SCT & depression

Maybe I should cry for help
Or maybe I should kill myself
Blame it on my ADD baby

Maybe I’m a different breed
Maybe I’m not listening
So blame it on my ADD baby

“Sail” by Awolnation

Just a note, this section reads like my diary of personal unhappiness as well as my consideration of rTMS therapy.

The reason why I even included this section on depression is because I don’t think the clinical profile of SCT would be complete without addressing this issue. Although I appreciate humor and would prefer to laugh, the fact is depression has plagued most of my teenage years and all of my adult life. Judging by community topics such as “SCT is a horrible disease”, “SCT…Ever feel like you are brain damaged?”, and “Are we the dementia patients of the future?” I may not be alone.

But there was a time when I wasn’t depressed. In my early childhood years, I enjoyed being a kid. I enjoyed soaking in the sun, playing in the sandbox with my neighbor, and catching caterpillars and placing them into jars hoping that one day I can see their beautiful transformation into butterflies. For vacation, my family and I went to a beach hot spot once a year. I still have that early 90s-eque picture of me wearing a bright colored bathing suit with my huge, oversized sunglasses. In reality they were my mom’s sunglasses that I stole from her to pose for the picture. I was generally happy; the only problem was that I couldn’t pay attention.

My therapist I went to a few years ago said that I was depressed. Not just depressed now, but depressed my entire life. When she sensed that I wasn’t pleased with her explanation, she assured me that at one point, people thought it was preposterous to suggest that children can get depressed, but indeed children do get depressed. She even went on to say that “mind fog is your body’s way of protecting itself” which I found poorly grounded, unscientific, and wrong for her to say.

She was one of the few local therapists that were covered under my insurance plan. The reason why I went to her in the first place is because I had a crisis that year. A few events that happened at school were the tipping point after years of tangled problems.

In most cases, the SCT student is so quiet that she never gets noticed. There are some exceptions to this rule however. In one of my final semesters in college, I took a specialized writing class. This class was already very small and by the end of the year, the class consisted of just six students. And with a small class sizes comes a certain kind of intimacy that made me feel uncomfortable.

One day, one of the students decided that something must be wrong with me. This may have come as a result of a group project where he asked me questions in the noisy cafeteria while I appeared to zone out (among other hints of awkwardness.) Referring to me obviously, he later tells one of his friends in the class that that girl must be very “slow.”

Another day, I did not show up to that class because I was busy with another class project. It was the only time I ever skipped that class which perhaps gave them plenty of time to gossip. The following time, my classmates came up with a different explanation about me. In fact, I did so well in that class academically to be called “slow,” and I have even surprised them with elaborate Photoshop work during a group project.

The reason why I was so awkward is because I have Asperger’s. That’s what my classmates thought. Why are you so monotone? Why don’t you look me in the eye? Can you tell me about Einstein’s theory of relativity? Those are the questions they asked me. They were not necessarily being condescending, and even came off as being a little intrigued about me. But still, I felt like I didn’t have to go through these directed “attacks” at the college level.

Luckily the semester was just about finished so I didn’t have to see these people anymore. Also, I had time to research this “condition” that I have. I started off reading about Asperger’s online and then hyperlink after hyperlink after hyperlink led me to another condition that legitimately got me worried.

I was one of the unlucky ones because before I found out about SCT I stumbled on an article called “Psychopathology of Frontal Lobe Syndromes.” Later, I would find myself printing that article out and reading highlighted parts out loud to my therapist. These are some of the strange, uncanny similarities between ADD-SCT and frontal lobe syndromes: (I am comparing SCT/ADHD-PI in retrospect.)

Frontal Lobe Syndrome (as discussed in Sluggish Cognitive Tempo/ADHD-Primarily Inattentive
Distractibility Distractibility
Poor attention Poor attention
Poor memory/“forgetting to remember” Poor working memory and retrieval from verbal long term memory
Perseveration Perseveration manifested as repetitive thoughts/actions, staring, and “hyperfocus” which is an intense focus on a single topic
Inability to switch from one line of thinking to another Difficulties with complex working memory tasks which test the ability to switch between multiple tasks (Dr. Diamond)
Inability to plan ahead Inability to plan ahead/ “Myopia of the future” (Dr. Barkley)
Difficulties with math calculations Math learning disabilities
Dynamic aphasia Subtle difficulties with high level language planning
Reduced activity Physically hypoactive
Emotional blunting “Zombie feeling” that SCT and ADD individuals often complain about
“Pseudo-depression”; Depression due to another underlying condition Depression or dysthymia due to the input-output processing disturbance rather than a completely separate emotional disturbance (underarousal – my personal experience)

(And no, in case anybody was wondering, I don’t actively go searching for this stuff in my leisurely downtime. Instead, I stumbled upon it completely by chance when a blogger made similar comparisons to Asperger’s. One of the things I have learned is that shouldn’t be ashamed to say something about anything, because most likely someone else is thinking the same thing. Also, Dr. Barkley has referred to SCT as similar to “white matter brain disease” as an analogy which isn’t exactly a pleasant comparison either…)

Let’s just say that the therapist told me that I simply needed more therapy sessions than we had originally planned. So many times she convinced me that I did not have a neurological problem. But I did not tell her I thought I had a neurological problem. I told her I am worried about the uncanny resemblance to those symptoms and the symptoms I experienced the greater part of my life. Then out of the blue one day she told me that she changed her mind and that maybe I should see a neurologist. (In all honestly, I believe that she was going through a hard time herself, perhaps peri-menopause, because she would always be fumbling and stopping mid-sentence in search of her next word. That makes the two of us I thought. There may have been a little SCT in the both of us, but with different roots.)

Instead, she referred me to a psychiatrist that would later be insensitive to my concerns, said I was anxiety-ridden, and wanted to write me an Rx for Xanax and get me out of her office A.S.A.P. (I also noticed that my therapist was a little apprehensive when she found out that THAT doctor was the only one available so it must be the doctor.)

The therapist I saw years before that other therapist was not of much help either. On the first day, I told said therapist that I had simply inherited the worst of both of my parents’ traits without any positive traits. “How so?” she asked. I told her that I was socially awkward like my dad, but did not have his strong math and engineering abilities. On the flip side, I had my mom’s terrible inability to follow math and directions, but did not have her precious social skills and ability to interact with people.

The abovementioned therapist then wrote me off as having a cognitive distortion in that I am only able to see in black and white. She then devised a plan for me on how to remedy this problem. What?! I am going to get a mental disorder label that has large and broad implications from just a single comment in a single visit? That is simply unbelievable according to my untrained insight about psychology. Talk about generalizing from a single example. I do not think “black and white thinking” is my problem. In fact, I see so many shades of gray that I cannot make any decisions. I stopped going to this therapist after just that single session.

My parents are not much help either. When I was 19, my mom told me that I was nothing but “years piling up” referring to my under-accomplishments and general melancholy and sluggishness. In the same vein, she also said my dad was nothing but “pills pilling up” referring to his myriad of health problems that require a miniature pharmacy of drugs in the kitchen.

I am just “years piling up” – a lifetime of moments passing me by. It’s not so much that she said it, but more that I know it’s true. I wish she would just shut up because I have to live with this clusterfuck of a condition and she doesn’t. So many countless times, I felt like the demented lab rat that can’t make it to the other end of the maze due to confusion or utter stupidity.

My mom tells me that she believes depression (or any “mental” condition) is a made-up illness, e.g., you are not in a wheelchair so you must be alright. Maybe I can excuse her because she is not educated. I don’t know if I can though.

The next step: Repetitive Transcranial Magnetic Stimulation (rTMS) for depression

Repetitive Transcranial Magnetic Stimulation or rTMS is a non-drug therapy for treatment resistant depression. In the treatment, the patient sits in a chair while a magnetic coil sends electrical impulses to targeted regions in the brain that are associated with depression. Each session lasts about 40 minutes and it is recommended that the patient attends five treatments a week for four to six weeks for therapeutic benefits.

Many people considering TMS see it as a last resort attempt at treating their depression after multiple unsuccessful treatments. Not only do I also see TMS as a final attempt at alleviating depression, I also see its possible benefits in a much more specific light. Some of this has to do with the portion of the brain that is stimulated called the left dorsolateral prefrontal cortex which is implicated in everything from depression to motivation and planning to verbal working memory. Unlike most other treatments for depression, TMS is able to highly target specific areas of the brain. Today’s psychotropic medication is more or less “hit or miss.” (I especially would NEVER consider electroconvulsive therapy due to its detrimental effects on memory).

I went to two doctors for a TMS consultation, Dr. A and Dr. B. Dr. A said that I was too “under medicated” to try this treatment right then and now and put me on Celexa and Concerta instead. I told him I insisted on the treatment. After the insistence, he said that I may try it after evaluating the effects of the drugs he prescribed me. He also said that I would have to remove my permanent retainer because the TMS magnet may attract the metal therefore causing the retainer to “fly in the air like a projectile.”

I wanted a second opinion. Dr. B was a specialist in childhood disorders including AD/HD, and I made an appointment to discuss the option of TMS. He basically told me that everything that Dr. A said about TMS was wrong. He said that TMS has the ability to help a multitude of conditions depending on where the therapeutic metal coil was placed on the scalp. He told me that I didn’t need to remove my retainer because it was such a negligible amount of metal.

Dr. B also gave me the verbal “seal of approval” that I was the most knowledgeable person on TMS that has ever walked in his office. He even told me that I know more about TMS than some doctors. This is what months of internet research can achieve. A part of me wanted to be proud of myself for my ability to hyperfocus, but another part of me thought that I was just plain screwed.

I was dead serious about TMS. This may be the treatment that can resolve my difficulties for good I thought. Even though the latter Dr. B I visited was far more experienced with TMS and has used the tool to treat not just depression, but anxiety, dementia, schizophrenia, and autism among other conditions, I ended up finalizing a start date with Dr. A due to cost. Dr. A said that he would greatly reduce the price and so I decided that he shall do for now. I was desperate after all. I went to my childhood orthodontist to remove the permanent retainer in my mouth that I had for years. And as soon as it was removed, I made the call to schedule my first TMS session.

In the end, I ended up not going for TMS. I had to cancel it for multiple reasons, some of the reasons I do not have time to explain. rTMS is just too damn expensive, not covered by insurance in most instances, and is still relatively new as a clinically available treatment for depression. Even less information is known about its effects on other mental disorders.

Even so, to this day I still ponder the possibilities of what TMS may bring.