By Dr. David Woo - January 3, 2019

Managing depressive symptoms is an important aspect of any treatment for depression, including repetitive transcranial magnetic stimulation (rTMS). Wellness practices hold a great amount of value as a complementary approach that helps patients foster self-compassion and self-care during treatment. Not only do many of our patients report that wellness activities — like mindfulness, exercise, and journaling — create a healthy, positive balance for them, but numerous scientific studies have shown that they improve symptoms of depression. Before we get to talking about specific wellness practices to help you manage depressive symptoms during rTMS, let’s answer the question, “what is repetitive transcranial magnetic stimulation”?

First, What Is Repetitive Transcranial Magnetic Stimulation?

Repetitive transcranial magnetic stimulation (rTMS therapy for depression) works by delivering electromagnetic pulses to the head in a non-invasive, painless manner. These pulses stimulate the part of the brain involved in mood regulation. TMS has become a desirable treatment option for patients because it does not cause the adverse side effects associated with antidepressant medications. In fact, rTMS treatment side effects are rare and mild compared to those of antidepressant medications.

What Are Some Ways You Can Manage Depression During TMS Treatment?

Studies have shown that these wellness activities are valuable tools for managing symptoms of depression.

Practice Mindfulness

Mindfulness techniques have been shown to prevent the recurrence of depression. (4) Currently, researchers at Harvard University are studying the effects of an eight-week mindfulness training, which includes body awareness and actively shifting away from negative thoughts, on individuals diagnosed with depression. This study will conclude in 2019. (5)

Mindfulness is paying attention to your experience in the present moment in an accepting, non-judgmental way. (1) Mindfulness meditation is perhaps the most well-known mindfulness practice. It involves sitting or lying down with your eyes closed for a set amount of time while focusing on your breath or mentally scanning your body to identify and release tension. (2,3) Even if you don’t meditate regularly, any moment can be an opportunity to practice mindfulness. For example, while you’re walking, you can pay attention to your movements or tune in to all the sounds around you. Yoga is another popular activity that incorporates mindfulness.

Exercise

Aerobic exercise is rhythmic movement that raises your heart rate and can be maintained for an extended period of time. A recent analysis of 11 different studies with 455 patients with depression showed that aerobic exercise significantly reduced depressive symptoms when practiced for about 45 minutes, three times a week, for at least 9 weeks. (6)

Try these easy ways of including aerobic activity in your routine:

• A brisk walk or a light jog in the morning
• Joining a Zumba class in your neighborhood
• Taking the stairs at work or when you exit the subway
• Riding your bike to work, or going for a weekend ride in the park

Write in a Journal

Journaling, or expressive writing, is an exercise in which you write your thoughts and feelings about emotional events in an unstructured way. Journaling can help you feel more in control of your thoughts and worries, give you an opportunity to use positive language, and even help you pinpoint patterns associated with your depression symptoms.

In fact, journaling has been shown to help reduce symptoms in patients with depression. For example, a study published in 2013 observed 40 individuals diagnosed with major depressive disorder, 15 of whom were taking antidepressant medication. For 20 minutes a day for three days, half of the study participants did an expressive writing exercise (writing about an emotional event), while the other half were asked to write in a controlled manner (writing about non-emotional events). Participants who practiced expressive writing showed greater improvement on depression questionnaires filled out the day before and the day after the trial. The positive effects of expressive writing continued when the subjects were asked to complete the questionnaires again four weeks after the experiment. (7)

Participate in Talk Therapy

Talk therapy is a method of psychotherapy in which patients share their thoughts and feelings by talking with a licensed therapist. For example, cognitive behavioral therapy is a kind of talk therapy that aims to help patients identify negative thought and behavioral patterns that contribute to depression, and then create positive thinking patterns. (8) Cognitive behavioral therapy has been shown to have long-term effects of up to one year for individuals diagnosed with treatment-resistant depression. (9)

In addition to TMS, Madison Avenue TMS & Psychiatry offers talk therapy as a complement to depression treatment like rTMS, or as a stand-alone treatment. Please contact us to learn more about our practice, or to make an appointment.

  Resources:

1. Keng SL, Smoski MJ, and Robins CJ. Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review. 2011; 31(6):1041-1056. Link. Accessed December 20, 2018.

2. Greater Good in Action. University of California, Berkeley. Link. Accessed December 21, 2018.

3. Mineo, Liz. With mindfulness, life’s in the moment. The Harvard Gazette: Health & Medicine. Published April 17, 2018. Link. Accessed December 21, 2018.

4. Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical Psychology Review. 2011; Aug;31(6):1032-40. Link. Accessed December 20, 2018.

5. Powell A. When science meets mindfulness. The Harvard Gazette: Health & Medicine. Published April 9, 2018. Link. Accessed December 20, 2018.

6. Morres I, Hatzigeorgiadis A, Stathi A, Comoutos N, Arpin-Cribbie C, Krommidas C, and Theodorakis Y. Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Depression and Anxiety. October 2018. Link. Accessed December 20, 2018.

7. Krpan KM, Kross E, Berman MG, Deldin PJ, Askren MK, and Jonides J. An everyday activity as a treatment for depression: The benefits of expressive writing for people diagnosed with major depressive disorder. Journal of Affective Disorders. 2013; 150(3): 1148–1151. Link. Accessed December 20, 2018.

8. Overcoming depression: How psychologists help with depressive disorders. American Psychological Association. Published October 2016. Link. Accessed December 20, 2018.

9. Li JM, Zhang Y, Su WJ, Liu LL, Gong H, Peng W, and Jiang CL. Psychiatry Research. 2018; 268:243-250. Link. Accessed December 20, 2018.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.