• Derek Schumm, MD

A Case Study of When Antidepressants are Not Enough!

Mr. B is a 52 year old, happily married, employed male with a history of chronic depression that first presented when he became sober from alcohol in 2010. At that time, he went to his primary care provider noting progressive and worrisome lack of pleasure response, “sad moods,” particularly in the morning, reduced energy and increasing feelings of hopelessness.

His primary care doctor prescribed a course of Prozac, followed by Zoloft. Unfortunately, he did not respond to either of these medications and experienced intolerable side effects of sexual dysfunction and apathy. He was referred to a psychiatrist at this point and was started on Wellbutrin™, which helped improve his energy but did little to mitigate his other symptoms of depression.

His antidepressant medication trials had just not provided enough relief to allow him to function in his life effectively, and a course of standard psychotherapy, though increasing his understanding of himself and his condition, did little to change his crippling morning mood states and lingering daily despair. He researched other treatments and found TMS therapy and BayTMS. He visited us intrigued and hopeful, yet at "wits end," desperate for relief.

We agreed to start standard TMS treatment. Mr. B tolerated the treatment well, noting only mild scalp pain which lessened as his treatment course progressed. After about seven treatments, Mr. B started to notice that his mornings weren’t as dark and that he was having period of “joy,” for the first time since he had gotten sober. He began motorcycling again, one of his life passions that had gone by the wayside. His wife commented on the positive changes she noticed in his emotional expression saying on particular morning: "my husband is back!" His response improved over time and after three to four weeks of treatment Mr. B’s depression had gone into remission as evidenced by clinical interview and psychometric evaluation (PHQ dropped from 13 to 4 and his MADRS dropped from 28 to 7). He completed his treatment with a broad smile upon his face stating that TMS had given him his life back. He was able to be more productive at work and more present in his life and relationships. Mr. B's only regret was not having found out about this remarkable treatment earlier in his illness course.

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