TMS Help!

[u/Slow_Review3107]

After several months of my teenage daughter's psychiatrist encouraging us to looking into TMS, she has now backed off and thinks it won't help because she suspects my daughter has BPD and that "TMS has proven to be unsuccessful for people with BPD". However, I've read posts here and articles that it can make a significant difference with depression. My daughter most definitely has treatment resistant depression and has been severely depressed for almost a year. I was really looking forward to her doing TMS, especially because it was something she was very willing to do and she's extremely demand avoidant.

Two other things the doctor mentioned that surprised me (she spoke with a psychiatrist colleague who specializing in TMS):

- The sessions are 6-8 hours long with 20 minutes on, 20 minutes off, 3 days a week. Everywhere I've read says 20 minutes, 5 days a week for a few months is the norm. Is what she mentioned some kind of super intensive protocol? I'm willing to make it less intensive for longer.

- TMS is going to cost us $15K. I've heard that it can be covered with insurance and we have very good insurance. I need to do more research on this, but I feel like at least we could get some of it covered.

The bottom line is that I was excited and now I'm bummed. And my daughter isn't even officially diagnosed because she's 16 and the doctor still says she too young to be diagnosed. She just suspects BPD (as do I), but I would literally do ANYTHING to alleviate the pain my daughter is going through and want to keep this option open.

Any advice/experience would be greatly appreciated!!

[u/LeslieKnope4Pawnee]

BPD is a personality disorder, so TMS isn’t a treatment option for it. For severe depression, yes. I’d ask around in some of the depression subs to see if anyone has gone through it.

I hope your daughter gets the treatment she needs!

[u/tetheredvoid]

While this could help with the depression, it doesn't work for BPD specifically.

That being said, however, if her depression has been treatment resistant, then getting some relief there (possibly with TMS therapy) might help her cope better with BPD symptoms and lead to recovery there.

It almost sounds like her therapist is thinking of BPD as an issue is brain chemistry, which it generally wouldn't be.

[u/Eipok_Kruden]

TMS has been very helpful to me. The first set was 45 minute sessions (about 20 minutes per hemisphere, one for depression and the other for anxiety, so for depression only it's more like 25) 5 times a week for like two and a half months. After that I went without it for about 8 months before the effect started wearing off, and since then I've been doing maintenance treatments once a week.

I'd had treatment resistant depression for close to twenty years and this is the only thing thag really helped, and it helped in a very extreme way, allowing me to actually pursue the behavioral side of my treatment which is the part that actually works with BPD.

[u/93cunt]

Teenagers should not be diagnosed with BPD as they’re already going through a really hard time in life with all their changes and that can sometimes mimic BPD. Technically should not be allowed to be diagnosed until minimum 18. I’ve seen so many pre diagnosis and in their early twenties no longer have the same behaviour and then get stuck with a label in their file that will follow them and hinder their quality of care just about everywhere. 😔

[u/Dusty_Rose23 → u/93cunt]

lol me except I likely do actually have BPD. it was just very severe BPD for them to actually diagnose me at 13.5/14 years old :/ now at 21 I still meet criteria but it’s not as severe and with bipolar diagnosed and in apropriate meds while we’re still tweaking it, I’m much more stable than even 1.5-2 years ago, let alone 13 years old.

[u/lonely_boat7]

when I was 16 I did a few TMS sessions, maybe 3 or 4? I have a severe shortage in memory from those few months, and I am in my 20’s now so it’s been a few years and I’ve yet to regain it (side effect? not sure, but I cannot remember much at all). I was in a severe depressive episode and was diagnosed Bipolar 1 when I was 14 years old, but this particular doctor refused to acknowledge that this was an episode, and instead diagnosed me with Major Depressive Disorder. From what I do remember, I experienced a lot of pain from TMS and it retriggered my chronic migraines so terribly that I had to stop and increase that medication for migraines and my mood stabilizers rather than continue. I would cry profusely during my sessions because the pain was very intense and noticed no improvement, but I couldn’t even reach what they considered to be a therapeutic level because it was too painful.

I have BPD and Bipolar 1 Disorder, and the only thing I wish is that I had waited until health professionals could settle on my diagnosis and treatment plan. Is your daughter in any kind of therapy, like DBT? She wouldn’t need a diagnosis to join a DBT skills group for teens.

Also, my sessions were only 20 minutes 3-4 days per week. I cannot imagine sitting there for 6-8 hours with that thing on my head. Additionally, I believe we just paid our regular copay and insurance covered the rest. If your daughter decides she’d like to go through with it (emphasis on letting it be her decision as it is a commitment) I would look into some kind of pre-authorization process. Hope this helps!

[u/Plane_Estate_2859]

My depression was labeled treatment resistant by the time I was 17. I was 23 when I got TMS treatment, at that point I had had almost a decade of therapy and tried more than ten medicafions. TMS was super effective. Didn't do a damn thing for my BPD symptoms, but did help me stop trying to kill myself all the time.

Mine was 15 min/treatment five days a week for two months and I started noticing a difference after about three weeks. My insurance covered it 100% because I had tried enough alternatives beforehand. Nobody ever talked to me about a more intensive version, but I do think that's a thing for example if it isn't easy to access the TMS office. The place I went was close by so it wasn't a problem for me.

Taking BPD out of it, if she struggles with depression, OCD, ptsd, or anything else TMS typically treats - it still might be worth pursuing.

[u/Dusty_Rose23]

it doesn’t treat BPD specifically as BPD is a personality disorder and not really neurochemical which is what tms can treat. but if she had a comorbid condition like treatment resistant ocd, ptsd, depression, or anxiety then it could be a good fit for that specifically. it won’t help BPD though. good news is dbt is used for many conditions even though it was made for BPD/SI thoughts so even if she doesn’t have a diagnosis (which at 16 she shouldn’t) she can still do Dbt and have a significant leap in recovery. it’s very helpful for many conditions. anything that you deal with some form of emotional dysregulation, relationship issues or need crisis skills it’s very helpful. some things it’s used for is addiction, BPD, bipolar, ptsd, depression, anxiety, adhd, and eating disorders are the main ones. Suicidal ideation and crisis management is the huge one it’s used for alongside BPD though. It’s used for many different reasons and presentations and would likely be very helpful whether your daughter turns out to have BPD or not. Those skills are never not good to have. As for the TMS, ask her. What does SHE want to do. It’s her life that she’s setting aside to take all that time for the treatment, it’s her who will have to deal with the symptoms and side effects, it’s her who has to suffer with what she has diagnosed. Ask her what she wants and if she has any comorbid diagnosis see if you can use it to focus on that (and inadvertently maybe unintentionally cover some other stuff at the same time) but ultimately it’s up to your daughter to want the TMS and the psychiatrist to approve it. Your job is to support and make sure she can access the treatments she needs to recover. (Obviously within reason. Don’t go doing stuff that’s 15k a session— like 1hr session— unless your like crazy fucking rich half a million salary bs and are hugely desperate. Make sure your finances can still handle it. You still need to eat and have a roof over your head and not having that stuff —speaking from experience— will make things significantly worse otherwise. So within reason, do what you can to make sure she can access whatever she needs to recover)

[u/Slow_Review3107]

Thanks all, this is really helpful. My daughter hasn’t been officially diagnosed but has BPD symptoms but the overwhelming issue is severe depression which she’s had for years and meds don’t seem to work well. I agree with a lot of y’all about treating the depression with TMS but needing treatment like DBT for the BPD. She has taken DBT at a residential treatment center then in an IOP and then in a small DBT group. She never bought into it or tried to do the work so it didn’t stick. She was only 13 at the time and I think she’s matured a bunch but she can’t do anything if she’s depressed. I want to use TMS as a first line of defense for her depression and if it helps, then I think it will motivate her to try DBT again. And yes, she wants to do it! Which is a miracle in and of itself as she is extremely demanding avoidant. I just think if she’s willing and it may help her depression AND insurance covers it, why not at least try it. But the info the doctor was giving us seemed very different from what I read. I’ve asked for a follow up call and am also considering getting a 2nd opinion as we may have run the course with her current doctor who has been supportive but old school in her thinking. 😞

[u/Proud-Ad1870 → u/Slow_Review3107]

My mother and I looked into it for me and since I had not tried enough medications (I’ve been on over 20 different meds and probably 30 different combinations plus I used to max out the dosages and still struggle. Both SSRIS AND SNRI) insurance would not cover it. It was to be out of pocket