I have depression for 32 years, but I am more depressed with my recent TBS. Why?

Question

Hello doctor,

I am 56 years old male and have been treated for depression for 32 years. I have tried numerous antidepressants. I have responded to ECT extremely well in the past but it did not hold me. I could no longer afford monthly maintenance treatments. I have currently started a treatment called Theta burst stimulation. After nine, 3-minute sessions I have had a few normal days but more days where I feel depressed. I am more depressed after I have started this treatment. Is this normal? I am scheduled to have a total of 36, 3-minute sessions.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concerns.

Although it is too early to measure the effect of TBS (theta-burst stimulation) after the nine sessions there is a good possibility that there will be an enduring effect over the coming weeks. My statement is based on the fact that early response (may be transient one) is an indicator of long term response for most antidepressant therapies including medications, TMS (transcranial magnetic stimulation), ECT (electroconvulsive therapy) and now rTMS (repetitive transcranial magnetic stimulation), and TBS.

Considering the above fact I like to state that reversal of symptoms after a few days of normalcy at this stage is considered normal and we need to hold on till the completion of therapy.

Although this is not the part of the question I like to draw your attention to the suboptimal dose of Effexor for someone who has depression over the 30 years. I rarely see any patient who responds to below 150 mg of Effexor after a prolonged history of depression, say 30 years.

I hope this helps.