October 20th, 2014
Hello Dr. _____
As you know, I am one of the participants in the rTMS study that you are currently running. This week will see me undergoing treatments 15 through 20. The following is something I've wanted to discuss with you in person, but, as I’m not terribly articulate or cohesive when I attempt to express complicated things verbally these days, I thought that it would be more effective if I conveyed my thoughts to you in writing here.
The reason for this letter is not actually to discuss my progress within the rTMS study, but rather my ongoing care and possible medication regime upon completion of the rTMS treatments. Specifically, I am very interested in the Ketamine study you are involved in, and have brought it up with my Psychiatrist, Dr. ____, who is also very interested and supportive of the research. In fact, I am very keen to explore whether I would be a suitable candidate for taking part in the Ketamine study. I do believe that the rTMS is helping (really helping) a certain aspect of my specific case (namely, the part of my brain that allows me to focus, have clarity, and have ambition), but the portion of my case that generally gets addressed with medication (the part that finds life dull, grey, and meaningless) is the portion I’m afraid will still be left wanting after treatment is complete.
At this point, after two decades of fighting the disease, I truly believe that there are two different types of (or components to) depression: one which I call noise depression is the aspect of my depression that the rTMS is definitely helping me with. It gives me clarity and focus and I am able to concentrate and persevere without having intrusive thoughts and self-criticism disrupt my activities. The other, which I call grey depression, is the feeling of anhedonic hopelessness and emptiness that appears to exist within me at a level that is deeper than my outlook or day-to-day thought patterns, down in my core mood or ‘being’. I think some people are afflicted by one of the two types of depression, and some people have both, and I believe that I fall into the latter category. My grey depression does seem to improve with medication or anything else that raises serotonin/neurotransmitter levels, but only for a short time and only at the highest dose. I've tried them all except MAOIs. I feel (and am terrified of this feeling) that after the rTMS is done I will have a very clear, focussed brain that is able to live in the moment, for the moment (without the noise of intrusive thoughts and ideas) but that this moment, this focussed being, will still feel grey and hopeless.
At any rate, as it is clear that I will still have to sort out my medication after rTMS treatment, and as I have very high hopes that participating in the Ketamine trial might be a promisingly effective route for me to take, I would very much like to know your thoughts on my suitability for the trial. I've been following the research into Ketamine for treating depression with great interest, and would really love the opportunity to be part of a study to prove its efficacy. Also, I’m not even sure that TWH study participants are allowed to be part of more than one study, so any information you could provide would be more than appreciated.
Thank you for taking the time to consider this request for your advice, and thanks also for all that you do,
-Nicole
November 18th, 2014
Hi again Dr. ______,
Firstly, forgive me if this email comes across as a platform or sounding board of sorts; I truly am curious to see if this thought aligned with the rTMS's study's basis and/or findings...
It was such a basic and obvious fact that I had this morning, one that had been staring me in the face all this time but I had never been able to fully articulate- and that is the fact that, very early in my childhood, my brain learned that focussing on one singular thing or idea was self-destructive and would essentially (and not even hyberbolically) be the death of me, simply because every time I focussed on a single thing or thought about a single idea it was always very dark and dismal. So my brain taught itself a new pathway, and that was to not focus on a singular defined idea, but to think about all sorts of little things all at once - to fragment and subvert, interrupt and divide, explode and implode - whatever it took in order to preserve itself (for which I would like to commend my former little self's brain with a Jurassic Park's 'clever girl' sentiment here). And now, today, this is the very reason I cannot concentrate enough to read the very books that I align my sense of identity with so fervently, and why I cannot decide on what to do about a very simple problem or decision, or why I cannot quiet my mind enough at night to just focus on the idea of getting some much needed sleep. This neural pathway, this Kafkaesque corridor of perpetually redirecting doors, has been so ingrained and so rewarded (by the very fact of being allowed to continue to live) for doing what is has been doing, that it has ensured this pathway be very deeply rooted, essentially assuring it be (and perhaps even irreversibly so) buried, indeed.
And so now, what I fear is happening, is that the dark and deep sadness that my brain taught itself not to focus on when I was little, is becoming terrifyingly close to being able to be concentrated on. rTMS has given me clarity of mind, and this pathway has been rerouted somewhat to allow for a singular line of focus to be actualized, but my brain (recognizing that this line of focus will be very dark indeed) is again trying to forge a different path, another spatial rearrangement of thoughts, so as to not self-destruct once again. And this spatial rearrangement that manifests itself into a noisy and unfocussed mind, again relapses into that familiar pattern of depression. A mental ouroboros, of sorts.
What I need is to somehow convince my brain that that clarity and focus that rTMS can offer does not necessarily mean that it will be a dark lucidity, but at the same time I struggle with this: if indeed the thing that my brain will be allowed to focus on (even if I can teach it to not fear focussing on one particular thing) is really that dark and desperate, how ever can I convince my brain not to reforge this new-found focus into something that essentially metamorphosizes into a confused and noisy redirection of thoughts? What is that dark area, how can I reach it, and how can I make it go away so that my brain does not recognize it as something to avoid?
These were my thoughts this morning, and thoughts that I was hoping you could give me some feedback on, in terms of how the rTMS thesis or subsequent analysis, has imagined or navigated these potential waters.
Thank you once again,
-Nicole
Seriously though. WTF. I have no idea how I would answer such emails. Probably with a variation on "fuck off you nut job". At any rate, I am back here, blogging, to use this forum as a adjunct to other therapy in hopes something finally gives. I'm (carefully) tapering my medication, going to once a week talk therapy, and writing. After all, I'm out of other options. This is the only combo I haven't tried yet. After 20 years of struggling with this with no respite, you'd think I'd finally give up. My therapist calls me stubborn for it. I like that. I'm not sure what this blog will become, since blogging is so different from journaling. There are, of course, things I would never write on here for the public eye. So in terms of how honest, how helpful it can be to me, that still remains to be seen. But for now, let's just do what doesn't kill us.
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