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.
