at Novant Health, where I sought to strengthen and develop their TMS program and training. Upon leaving my work at Novant, I opened my wellness center and gladly took a position at Greenbrook TMS as their Regional Medical Director in Charlotte in order to do more TMS and let more clinicians know about it and to educate the public about it. After years and years in practice, if you go into medicine for the right reasons, your goal is to get people better consistently . Because there are so many people that don’t respond to antidepressants you want to have a place to go and Greenbrook TMS Therapy affords that.
Is it true that depression can affect anyone?
Yes. Because life is unpredictable. There are events that can happen in a person’s life that can trigger a depressive episode. The loss of a spouse, a divorce, death of a family member, assault- Genetic makeup can put one person more at risk than another person, early childhood experiences, whether they were premature when they were born. There are many congenital or genetic factors that can impact a person’s risk for developing depression, and then there’s life. How someone was raised, whether or not depression was modeled in their home through a parent with untreated depression. There’s many factors. Even with no family history of depression and a fantastic childhood, there are still life circumstances. People should always have their ears and eyes open for it the way we look out for physical illnesses.
Apart from sadness, what are other common symptoms of depression to watch out for?
Isolation is a big one. Maybe you notice that you haven’t been picking up the phone when it rings, or that you haven’t made any contact with family and friends. There could be someone that you regularly talk to and you find a suddenly that you just don’t have the energy to call them. You’re calling out of work twice a week, you don’t want to see people or do things. When your regular interactions become too burdensome, that’s when you should consider that things aren’t right. Insomnia, loss of appetite, feeling worthless or hopeless and not having the energy to do what you used to love to do are important signs. And unfortunately for some, feelings of not wanting to live or wanting to take one’s own life, is a strong predictor of Major Depression and should be attended to immediately.
Can untreated depression affect parenting?
Children are so keen, they know what’s going on with their parents. When a parent is suffering with untreated depression, that child notices that the parent is isolating, doesn’t want to play with them like they used to. It’s a loss. With a depressed parent, the child notes the facial expressions, the lack of energy, they perceive the lack of joy. I talk to a lot of adult patients with depression who say “Oh, my mother absolutely had untreated depression” or “My father was definitely depressed. He might not have thought about it that way, but he definitely was.” Once they realize it after going through their own depression and recognize their parent in that, it make a strong impression. Once the depression has been treated, patients notice their relationships with their own children improving. Good parenting requires high energy and a Major Depressive episode saps that. After treatment, their decision-making is better, their irritability is decreased. Patients find themselves enjoying spending more time with their children.
What’s something that you love about the work you do?
The feeling that I get when a patient looks so much better and is able to say that their experience is so much improved. I’ve had patients tell me “you have saved my life.” Utilizing TMS Therapy, I will say that I’ve experienced more of seeing people turn around and so it’s definitely something that’s worth people knowing about. I genuinely believe that someday, TMS will just be par for the course as treatment for depression the same way antidepressants are now. I consider it a privilege-being let into someone’s life in a way that improves it.
What do patients notice about themselves when Greenbrook TMS Therapy starts working for them?
One of the first things is more energy and motivation to get things done as well as improved sleep. They’ll tell me that they’ve noticed they were the one in their family who took the dog out for one of its walks yesterday. They noticed that they actually wanted to make their special lasagna last week, for the first time in two years. With untreated depression, the little joys that we have, the little things we love to do, they’re just gone.
One of my patients had told me that she was driving and stopped on the side of the road to check on something with the car she was towing. When she stopped, she noticed that next to her was a forest, with the sun coming through the trees. It was beautiful-she said. And my patient says she just stood there looking at it. She told me, “Those are the things I used to love. The beauty of nature. For 10 years, I hadn’t noticed it.” Those are the things we take for granted: that we can look at something beautiful and feel it. With depression, that just doesn’t happen and with TMS we often can get it back.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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