Nov 10, 2015
4
1
Status
Resident [Any Field]
Oh boy.

TLDR: TMS therapy for severe depression while in med school?

I'm an MS1 at an allo U.S. school. I've been treated for MDD since age 8-- somewhat controlled, with some relapses. I've never been hospitalized. My father was a physician with depression who died of an overdose when I was young.

At the hospital where I go to school they have a TMS machine, but the department says they aren't accepting any new patients. I'm prepared to fight my insurance to cover it, and to convince the Director of Psychiatry (who conducts the TMS care) to take me on as a patient. I wonder if I can put my chips on this, get started asap, and get better enough to continue with school.

As a future doc, I've learned to be objective. There are days when I realize I'm fighting for my life. I'm never giving up on beating the depression.
 
Last edited:

Rei02sDinnerParty

2+ Year Member
Oct 15, 2015
186
326
Status
Medical Student (Accepted)
Oh boy.

TLDR: TMS therapy for severe depression while in med school?

I'm an MS1 at an allo U.S. school. I've been treated for MDD since age 8-- somewhat controlled, with some relapses. I've never been hospitalized. My father was a physician with depression who died of an overdose when I was young.

Six months before school I was dealing with a level of depression I had never known, despite working a job and living in a city that I loved. The depression had no reason to be there, but I could not believe the pain I was in. And it was different from before-- it would come in waves, course through my body for a number of horribly incapacitating hours, and then eventually leave me feeling like I had survived a war.

This happened once or twice a day, and was the only time I began self-medicating with dextromethorphan to survive. This isn't like me. I was constantly exhausted, and tried several different med combos with my doc (including atypical ones). Nothing would touch it-- except for a stimulant like Vyvanse, but the crash and insomnia are awful. As med school loomed closer, I feared the worst. I talked to my doctor about deferring a year, but I had no job lined up and no money to figure that year out. My doctor said "Maybe you'll be too busy to feel depressed."

I should have deferred a year. But I had hope that I would somehow hit the right combo and get better.

A few months before school started I was the victim of a pretty violent hate crime. My knee was fractured and peroneal nerve was damaged, so I had drop foot for a while. I actually had to miss our second exam because I lost feeling in my leg, so I had to tell the Dean what happened. I'm sure that story sounded really sketchy, but it's true.

In the first month of school I was struggling a lot-- I had to move apartments and that was stressful. I feel like the administration already senses that I'm "that student." I don't know who all has access to our grades, but I barely passed our first block, and I wonder how many of the faculty have lowered their expectations of me.

I'm still struggling to keep up because the depression grabs me at any time of the day, and has severely affected my concentration and focus, not to mention my ability to connect with others. Despite my efforts with therapy, exercise, relaxation, CBT, positive talk... it sort of owns me. A few weeks into school I started having massive panic attacks for the first time. I felt like I was living minute to minute in a world I couldn't control.

Note: I've never felt like a victim and have always controlled my future despite setbacks. But this hit me hard. It seems to have no real connection to school, either-- our curriculum is not that stressful right now, and this happens even when we're on break. I love medicine and I love my school. I wish I could enjoy this time.

Over the past four months I've lost my appetite, have been losing weight, and the depression is at its worst. I feel very weak, and went to an endocrinologist to get checked out. TSH normal. I might see a neurologist too.

The school's therapist suggested I take a Leave of Absence after this semester and wants me to do an outpatient program. I've been thinking about this all semester. There have been times when I've been so sick and fatigued. Some days I have to go to my car to sleep in between classes. I confided about feeling ill and considering LOA to our block director (maybe not the greatest idea, but I didn't want to go straight to the Dean). He told me that no one cares about your pre-clinical grades as long as you're passing, and suggested I wait and see if I get better.

If I take an LOA, I'm not sure how I would find a job that quickly and pay my rent. I don't know if I would go into loan repayment. I don't know how I'd explain this to everyone. I wonder if this would be even more stressful.


I'm supposed to talk with the Dean about the possibility this week.

I'm on Effexor and added Wellbutrin-- max dose. And when the Vyvanse kicks in, that's about the only time I get relief. I don't know what's going on in my brain, but it's very treatment-resistant.

At the hospital where I go to school they have a TMS machine, but the department says they aren't accepting any new patients. I'm prepared to fight my insurance to cover it, and to convince the Director of Psychiatry (who conducts the TMS care) to take me on as a patient. I wonder if I can put my chips on this, get started asap, and get better enough to continue with school.

As a future doc, I've learned to be objective. There are days when I realize I'm fighting for my life. I'm never giving up on beating the depression.
FYI: ECT is widely recognized as the "gold standard" brain stimulation antidepressant.
 

Goro

Gold Donor
10+ Year Member
Jun 10, 2010
59,169
88,944
Somewhere west of St. Louis
Status
Non-Student
Very sorry to hear of your woes, OP. I hope that your Administration is doing what they're supposed to do and help you. I think a LOA is called for; perhaps your Faculty could help you network for a job?

As for ECT, doesn't it cause short term memory issues??


FYI: ECT is widely recognized as the "gold standard" brain stimulation antidepressant.
 
  • Like
Reactions: NontradCA
About the Ads
Nov 10, 2015
4
1
Status
Resident [Any Field]
Thanks so much for the responses. Sorry for the super long post.

So I brought up ECT to my doctor last year, and he also mentioned the memory loss issues. He said I shouldn't consider it if I want to be a doctor (but I know there are doctors who've done it-- I remember a TED talk about it).

I am near the point of ECT but I want to try to fight for TMS first.
 

Rei02sDinnerParty

2+ Year Member
Oct 15, 2015
186
326
Status
Medical Student (Accepted)
Very sorry to hear of your woes, OP. I hope that your Administration is doing what they're supposed to do and help you. I think a LOA is called for; perhaps your Faculty could help you network for a job?

As for ECT, doesn't it cause short term memory issues??
Yes.

Not telling you what to do; I'd just keep all options on the table. The likelihood of responding to ECT is better than that of TMS.
 

Goro

Gold Donor
10+ Year Member
Jun 10, 2010
59,169
88,944
Somewhere west of St. Louis
Status
Non-Student
Just a word of warning, severe depression is poorly managed on anonymous Internet message boards.
 

sloop

5+ Year Member
May 12, 2015
1,085
1,779
Status
Resident [Any Field]
Isn't this "asking for medical advice" per SDN rules?
 

cbrons

Ratatoskr! *Roar*
10+ Year Member
Jul 29, 2007
6,580
3,666
DEFEND MIDDLE LANE!
Status
Non-Student
Just a word of warning, severe depression is poorly managed on anonymous Internet message boards.
Isn't this "asking for medical advice" per SDN rules?
No, it seems like he is more telling his story, asking about undergoing major procedure while he is a med student. Not really asking about if he should do the procedure, more if he should while tackling medical school. Seems like a legitimate post to me.
 
  • Like
Reactions: Goro
Nov 10, 2015
4
1
Status
Resident [Any Field]
To the people who so kindly responded to this: I thought I'd update. With some results back from the endocrinologist, it looks like I may have Lupus nephritis. I don't know if this can cause severe depression and anxiety, but certainly fatigue.

I did talk to my Dean and told him about this possibility. If I have Lupus, I think it would be best to keep that from my classmates and the faculty in general. I don't want it to define me or make people look at me differently. I also told him I had a history of depression. I'm not sure if this was the best idea.

So, we increased all my meds even more and (thank God, just in time) I'm feeling like I may be experiencing a taste of remission for the first time in a year. Usually I only get a couple hours of feeling better, but I've been much better for a week. I forgot what this feels like. I do live with the fear that the depression will come back, but for now this looks good. I can "feel" music again and am eating, smiling, & interacting with people.

Now that I'm doing quite a bit better, do you think it's possible for me to win back admin and faculty trust if I do very well? Or is the first impression going to be hard to overcome? If I am not depressed, I think I can do well. I wonder if the sudden change will seem suspicious...

I feel like I missed out on all of my 1st semester. I also feel like I didn't master a lot of information because of this, and will need to go back and review.

But I'm happy to be here.
 
  • Like
Reactions: threesparrows

Amygdarya

10+ Year Member
Feb 14, 2009
2,135
1,685
Status
Resident [Any Field]
Hey @gettingby101 , glad you're feeling better and are motivated to do things. It's all that matters really. I don't think you should worry about the impression you may (or may not) have made on your administration; there are really 2 options: 1) your school administration are caring and supportive people, in which case they're only interested in you doing well; or 2) they are not actually caring and supportive, but they're still interested in you graduating and matching successfully for the sake of the school's reputation, if nothing else - and since you can't change your administration anyway, there is no use in worrying about it. Focus on your health and on doing your best at school, it's all you can really do, and it's quite enough. Stay well!
 
About the Ads