TMS THERAPY
FDA-cleared, non-medication depression treatment
Greenbrook TMS Patient Journeys: Josephine
Josephine is a 67 year old retired teacher from Missouri. She completed treatment with Greenbrook TMS six months ago. We spoke with her to learn more about how she found her way to Greenbrook TMS and what life has been like since completing treatment.
What was depression like for you?
My father died in 1996. I was just so sad, and as the sadness left me as time went on, the general sadness of depression continued. And that’s what I couldn’t figure out. Even though I was on Prozac I continued to be sad. It worked for a little while and my doctor kept switching my antidepressants but over the course of decades nothing really helped. I would still suffer bouts of depression. I remember experiencing depression at one point where I couldn’t even talk, which was probably the most painful experience I had because I was totally non-functional. I would have much preferred a serious physical disease because depression is just so misunderstood and just so debilitating.
How did you first hear about Greenbrook?
When I moved to St Louis, I happened to go on the internet and found you. I read about TMS therapy and I thought okay, why not give it a try? I must admit that I was skeptical that it would work, I really really was. But I was at my wit’s end.
The medications just weren’t working. Even when I had good events or the uplifting spirits that holidays bring, I wasn’t feeling that.
I had gone through a lot of changes and all the stressors of moving and I thought, I have to take action. I can’t do this myself.
When did you start noticing a change?
I noticed a difference after two weeks, it was unbelievable. I quit crying, I had a real lift in my mood, and I started telling everybody about it. My close friends would remark and compliment me and say “Wow! That’s our old Josie.” They were very sweet. I couldn’t be more pleased. It was helpful when I would go into the office to talk to people going through the same thing. I remember one older gentleman who would come in the same time I did, and I just noticed that he started smiling more and talking to me more. He became more cheery.
When I was in the waiting room, I would go at the same time every morning for treatment and I felt like I was in a cohort group because some people would come in at 10 or 11 am and I would run into them every day. I would ask them how they’re doing and we had all sort of connected. And they were all doing really well, too—people of all ages. It really gave me hope.
What's changed for you after Greenbrook TMS?
I used to get tremendous pleasure out of reading, but I’d given that up. Now I’m back to reading again. I enjoy those simple pleasures. It’s not like I have to win the lottery to be happy. I just became more active, I went back to my fitness habits, I enjoyed cooking again, entertaining friends. It really helped me socially. I remember that I wanted to be with people. By nature I’m an introvert but that sort of changed. I talk to people more often, even strangers. And it was fun! It gave me more fun in my life. I don’t know how you quantify “fun” but on a fun scale I really really went up. And I noticed it truly after 2 weeks. I really noticed that I became more honest with people. I was able to explain my depression. Before I was ashamed of it but I no longer felt ashamed because I was proud of my improvement.
What was it like going to treatment every day?
I had wonderful Technicians that were very kind and entertaining, so every 20 minute session would go by so fast and I really looked forward to them because I had this attitude that with every session, I was getting better.
And the TMS technicians were so good at explaining everything to me, and they talked me through everything. I felt like we were a team. It was very important to me to have that connection with them. All of them were excellent people.
They weren’t always the same people but I knew them by name but they really believed in the treatment and that helped me believe in the treatment. So kudos to them! They were so committed to it, I could feel it. It wasn’t just a job to them. It made me feel normal. I didn’t just give them answers they wanted to hear, but I told them the truth.
How do you handle stressful situations nowadays?
Now when I face situational depression, I’m able to recognize it and say “this too shall pass” because everyone faces tragic events and stressors in their lives and then it goes away. I’m able to recognize the difference between ongoing depression and situational depression. I just feel stronger and I’m able to bounce back in a rational way. It really helps to know that depression is a brain malfunction. It’s not that something is wrong with me emotionally, but it’s hereditary in my family. I’m not unique-- other people go though this too.
What would you say to someone considering TMS therapy?
If I’d known about this before, I would have gotten treatment sooner. I had gotten to the point where I was hopeless. I’d just tried everything. I’ve come to realize that antidepressants aren’t cookie-cutter. Everyone’s brain is different. I consider myself a well-balanced person but this depression was just a plague that went on for decades.
I couldn’t brag more about the results. I’m off all of my antidepressant medications. If my depression ever comes back, I wouldn’t hesitate to go back to Greenbrook TMS.
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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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