Most individuals who read this workbook will have a fairly good idea what depression is because they have lived with it for a significant period of time. TMS is not just for these patients, people who seek repetitive transcranial magnetic stimulation (TMS) for their care have often had an aggressive form of depression. Transcranial Magnetic Stimulation is indicated for the treatment of Major Depressive disorder and can be used at any point in the illness course. Many insurance companies limit the use of TMS to patients who have not responded to several medications. For these warriors, surviving the day-to-day struggles with the illness is tough. Most individuals seeking TMS have been living with depression, but as you, your family, and friends may not have had a practical definition, we will give an overview of the illness. What follows is a general definition of depression and the current understanding of causes and the current (2017) standards for its treatment.

Depression is a brain illness in which the pathways which control mood are not functioning well, they are ‘depressed’; these brain pathways, neurons (brain cells), are not working as they once were. Depression has many origins, but the outcomes (symptoms) that most people with depression feel and show to others are similar. The symptoms of depression are: a depressed mood defined by sadness, guilt, lack of pleasure and disinterest, low energy and inactivity, low motivation, difficulty with thinking and concentrating, appetite and weight disturbance, feelings of hopelessness, helplessness, and sometimes thoughts of death and dying and unfortunately even suicide. These symptoms cause terrible suffering but depression can become worse and some depressed individuals can experience very distorted thoughts called delusions, and/or auditory or visual disturbances called hallucinations. Many cases of depression are complicated because they are also associated with anxiety, physical illness, or pain (emotional or physical). Often the illness is accompanied by anxious, fearful, obsessive, ruminative, or even nihilistic thoughts.

There is a significant lack of education in the world concerning depression and therefore, there is a large amount of stigma associated with the illness. Depression is not caused by poor motivation; it does not occur because the person did not try hard enough, did not read enough motivational books, or did not pray, meditate, or exercise enough. People do not cause depression to occur to them, but the illness does affect them significantly. Unfortunately, many people are uninformed and uneducated about depression which can strengthen the stigma of the illness.

Depression is an illness that does not discriminate based on race, gender, or socioeconomic status; anyone can get depression. Statistical studies show between 8-12% of people in the United States will meet the diagnosis of depression during any given year. Depression is presently the most disabling illness according to the World Health Organization. For those that have suffered with depression it is felt as a “dark hole”, “an abyss”, “a gray veil over life experiences.”

Diagnosing depression can be difficult, but with a professional evaluation, objective and subjective tests, and by excluding other medical illnesses, depression can be identified and treated. Over the last few decades, scientists have been able to develop tools to visualize the depressed brain and compare it those individuals that do not suffer from depression. In fact, Major Depressive Disorder (MDD), as an illness, is appropriately named; MDD is characterized by dysfunctional ‘depressed’ processing and communication among areas of the brain which we call networks. The important networks in the brain which are involved in depression include the dorsolateral prefrontal cortex, the anterior cingulate, the hippocampus, and the amygdala. At times, some of these areas are ‘depressed’ in their functioning and other areas may be overactive.

Depression is a brain disease that has genetic, biologic, psychological, social and spiritual causes, and, more often than not, the illness is multifactorial, meaning that many causes come together to give rise to the ultimate symptoms. Clinicians treat depression many ways; multifactorial illnesses get multifactorial treatments. Most treatments are biological, psychological, social, and spiritual-cultural-mindful interventions to help patients who suffer get well.

In this workbook, you will make note of your clinician’s plan for your treatment. Addressing all potential areas of your need, can help you get “fully well.” “Fully well” is another way of saying that depression goes into remission. Most people know the word remission when it pertains to cancer. Specialized doctors, oncologists, work to help patients with cancer, get to a cancer-free place (remission). Most everyone knows that cancer can recur; however, oncologists know that treating cancer to remission can help prevent recurrence. Depression is frequently a recurrent illness like cancer, and Clinicians have known for decades that if we can get a patient to remission, the patient is less likely to have a recurrent depressive episode. Combining many treatments is the current strategy to help insure that patients get into remission and maintain remission from depression.