Neal Brennan Has Tried a LOT of Things

Neal Brennan on Depresh Mode.

If you’ve listened to our show before, you know that we recommend a period of trial and error to find a mental health treatment that works best for you. Nothing works for everyone, after all, so you have to see what you respond to. Neal Brennan is the embodiment of that concept and in this interview he reports back on how well or poorly it went for him trying Freudian therapy, antidepressants, transcranial magnetic stimulation, a special kind of TMS available in China, ketamine, ayahuasca, 5 MeO-DMT, and other solutions. The good news: Neal’s mental health is doing much better than it had been.

Check it out.

Stanford researchers devise treatment that relieved depression in 90% of participants in small study.

I did TMS from September 2017 until November 2017. I was introduced to it through Neal Brennan, a comedian I follow on twitter. Ignore that this clip is from Joe Rogan (he sucks, and his bro army is gross) - it's what I found on YouTube.

He recently re-tweeted an article out of Stanford Medicine:

Stanford researchers devise treatment that relieved depression in 90% of participants in small study 

Stanford Medicine researchers used high doses of magnetic stimulation, delivered on an accelerated timeline and targeted to individual neurocircuitry, to treat patients with severe depression.

My experience was positive. But nothing is as simple as just that snapshot of good or bad. I also had just started working for the government, and had solid pay and work and benefits for the first time in my life. I was walking to and from the appointments 4 or 5 times a week, getting fresh air and sun and cutting into my work hours. I was feeling like for the first time, in a long time I was able to seek help for my depression in a tangible (medically recognized) way. So, yes, I feel the procedure helped me. But it cannot be extracted from how the confines of my life changed during that time as well.

I accessed the treatment through McGill University - and have since had no follow-ups with them. Nobody ever called me, or checked in - so I've not had the opportunity to go back in for other appointments. Like many services I've access in the past - I've just been let go back into the world.

I hope word gets out and this becomes widely available. I'd like to go back in. I'd like for other people to not have to work so hard to access relief.

I'm still here.

I am still around. Adjusting to my new schedule and the responsibilities of having a dog has been a lot ( he is trying to chew threw a box as we speak - I just stopped writing to try and fake eat his bone so he'd get jealous and switch chew-targets).

I've also been going to TMS 5 days a week for a month, and am only now weaning down my appointments. These have been daily and have included missing work time and taking some sick-time hours and vacation hours as not to decimate my paychecks.

Weekends have been busy, but I'm also tired.

The TMS clinic thinks I might have sleep apnea so I also tested for that and am waiting for the results.

I want to write, I just don't want to be sitting at a computer.

My work situation has ben nuts, it's a long, someone else's work situation story so I'll spare you. Long story short a project that should have taken over a year to plan and execute with a team twice our size is now being forced through in 3 months on an all new team. We're burnt out but for most of us it's our first job for the public service sector so we want to make sure we get repeat contracts.

Unemployment and poverty motivate.

If there's anybody out there that reads this stuff, I'm still here.

Black dogs.

I continue to be busy. I'm working and taking care of Buddy and going to TMS 5-days a week during work hours. It's been a lot. 

The weather has been unseasonably warm in Montreal, so the fall is only starting to make an appearance. 

I've been thinking about how I'd like to write about black dogs as a theme. I read a memoir called Killing the Black Dog, apparenly the black dog is a metaphor for depression. 

I find it an odd metaphor, since for me black dogs have always been symbols of companionship and familiarity, since every dog I've ever had was black. A black labrador retriever, a black schnauzer and now with Buddy, a black pug. 

The labrador, a confirmation of my fragility and the cruelty of life.

The schnauzer, a crescendo of anxiety and tumultuous happenings.

The pug, an acceptance of the absurd and an attempt to move on. 

Depression to me may feel like a fog that creeps into the brain and covers me like a cloud. Or an evil spirit that feeds off of my energy, joy and ambition. I don't think a representation of depression in popular culture has ever been as spot-on as Dementors in the Harry Potter universe. 

TMS has been going well. The appointments break-up my day. After the first week and a half, I felt my brain to be less cluttered and "cloudy" feeling. Less foggy. It's like there was this density and weight I couldn't see past, and it lifted. I would imagine it to be similar to feeling congested, except without being centrally focused in the sinuses. It's also similar to being sleep-deprived. 

The doctor at the TMS/neurology lab also wants me to be tested for sleep apnea, since I'm perpetually exhausted. I'll be doing that this upcoming Friday. 

If TMS continues to go well (I'm about half-way through the 4-6 week treatment) I may experiment with lowering my anti-depressant dossage, and see if it helps with my energy levels and sleep. 

TMS isn't invassive. It's a time commitment and a hassle to get to, but it's covered by medicare. I think one American I read about having done it paid for it out of pocket and he said it cost him roughly 15 grand. SO, I thank my lucky stars for Canadian healthcare because that's the entirety of my savings for a downpayment. For a treatment that may or maynot help me. 

The treatment itself is a little odd. You sit in a chair, not unlike a dentist chair, lean back, and a large flat thing is put on your head. It's places on your frontal lobe area and then you get tapped on the head. That's basically it. It send you magnetic pulses that feel like being tapped on the head by a woodpecker with a blunt beak. Tap tap tap, 5 seconds, beep, tap tap tap and so on. 

After a few sessions I started falling asleep. It's not painful, just weird and hard to ignore. Some times the magnetic pulses must be stronger, because sometimes it's harder for me to fall asleep since I really feel them, and they make my eye and nose twitch. Other times I feel like a cat leaning into a scratch and barely feel them, but it's comforting. 

I think about writing a lot, I just don't want to spend more time in front of a computer. In a few months time I may start working from home a day a week, in which case I could set aside a little bit of time on that one day a week to write. We'll see. 

I'll definitely keep updating about TMS, since I myself came to it through online blogs and personal accounts, and there's very little out there about it. 

One long day.

It's been really difficult to find the time to update the blog. I have had a lot going on with the dogs' adoption and work. I've just been very busy. I get home during the week and I walk the dog, I have dinner I take a shower and I go to bed.

On top of all of this I started TMS treatments. Everything happened really quickly: they called me, they gave me an appointment for a few days later, there was an intake interview (How depressed are you on a scale of sheetcake to paint huffing? Do you think you're a bummer most of the time, some of the time or all the time?) and I started treatments the same day.

I started this past week. I went in on Wednesday, Thursday and Friday. I will be going in five days a week for 4 to 6 weeks.

It's all a lot of unknown. I don't know how long this'll last, I don't know how I might react, I don't know if they'll keep me for the full six weeks or shorter/longer.

All I know right now is I'm exhausted and it's a lot to go in for treatments and to work full-time. I am missing work for an hour or two daily to go to these sessions so I'm using a lot of my sick days and possibly also my vacation days. It's causing some stress. When I get home I don't feel like being on the computer so that's why I'm not really on the blog these days. Maybe eventually when things quiet down I'll be able to put some time aside every week and spend more time writing.

I'm still here, doing my best, not dead yet.

New news, continued.

Well, it's been a while.

I started the new job on June 5th and it's been a lot. 

The Monday I started I got home and was just so overwhelmed I could barely stand it. The change of culture, from private to public, the training for the job, the new names and faces, the size and scope of the office, leaving the comfort of the old job, all of it - it hit me that Monday afternoon. 

I was in the archive, having a moment, lost in a spiral. I spiralled pretty hard. There was a lot of worry about whether or not leaving the safety of my old job was smart. If I would be able to cut it at this new job. If I would make it. If I would be fired. If I would go back on unemployment. If I would live with my mother forever. If I was ever going to be able to take care of myself. If I would just curl up and die. 

I felt like I should cry, and desperately wanted to but wasn't able to. It was all just stuck in my throat. 

My first week was a lot. I'm just overwhelmed right now. There's change and there are a lot of questions and there's insecurity and there's a lot of unknowns for which I just need to be patient - not my strength.

In order for my contract to becoming official, I had to take a French oral exam, in order to be classified as "officially" bilingual. If I pass with a C (grading goes, C, B, A, X for a fail and E for exempt) then I'll be "officially" bilingual and will be offered a 1-year contract and should also receive an 800$ raise. 

The test ended up being this past Friday. The whole ordeal gave me a headache. I'm now dependent on those results for an official one year contract. 

I'm just really tired right now.

Overall I'm feeling pretty good about the job itself, it's just been a lot. And I feel like my mind is racing. I'm just trying to take it one day at a time. 

I'm really tired.

I haven't heard back from the hospital about my request for TMS, so that was a build-up and let down as well. I'm just in this weird internalized place that I can't really get out of. Sometimes I feel like I need a hard re-start. 

Looking to TMS, for now.

I'm having a lot of trouble focusing these days. I have resting-anxiety that’s higher than normal, and I can’t get enough sleep. I’ve changed my commute to work in order to walk more, and also to cut from a bus and two metro rides to just one long bus ride. This means I’m on a bus for about 45 minutes to an hour, so I nap twice a day nearly daily. It’s still not enough sleep. It also allows me to read or just sit quietly. Then, once in the city, I have a longer walk uphill so it's a nice start to the day.

Right now my mind is on TMS. I’m considering TMS, and I hope I’m a viable candidate for it. I need a change. I’m afraid and worried, but I’m also at a low point right now and I’m all out of ideas.

So right now, the focus is on TMS. If it’s a yes or a no, I can then move to the next thing, which may be microdosing.

I have an appointment tomorrow with my family doctor, Dr. Rishi. I sent him a letter last week (they don’t have an office e-mail, so I mail him things like a war-time bride) asking him to look up TMS and microdosing before my visit. TMS is offered at the neurology department of the McGill University Health Centre, so it’s an option.

A piece on NPR mentioned TMS being used for "treatment-refractory depression" - which is depression that does not respond to common treatment methods. That sounds like me. I am on a pretty high dosage of anti-depressants and I'm barely functional nonetheless.

I also read a piece in a psychology journal about recent findings:

A recent study presented at the 2016 Annual Meeting of the American Psychiatric Association (APA) in Atlanta, Georgia, investigated the effects of TMS on depressive symptoms in a private practice setting.3 The sample included 123 patients (67.5% female) with MDD who had not responded to an average of 3.9 treatment attempts with antidepressants. The mean number of TMS sessions that patients received was 40.8. 

Following the acute phase of treatment, patients demonstrated a 76.4 to 78.8 response to treatment as indicated by their Beck Depression Inventory (BDI-II) and Patient Health Questionnaire PHQ-9) depression scale scores, and no notable adverse effects occurred during or after treatment. Remission rates were between 52.5 and 72.4, and of these patients, an 80% long-term remission rate was observed among those available for follow-up assessments over a period of more than 4 years. “These findings further establish TMS as a safe, effective and durable treatment option, both acutely and on a continued basis, for those who suffer from a high degree of symptom severity and/or do not gain relief from antidepressant medications,” concluded the authors.

Those are encouraging findings, the article, Transcranial Magnetic Stimulation Effective for Major Depressive Disorder, Generalized Anxiety Disorder, ends by saying that 60% claimed remission and that 70% showed significant remission. Those numbers aren't nothing.

For now, I just have to wait until tomorrow, where I can talk to Dr. Rishi about it.

Until then.

Update: 

Musician streams TMS treatment live on Facebook.

Also, there's this bit on gut health and the brain and TMS. They seem to correlate TMS with gut-health and weight-loss, but I'd argue if you're less depressed shit gets better in general.

Neal Brennan on mental illness, the brain and TMS.

Starting around the 01:01:00 mark, Neal Brennan and Joe Rogan start talking about mental health, research on the brain and all sorts of offshoots of brain health and mental health. Brennan discusses his history with antidepressants and the constant work of seeking treatment.

It's a solid conversation. Rogan is interested and Brennan is an active participant in seeking treatment. You have to be when you're depressed - as is pointed out many times in this interview - very little is actually known about mental illness and the brain in general.

In his stand-up special, 3 Mics, he also talks about his experiences with ketamine (in the above podcast he's still in the process of that treatment) and his experience with TMS (transcranial magnetic stimulation). 

I'm going to ask Dr. Rishi about TMS, because Brennan says it helped him a great deal. It's covered by medicare in Canada, and it seems to be available at the MUHC.

I'd suck on a magnet if it alleviates some of my fucking pain. I've sucked on worse.

Update (2016-04-20) - Jenny over at The Bloggess posted about TMS, asking her (extensive) readership about experiences with it. Check out the comments section for more.