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Dr. Mike 8 min read

New type of technology helps those with "treatment-resistant depression"

Sadness, misery, melancholy, sorrow, woe.

We can use multiple words to describe one of the most common human experiences: depression.

Reports of people experiencing depression date back several millennia.

One of the most familiar ancient references might be that of King David from the old testament.

He wrote in the Book of Psalms “I am worn out from sobbing. All night I flood my bed with weeping, drenching it with my tears.”

I’m sure that experience sounds very familiar to anyone who has dealt with a major depressive episode or what those in ancient times called “The dark night of the soul.”

Treating depression has changed

While the experience of depression has been a constant across the rise and fall of every human culture, how we address the symptoms of depression has certainly changed over time.

Egyptians used physical restraint and starvation to deal with depression.

The Romans tried a kinder, gentler approach using massage, diet, music and baths.

It wasn’t until the early 1900s that the precursors of modern psychological theories began to dominate our understanding of depression and how to treat it.

Freud wrote about mourning and melancholia, where he theorized depression was rooted in anger about a real or perceived loss.

More recent approaches increasingly stress the biopsychosocial model that looks at the biological, psychological and social factors that play a role in depression.

As our understanding of depression has yielded incredible progress in treatment options, it is fair to say that modern psychology has yielded effective interventions like psychotherapy and medication that directly improve levels of depression.

The good news is that we no longer use physical restraints or baths to try to help people walk out of the dark night of the soul.

Therapy works. Medication helps people feel better. These are proven facts in the research.

Some depression is hard to treat

However, the common wisdom in the field suggests that between 20 and 30 percent of people who struggle with depression never find full recovery.

We call this phenomenon “treatment-resistant depression” and it leaves some professionals scrambling for other treatment options that might help people feel better.

Throughout my early career, there were many times that I struggled to design treatment plans to help people with treatment-resistant depression.

It’s so hard to watch some people with depression get better while others just seem to be stuck in a recurring cycle of pain.

I imagine I felt much like an ancient Egyptian or Roman when the warm bath just didn’t seem to relieve my patient’s heartache.

In the last several years, I have spent a considerable amount of my professional energy looking for creative and effective ways to address treatment-resistant depression.

What do you do as a professional when someone is metaphorically “worn out from sobbing and flooding their bed with tears?”

Thankfully, I’m happy to report that we have been able to implement strategies based on research that provides hope for people with treatment-resistant depression.

If you or someone you love is stuck in this never-ending cycle of depression, I want to encourage you with this simple message: There is hope.

You can break free from the chains of depression and begin to live in peace and joy.

We’ve started more intensive programs at our LiveWell clinics that combine psychotherapy with medication and other holistic treatments that work to combat treatment-resistant depression.

Transcranial Magnetic Stimulation

Of all the unique and creative treatments we offer, let me take the rest of our time here to focus on TMS (Transcranial Magnetic Stimulation), which is perhaps one of the most exciting new technologies that directly addresses treatment-resistant depression.

TMS is a new technology that has approximately a 70% success rate.

The entire procedure is based on a biological understanding of the cause of depression which suggests that an imbalance of neurotransmitters in the brain is one of the most significant factors that contribute to the experience of depression.

In short, when looking through the lens of neurology it is clear that brain activity is reduced in people with depression.

I’ve included an image of two PET (Positron Emission Tomography) scans, which measure vital functions such as blood flow, oxygen use, and blood sugar metabolism that demonstrate just how dramatically brain activity is reduced in depression.

The image on the right is a non-depressed brain.

Notice all bright yellows and greens that reflect the vibrant brain activity of a person who is not currently experiencing depression.

The image on the left of a depressed brain tells a different story.

As you can see, there are hardly any bright colors that indicate healthy blood flow and activation.

Instead, the brain is almost completely dark and lacks any significant activity.

When a client receives a TMS treatment, the brain is mapped to identify areas that are lacking these vital functions and activation.

After a client’s unique neurological makeup is identified, the TMS provider uses a highly focused pulsed magnetic field, similar to what is used in a MRI imaging machine, to stimulate cortical neurons involved in mood regulation.

This stimulation physically modulates neurotransmitter release and increases cerebral blood flow and glucose metabolism.

In short, the TMS protocol achieves the same stimulation of neurotransmitters that are encouraged by anti-depressant medications, but it does it in a much more sophisticated and targeted manner.

Professional shares expertise on TMS

I sat down with our medical director at LiveWell Behavioral Health, Dr. Parwati Maddali, to ask her a few questions that might help me relay how TMS stimulates the brain and also provide her understanding of the value of TMS from a medical perspective.

As a psychiatrist who has been practicing for decades in the mental health field, Dr. Maddali is in a unique position to talk about the efficacy and benefit of TMS to those struggling with depression.

Here is a snapshot of our conversation that illustrates some of her most important insights.

Q: Dr. Maddali, can you explain the difference between how TMS stimulates a depressed brain as opposed to how an anti-depressant might stimulate a depressed brain?”

A: Anti-depressants are designed to increase the stimulation of the brain’s neurotransmitters similarly to a TMS treatment. While a TMS treatment directly stimulates the brain using electromagnetic stimulation of nerve cells, anti-depressants are systemic, which means they must travel through the entire digestive system and into the bloodstream before they finally end up stimulating the brain.

Although this is a very rudimentary explanation it highlights why anti-depressants come with more side effects than TMS. Many times, my patients who are taking anti-depressants experience side effects like insomnia, headache, blurred vision, dry mouth, fatigue, weight gain, nausea, G.I. distress, and sexual dysfunction.

Because anti-depressants travel through the entire system, the side effects are potentially systemic. TMS on the other hand directly stimulates the brain without involving other bodily systems which will eliminate many of these systemic side effects. The most common side effect of TMS is mild scalp discomfort at the treatment site. So TMS is safe, easy to tolerate, and effective.

Q: Speaking of effectiveness, how effective is TMS in your experience?

A: Medications can typically take 3 to 4 weeks to be effective and can have several of those systemic side effects that I’ve mentioned. Especially after psychotherapy and trials on two or three medications have not been effective, I have seen many patients get better with TMS, and it usually doesn’t take weeks to see the treatment's impact. Many times we see progress after just several days. It’s a great treatment option, especially for people with treatment-resistant depression.

Q: Any TMS success stories you’d like to share?

A: There’s one patient I remember, in particular, who made incredible progress with TMS. Before I prescribed a TMS treatment, this young mother encountered many problems getting her depression in check.

It was so gratifying to see this woman, who worked full-time, go from sitting on the couch feeling guilty about how disconnected she was from her kids and career to getting her life back. It was simply gratifying to watch."

After speaking with Dr. Madalli regarding her experience with TMS, it confirmed my own experience professionally, TMS is a great option for many people who are struggling with treatment-resistant depression.

Even insurance is onboard with TMS treatment

The beauty of TMS is that the research continues to confirm our professional experience. TMS is safe and effective and comes with very few side effects.

Even the major insurance companies agree with the effectiveness of this new technology to treat depression.

Almost every major insurance carrier will cover the treatment, which is, in many ways, the gold standard of the efficacy of a psychological or medical intervention.

Insurance companies don’t like to pay for treatments that might or might not work. Instead, they usually wait until the research is unequivocal before they will reimburse for these kinds of services.

Thankfully, we have built enough of a research base that TMS is considered part of the standard of care for treatment-resistant depression.

Yes, depression has been around for millennia and is most certainly part of the human condition.

As our understanding of depression has grown, so has our ability to treat it. It’s exciting to know that we have growing options to help people at our LiveWell clinics.

My encouragement to you is simple: if you’re struggling to find freedom from depression, don’t struggle in isolation.

We have professionals at LiveWell that can meet with you to determine whether or not a creative treatment like TMS is right for you.

Most importantly, have hope that even though depression is an age-old problem, we have more tools at our disposal than ever before to help you move forward out of this dark night of the soul.


Dr. Mike


If you’re struggling through a difficult situation, finding yourself in a challenging season, or feeling frustrated in a conflicted relationship, consider seeing a therapist who can help you process how you feel, identify what you need, and establish tangible goals for your growth. Our team at LiveWell Behavioral Health is ready to respond to your needs and provide you with meaningful and effective care. Give us a call at (321) 259-1662 or find us online at We’re here to help you get healthy, stay healthy, and live well!