TMS THERAPY
FDA-cleared, non-medication depression treatment
Is Depression a Chronic Illness?
Daniel Hageman
Some people with depression may be reluctant to pursue new treatment options because they believe that nothing will work for them or that their persistent low mood is just part of who they are. But it is possible to find relief from depression symptoms, even if first-line therapies have been ineffective. Is depression treatable? Yes. However, persistent or "chronic" depression is a distinct form of depression that often requires specific treatment. The key is finding a treatment option that works for you.
Is Depression a Chronic Illness?
Though definitions vary, the Centers for Disease Control and Prevention characterizes chronic illness as a condition that lasts at least one year and demands ongoing medical attention or restricts activities of daily living. Examples of common chronic conditions include asthma, heart disease, and diabetes. Treatment options for chronic diseases tend to involve lifelong symptom management rather than curative courses of treatment.
In most cases, major depressive disorder will not meet this definition of "chronic," as the average length of an episode of depression is three months. However, many people experience chronic symptoms because they have not received the right treatment. For instance, about two-thirds of patients with chronic depression do not receive a medication of adequate dose and duration.
For people who experience depression that lasts longer than the average episode, depression can have a greater impact on daily life than other chronic conditions—whether at work, at home or socially. In a national depression survey,
96.9% of respondents reported at least some form of impairment in their day-to-day lives, most commonly in their social life. They had 35 days "out of role" in total, which means they were unable to perform their normal activities for over a month. This contrasts with most other chronic conditions, such as heart disease and high blood pressure, for which patients reported 15 days "out of role" on average.
What about Persistent Depressive Disorder?
Also known as dysthymia, persistent depressive disorder (PDD) is a specific form of chronic depression that causes people to experience symptoms for at least two years. Of individuals diagnosed with depression, around 30% report PDD, and the National Institute of Mental Health estimated that 1.3% of all US adults had experienced persistent depressive disorder at some point in their lives.
If you have PDD, you may feel depressed more days than not. You might also experience other symptoms of depression, such as a change in your appetite, disrupted sleep, or diminished energy levels. You are more likely to develop PDD if you experienced early life adversity, such as childhood neglect or emotional trauma, or if you have a family history of mood disorders.
Is Chronic Depression Treatable?
It is possible to find relief from long-lasting depression. A major 2019 review found that chronic depression responds well to several treatments, including psychological therapy and medications. Here are some options you may wish to explore:
- Changing medications: If you are already on medications, you could speak to your doctor about optimizing the dose of your current medication or trying a different one.
- Targeted therapy: Since PDD is more associated with childhood adversity than non-chronic depression, attending therapy sessions can be an important part of addressing the condition. Specific therapy techniques that address childhood maltreatment have been shown to be more effective in treating chronic depression than standard (non-specific) psychotherapy.
- Transcranial magnetic stimulation: If you are still experiencing symptoms after trying medications and therapy, there are other options available. Transcranial magnetic stimulation (TMS) is a non-invasive and non-drug treatment that has been cleared by the FDA when at least two medications have not been effective for depression. TMS uses gentle magnetic pulses to stimulate brain regions involved in mood regulation; these regions are underactive in people diagnosed with depression. TMS can help to relieve some, or even all, symptoms of depression in many patients. Sixty-two percent of patients report a reduction in depression symptoms at the completion of the acute phase of TMS therapy, which lasts six to nine weeks.
What If I Experience a Recurrence of Depression?
If your symptoms have improved, could they return? Yes, but recurrences generally respond to treatment.
Taking antidepressants over an extended period of time may reduce the severity of your symptoms. Continuing psychological therapy may also decrease the chance of depression returning, and TMS in particular may help patients who have not found relief from medications. To learn more about whether TMS might be right for you, consider scheduling a no-cost consultation.
Reaching out for treatment is a meaningful and empowering step toward improving your long-term well-being. Remain hopeful as you pursue a treatment option that works for you. You don't need to settle for anything less.
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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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