To see Tanner Hinds, 26, perform a stand-up set on stage at Go Bananas Comedy Club, it might be hard to imagine that just a few years ago he was struggling with major depressive disorder, feeling very "blocked” and finding it hard to engage with anyone or anything.
Hinds started experiencing depression as a teen, but it was nearly two years of having symptoms before he even told anyone, at the age of 18. "I finally talked to my parents, and so we saw the doctor and started on an antidepressant (Zoloft),” he says. "I’ve gone on to try 12 different medications in 8 years, in combination with outpatient therapy.”
The symptoms of depression—technically referred to as major depressive disorder—are characterized by an overwhelming feeling of sadness, isolation and despair that lasts two weeks or longer at a time, beyond the occasional bout of feeling sad or lonely, that most people experience.
What Hinds finally did try, and what worked for him, was something that may sound a bit intimidating: transcranial magnetic stimulation, or TMS. A non-drug, non-invasive treatment, TMS uses an electromagnet similar to what is in an MRI machine, placed on the scalp to stimulate nerve cells and increase brain activity in patients with severe depression.
It is one form of treatment offered at UC Health, as part of the University of Cincinnati (UC) Psychiatry Treatment Resistant Depression Program.
Helping Patients Who Don’t Respond to Traditional Therapies
"We specialize in patients who are considered refractory, or treatment resistant, meaning they are not responding to medication and need to seek out other treatment alternatives,” says Stephen Rush, MD, assistant professor of clinical psychiatry and co-director of the Treatment Resistant Depression Clinic, along with Erik Nelson, MD, an associate professor.
"If someone who comes to see us is experiencing depression and having no response to medication, we would set up an evaluation at our clinic,” explains Rush. That evaluation is overseen by both a psychiatrist and UC psychologist Alisha Lee. The team conducts a comprehensive review and medical workup to rule out other things that might be contributing to depression.
"We really want to get to the root of why you are feeling depressed. Let’s find out the reason, and maybe we’ll end up revising the diagnosis, with the goal of finding the right treatment for what your particular source of depression is. People can feel depressed for a whole host of reasons,” Rush says, adding that depending on the consultation, they may suggest medication changes, refer a patient to treatment at the Stress Center (for post-traumatic stress disorder or PTSD) or look at treatment alternatives like TMS, electroconvulsive therapy (ECT) or ketamine.
TMS treatment is usually a six week cycle; patients receive treatment five days a week for about 40 minute sessions.
"We apply trains of pulses, down to the very surface of the brain, and at the high frequency level, the pulses have been found to increase brain activity,” Rush says.
He adds that in patients with depression, "there is lower activity in the brain. After TMS, [in imaging studies] you can see the increases in oxygen and neurochemicals like dopamine and serotonin.”
Hinds received TMS treatment at UC Medical Center two years ago in April 2015 and has not needed additional treatment since. He described the initial feeling of receiving TMS on the podcast Anecdotal Experience
"Like if a woodpecker mistook your head for a tree, that’s kind of what it would feel like. Like a little knocking on your brain in one spot. This pulsing continues and off for 40 minutes, and you are conscious, awake in the chair [with the nurse administering it]. I didn’t think it was painful, it’s uncomfortable, but different people respond to it differently.”
While receiving treatment, patients can continue to carry on a conversation, listen to music or watch TV.
Able to Laugh—and Make Others Laugh—Again
Hinds says after the fourth week he started to feel different. "I had stopped doing a lot of things, and about half way through treatment, I felt well enough to return to hobbies and interests,” he says.
Rush says that is a common timeframe for starting to see improvement, and after full treatment, patient success for TMS is typically gauged in two ranges: a response or remission.
"A 50 percent improvement in symptoms is considered a response,” he says. "Then, the other is remission, where the patient experiences an absence of symptoms.” He does clarify that "remission” can be a bit of a misnomer because patients may continue medication and/or outpatient therapy.
"In our clinic, I think we have about a 51 percent response rate and a remission rate around 30 to 40 percent.” TMS is only approved for severe major depressive disorder; however, Rush cautions it may not always be covered by insurance.
Hinds says that in 2014, prior to starting TMS, he had stopped doing stand-up and fell out of working in the music industry he loved, but after the course of treatment, he started to pick up both again.
He now works at Audio Grotto in Newport, Kentucky, and in the evenings, you can see him perform stand-up a couple times a month at local comedy clubs.
"Cincinnati a really good city for standup; there are lots of opportunities to get up onstage most nights of the week,” says Hinds. "Go Bananas is my usual club. They do a good job of getting local people on stage. I’ve been doing it about three years now, all over town, just learning and improving.”
Having been frustrated with the typical path of mental health treatment, where therapy and medications just weren’t working, Hinds says having this option at UC "was pretty important.”
"I’m thankful for it,” he says. "It propelled me into a better state (of mind) and was really a catalyst for me, so I can’t say enough about it. It cleared this path for me to deal with and feel emotions for the first time in years.
"I wish it was more of an option known to people who like me, who are treatment resistant.”
To learn more about the UC Treatment Resistant Depression Clinic, call 513-584-2604.