How Transcranial Magnetic Stimulation and Genome Testing Pulled Me Out of a Severe Depression
My uncle Peter Wollheim made some national news last year following his suicide. He had worked tirelessly to set up and support a suicide prevention hotline in his Boise community, so naturally there was interest in someone who had that mission, but ultimately took his own life. He was also the son of Holocaust survivors, and People Magazine in particular did a good job of explaining what this kind of childhood was like for him, and the role it played in his personal struggles.
There are points where my uncle’s story intersects very closely with my own. The difference is that I am here and he is gone, and there is a reason for that: I got the right treatment, and he did not.
Peter was my mother’s only sibling. His father, my grandfather Norbert Wollheim, was a hero to many within the survivor community. During the war, he organized the Berlin Kindertransport, an effort that saved the lives of thousands of Jewish children. His personal accounts were featured in Into the Arms of Strangers, which won the Oscar for Best Documentary in 2001. After the war, he successfully sued to obtain reparations for the slave labor he performed in the camps, which set the precedent for other survivors to be compensated. In 2008, a memorial to my grandfather was unveiled at the IG Farben building in Frankfurt, which German students insisted upon, as it had been a center of industry and slave labor during World War II. I am Norbert’s only grandchild.
My mother married Herman Wachter, my father, also the son of Holocaust survivors. My father took his own life in 1993, when I was 11 years old (his situation was also compounded by drug addiction). Many of the people in my family have been through a mental health crisis that required inpatient hospitalization at some point. Yes, my mother and father had a difficult childhood being raised by parents who had been through unspeakable horror, which put them in no position to be properly empathetic. But there have also been scientific studies closely linking parental trauma, specifically experienced by the mother, actually being passed down to offspring via DNA and making children more susceptible to PTSD and depression. So this is not only an environmental issue, but a genetic one as well.
I happened to be fairly lucky. Through 30 years I hadn’t experienced much depression, although I did have some anxiety that was well managed through therapy. I was your classic overachiever: during my freshman year of college I found work as a writer in the gaming industry, and was flown all over the world and paid well to report on and market big money tournaments. Between studying and my writing career, I spent my downtime playing six tables of online poker at once, often making $1,000 on weekends. Two months before graduating from college with three honors distinctions, I had a job offer waiting for me in San Diego. After moving there from New York, I quickly bought a Mustang convertible (my first car), and moved into a house with co-workers that had the Pacific Ocean as our backyard. By the age of 30, I was married with a child and had an exciting job in the tech industry. I ran nine miles most Saturdays and would go to the gym on my lunch breaks at work.
Sometime around this point, I had a particularly bad panic attack that developed into panic disorder. A month into struggling with it, I tried my first SSRI and had a terrible reaction with worsening depression. The next eight months were extremely difficult; I did see a CBT therapist, but more than anything he helped me keep my head above water. I had a persistent feeling that my day-to-day struggles were accumulating with no relief, and I would eventually drown.
The trouble wasn’t so much the panic attacks themselves. It was more the effort it required to keep a straight face during a work meeting or a family party to pretend everything was normal while my brain and body exploded, shouting at me (falsely) that I was in extreme danger. In most daily situations, you just need to sit there, smile, and take the hit despite your experience beneath the surface.
At a point, the constant high level anxiety became too much, so I took some time off and tried four different medications over the course of six weeks. None of them worked, I had more bad reactions to them, and I was left off much worse than when I started. I could barely eat, lost fifteen pounds, and was in a state of perpetual anxiety: heart constantly pounding and my body pumped full of adrenaline and cortisol. If I was lucky, I would sleep one hour per night.
This was more than my body could take, and shortly after, the pendulum swung in the other direction. I entered a state of constant exhaustion. I would sleep like a rock for ten hours, and wake up feeling like I got no sleep at all. I could not focus on any mental tasks. Exercise was always my outlet for a guaranteed mood boost, but even doing that would leave me sobbing in the shower afterwards, feeling so much worse (this in particular really scared me, and confused my doctors). Not understanding what was happening to me, and in some denial due to lack of experience, I insisted on doing a sleep study and getting a workup from an endocrinologist to rule out any physical issues. When those came out fine, I had to face that I was in a severe depressive episode hallmarked by crushing exhaustion.
Really, I think the term nervous breakdown applies better than anything. The amount of stress I had put my body and brain through made the whole system completely shut down and left me without the energy or focus to do much of anything, despite having the motivation. It felt less like a mood disorder, and more like a physical issue. Very confusing and disorienting at first, especially since it wasn’t what I had thought “depression” felt like. I always pictured someone inexplicably sad, which didn’t quite feel like my situation or my personality. A year prior I had run a half marathon, and now crossing the street to mail a letter felt like climbing a mountain.
Given that I had reacted so poorly to medications in the past, I had no idea how I was going to get out of the situation I was in. After a few months of not resembling much of a functional human being, and hoping it would get better through talk therapy alone, I looked up the best psychiatrist I could find in Los Angeles who took my insurance. To my amazement, he spent ninety minutes talking to me during our first visit, and prescribed no medications (anyone who has visited a psychiatrist will tell you this is like finding life on Mars). Given my sensitivities, he recommended we do a genome test to get a better idea of which medications could work best for me.
I sent off a saliva sample to a lab, and a few days later we had the results. They were not good. The test showed I’m a poor processor of drugs that go through the CYP2D6 enzyme, which is almost every modern antidepressant on the market, and most tranquilizers like Xanax and Valium (this explained why even the smallest doses hit me like a hammer). If I were to use any of these drugs, they would need to be sub-clinical doses. There was also a measurement of how likely I was to tolerate SSRI’s in particular. On a scale from 1 to 5, with 1 being “You should be fine”, and 5 being “This is probably a really bad idea” (paraphrasing here), I was a 5.
It was a validating revelation to know that the bad reactions weren’t all in my head, but also frustrating to confirm that there weren’t many options to pull me out of the depression. More or less, the only drug released after the 70s that didn’t fit into “Your body can’t process this correctly” and/or “This class of drugs doesn’t sit well with you” was Wellbutrin.
I got a prescription for the lowest dose, and was instructed to get a pill cutter to split those in half to see how I’d tolerate it. Wellbutrin is great for depressions like mine with a hallmark of extreme fatigue, but can make existing anxiety worse. It can also kick in pretty fast when it does work. So I took my first dose and braced myself for something like a Red Bull on steroids. Instead, I felt like a lethargic zombie, and had even more difficulty functioning than usual. Three days later, I was in much worse shape; my functioning level had plummeted below its already low bar, and my mood fell into a place of constant emotional pain. I was instructed to stop.
Rationalizing that it couldn’t possibly get worse than this, I decided to double down, and try an SSRI at 1/4th of the lowest starting dose. After seven days, I could not leave the house or eat, and the emotional pain was worse than anything I had ever experienced. At this point I was too much of a mess to manage from home, so my psychiatrist recommended inpatient.
I actually went in feeling hopeful and relieved, that being in a safe place surrounded by doctors would help figure out this puzzle. Even though I was in pretty bad straits, many of the patients around me were in even worse shape, with schizophrenia and drug addiction being common issues. I felt like an easy fix, with just standard unipolar depression.
My first morning there, I remember one patient teaching me a rummy game we could play to help pass the time. Being a lifelong card game enthusiast, I was eager. But the mental effort it took to play was exhausting, and after two hands I had to go lie down for an hour. This was a far cry from my amateur poker days of all night sessions and big profits.
Unfortunately, the doctor assigned to me did not have a magic wand to make things better. The drug options were the same as before, and the outlook was not great. We did find one more drug that didn’t fit that genome test parameters, and once I was tolerating it okay (which I was grateful for), I was discharged and sent to an outpatient group.
Ten days in, the drug started to work a bit. This lasted for all of a week. Soon, my mood and functioning level plummeted once again, and after trying to make some dose adjustments I was back in the inpatient facility. This time though, I knew this was something that wasn’t going to be fixed with drugs.
Transcranial Magnetic Stimulation, or TMS, is a depression treatment that was approved by the FDA in 2008. It involves placing a magnetic coil on the patient’s head, and stimulating neurons in a specific part of the brain known to be underactive in depression (the dorsolateral prefrontal cortex). Best of all, it has very few side effects: only some uncomfortable tapping on the head where treatment is applied. There are none of the standard side effects we’ve come to associate with medications.
The general public seems to be confused by the nature of TMS, thinking it’s similar to ECT. In fact, they are very different; TMS has none of the same side effects, and does not require anesthesia. Here’s the best way I can explain it: imagine your depression is a bunch of bad guys in your brain you’re looking to take out, akin to a war. ECT is like dropping a bunch of bombs on the whole city, rationalizing that the casualties of mass destruction are a worthwhile sacrifice to annihilate the offending occupants. TMS is more like a calculated strike, only going after the affected area and fixing it with extreme precision.
I had heard of TMS through online research and was intrigued. Following the genome test my psychiatrist did think it would be the best option for me, but we assumed I would need to fail a few more medications before getting insurance approval. Once I returned to inpatient, I spent every hour available when I could muster the strength to call providers and my insurance to get it set up.
I got in touch with the director at SoCal TMS, and one day after inpatient discharge I was at their office for an intake visit. My situation was a perfect example of someone who medically needed TMS treatment, and within two days the treatment was approved by my health insurance.
It’s important to note how fortunate I was to have insurance that covered TMS. I had Anthem Blue Cross through the ACA (Obamacare), and they just so happened to be the most willing carrier to approve TMS for their members. Without insurance coverage, a full course of TMS can easily cost between $10,000-$25,000. From what I’ve been told, insurance providers are slowly becoming more eager to pick up the tab, as it’s cheaper in the long run than paying for multiple inpatient visits or a lifetime of medication maintenance.
By the time my first treatment started, I was an absolute mess. I was in indescribable emotional pain every moment, and would simply count down the hours until I could go to sleep and make the day end. I could not leave the house or drive. To elaborate on that, I don’t mean that I was too anxious to drive, or that I didn’t have the motivation to do it. My exhaustion was so strong, and my ability to focus on mental tasks was so destroyed that I was physically unable to drive without being a danger to myself or others. So, I took an Uber to my first appointment, having panic attacks the whole way there.
For the first treatment, I met Dr. Todd Hutton and Stephanie Vergara, the nurse who would be administering the TMS. The chair was configured by finding the least amount of power that would cause my thumb to move involuntarily; this would be my motor threshold. After reading up on TMS and expecting it to possibly be painful, I was pleased to find it wasn’t that bad at all. Most patients describe it as a woodpecker on your head; to me, it feels more like a tiny static shock. Either way, it was perfectly tolerable.
The TMS chair was similar to what you’d find at the dentist (a leather recliner), and I’d have a remote in my lap to flip around television while getting “zapped”. The first few visits involved getting used to the treatment, and slowly ramping up the power. First we were at 100% of my motor threshold, and by the end of two weeks we were at 120%. At that point, there were small signs I was starting to improve: my appetite got better, my sleep was improving, and I had glimpses of being able to enjoy music, or have fun skateboarding down the block for ten minutes.
Even with the small glimpses of improvement my mood was continually bad, except for two inexplicable moments of feeling really happy, each lasting for an hour. For one example, I vividly remember my wife driving us through a fairly sketchy neighborhood in Los Angeles, and for some reason I felt like it was an overwhelmingly beautiful place. I looked at the rundown supermarkets, bodegas and liquor stores and thought to myself, “What a wonderful community!” and deeply felt the connections between the people there.
I’ve never done MDMA . . . but from what I’ve heard, I have to imagine it goes a little something like that. To have it plopped in the middle of a severe depressive episode was quite odd.
This over-the-top happiness and optimism came back down to earth soon after we got home. But this was enough for the staff to be strongly encouraged. Stephanie had a motto that helped me through it: “Once a responder, always a responder.” In other words, if during your treatment you have these small moments or signs of feeling better, it means your brain is taking to TMS. She used the analogy of starting a lawnmower: you pull, it goes for a second, it stops. You pull again, same thing. You keep pulling until it finally runs on its own. Another pattern they see quite often is that it’s very likely that if you respond to TMS, you will eventually achieve full remission. Most patients get all the way better, not just partially better.
But again, the process of getting there is very frustrating. It’s a rollercoaster week to week, where you can feel like you’re getting better before being dropped back down. Sundays were especially bad for me at the start, because at that point I was 48 hours removed from my last treatment. I got very low on those days, but reminded myself it was a sign that TMS was working and my brain wanted more.
It’s been noted anecdotally that a lot of TMS patients experience a dip at some point, which was definitely the case with me. Around week five or so, my mood plunged and I felt so much worse than I had before starting, which was pretty unbelievable (I’d love to know the science behind this considering it happens to so many patients). After a few days, I came back up to my standard depressed state. The point is, it’s not a straight shot towards getting better.
In my case, it was a long slog. Three months into treatment I still couldn’t drive, but enough things were improving that we kept going. As we got further along, we dropped the treatments down to three times a week, then two, until we were doing them weekly.
Once we got down to weekly, I felt better but not “better”. Here’s where another critical piece came in: the doctor explained that in many cases, improvements come after treatment ends. At the weekly treatment pace, we noticed that I’d go into a brief dip the day after, so we decided to stop and let my brain sort itself out.
They also got me in touch with another patient who was doing much better, and he was extremely helpful explaining that the process of improvement happens after TMS is over. In his case, it had been almost two years removed from starting TMS, following a crippling depression that lasted for five years. He still felt he was getting slightly better every month. This gelled with what the doctor had explained; after treatment, your brain needs some time to heal on its own and readjust.
Going Outside the FDA Box
There is something incredibly critical regarding TMS treatment that needs to be explained more often, and is my main motivation for sharing this experience. When TMS was in trials to get approved by the FDA, here’s how it was administered: five days a week at a maximum of 120% above motor threshold, 3,000 total pulses each time and a total of 36 treatments. None of the patients were on medication.
As a result, the documented success rates were not nearly as high as they look to be in real life practice. Unfortunately, this is where TMS fails a lot of patients. If you follow the FDA trials to the letter, it’s pretty rare you’re going to feel significantly better by the end of it. For whatever reason, many doctors still follow this protocol.
The more experienced doctors push the treatment beyond these boundaries, but it’s still quite safe. In my case, and with many others, Dr. Hutton pumped up the motor threshold to 140% in the third week so we’d get more power with each treatment. We also did 5,000 pulses per treatment, which he does with every patient I’ve talked to (almost doubling the bang for your buck). Most importantly, and this is the big one: he doesn’t stop at 36. They will keep going until you get to a point where you are significantly better.
In my case, this was critical. I ultimately needed over 70 treatments, which I’ve been told is at the very high end of the spectrum. If I had gone to any other provider who was too locked into the FDA trial template, I would not have gotten better.
The FDA success rates for TMS were very modest, in the neighborhood of 20% remission. The real world results seem to be around 70%, which is remarkable when you consider that antidepressants are around 30%-40%, taking into account lots of guesswork. Also, people who get TMS treatment are generally in a severe depression that has been treatment resistant. This context makes the 70% figure nothing short of miraculous.
TMS can also treat anxiety, which has not yet been approved by the FDA but is done “off-label” by most doctors as it’s proven to be effective. I always found this very interesting: with the depression treatment they stimulate the left side of your prefrontal cortex to “wake up” the part of your brain that is too slow. With anxiety treatment, they do the right side with a different frequency to “slow down” the part of your brain that is being too hyperactive (this is also used to treat chronic pain).
It’s worth noting that better results come from being on medication while doing TMS, and staying on it afterwards (something that was not done in the FDA trials). Some people are able to lower their dosage towards the end or taper off completely. That’s between the patient and the doctor; my instinct is that if you are feeling better and your medication side effects are manageable, it’s worthwhile to stay on and not rock the boat.
I’m happy to report that two years after my hospitalizations, I’m doing much better. To my disappointment, this didn’t mean rolling out of bed one day and getting back to the way I used to be. I’ve had to do a lot of the hard work on my own, challenging myself to continually do new things that make me uncomfortable so that I could get back to a good quality of life.
What the TMS gave me was the ability to do the work. My non-functional state was not going to be “snapped out of” to use a depression cliché. TMS pulled me out of the hole, but it was on me to get where I wanted to go after that.
Now keep in mind, I went through an extremely severe depression. If you’re still functional but your mood is poor, I’d imagine TMS will be even more effective for you. For example, Neal Brennan (Comedian, Chapelle’s Show writer) went on The Daily Show and a Slate podcast earlier this year to talk about how effective TMS was for his depression. From what he described, his symptoms weren’t as debilitating as what I experienced, and the treatment has made a huge improvement in his life and mood.
In my case, I went from the lowest depths of non-functional hell to a pretty good place: I enjoy things again, I’m fully present for my family, my mood is generally quite good. Concentration tasks are still difficult and I have brain fog to wade through to varying degrees/fatigue more easily than before the depression. I still have low moments and bad days, but they have become easier to manage as time goes on.
For TMS patients, it’s important to go in for maintenance treatment. For some people this means monthly, for others it’s more like a few times a year. I go in 3–4 times a year, and seem to reach a higher point of overall wellness each time. I watch TV for 30 minutes while I get my TMS, experience zero side effects after, and go about the rest of my day as normal.
This is also critical for relapse prevention. If you have one episode of Major Depression, there is a 50% chance you will have a second. After two, your odds of having a third go to about 70%, and after three you’re looking at 90%. The neuronal pathways get grooved in more with each episode. Given my family history, this is quite terrifying. Luckily, TMS is very effective at preventing relapse, and more effective than medication in this regard. But I also need to do my part; after spending most of my adult life being a glutton for stress and practically needing it to thrive, I am now mindful that I need to keep it minimized in order to stay well.
I’m Not on Medication
2018 Update: Hey, I’m on medication! I went through a less severe relapse where the TMS wouldn’t “stick” consistently. It was recommended to give Lamictal a shot; it’s a bipolar medication that often helps antidepressants work better with patients who aren’t bipolar. Given my medication sensitivities I resisted at first. But here’s the funny thing: my mom had brain surgery a year prior (she’s doing great now!) and has to be on anti-seizure medication for the rest of her life. The first one she was placed on was too heavy, so she was switched . . . to Lamictal. In addition to being an anti-seizure drug, it also happens to be the best medication for Bipolar 2. And once she switched, her mental health improved significantly.
In a psychiatric sense I most resemble my mother’s side of the family. We are very sensitive to psych meds, and my uncle had a very clear Bipolar 2 diagnosis. So I gave it a shot, and it’s been a very helpful part of my treatment plan. My psychiatrist defines this as being “bipolar-ish/bipolar spectrum”, where the manias are benign enough to barely be noticed (or don’t exist), but the patient responds to bipolar medications based on family genetics. If my mom hadn’t gotten a brain tumor, neither of us would have known. Life is weird.
TMS generally works better when there is a medication in the mix. Now that I have a proper one working that fits my genetics, I’m hopeful it’ll continue to be a good combination for me.
This is the big one. Anyone who goes through this bad of a depression is told, “You’re going to have to be on medication the rest of your life.” I’m not on medication. Most likely, given my history, I never will be. It does work for a lot of people, and I’d encourage you to stick with it if that’s the case.
Here’s the big reason this is so key for me: if you’re on medication for your depression, there is a solid chance that eventually will stop working (I can’t tell you how many people I met at inpatient or outpatient with this problem). You’ll need to switch, pump up the dosage, or throw in a second, third or fourth medication. At some point, it becomes guesswork.
I go in for TMS a few times a year to ensure I stay above water. If things ever go downhill, I’ll go in for another continuous round. I know it works and will keep working, there’s zero guesswork. If I have lingering symptoms, I know it’s my depression or anxiety and not the meds I’m on. I’m also happy to report my sex drive is healthy and my weight is where it should be (these seem to be two of the most common complaints regarding antidepressants).
The Future of Depression Treatment
Peter Wollheim did not die from suicide, he died from depression. It’s an important distinction to make, and one that I couldn’t have possibly understood until I experienced it myself. With a depression as severe as the one we both went through, ending the pain is a far more logical, reasonable decision than society is comfortable admitting. If you felt it day after day with no end or hope in sight, it would be irrational to want to keep living. The only saving grace is that depression is almost always a passing condition, and it is treatable.
That being said, after my experience I have conflicting emotions when anti-suicide movements make such a strong point to “go get help”. Certainly, it’s a sentiment I fully support. Yes, there are stigmas we need to conquer and it’s extremely important to encourage those going through it to seek treatment. Most of the time, it is a life saving intervention. But what happens when you’re taking your medications as directed and don’t get any better? Or the treatment makes you worse? That’s the situation many in my outpatient group were in. These are not “others”. They are professionals of all types. They’re our neighbors, who suffer immensely because the standard treatment isn’t working for them, and there are very few options offered aside from medication roulette. This happens more frequently than we want to acknowledge, and when it does, the conversation needs to shift from “get help” to “get more effective help”.
1 in 5 Americans will go through a major depressive episode at some point. It is a debilitating disease, and we are far too quiet and complacent considering how common it is. We are still treating it with drugs that have been documented (with some amount of controversy) to be no more effective than placebo, except in the cases of severe depression. It’s akin to sticking with a rotary phone when there is iPhone technology available. Even if the medications do work, getting off of them later can be a living hell: simply Google withdrawals for Paxil, Cymbalta or Effexor to get an idea.
We also need more research into TMS protocols to optimize them, and should aim to improve upon the technology so that we can more effectively get the same results, but faster and with even better success rates. Promising research is currently underway for depression treatment utilizing multiple TMS magnets, theta burst stimulation, trigeminal nerve stimulation, and ways to reach the anterior cingulate cortex section of the brain. I’m not sure how many of these will pass studies and get approval, but it feels like we’ve reached a critical turning point. We are on track to pivot away from throwing medications into the body with guesswork, and towards using 21st century medical science to directly, gently adjust the parts of the brain that aren’t working properly.
My uncle clearly had the same medication sensitivity I do, it’s a trait across my mother’s side of the family. Peter did a good job of hiding what he was going through during the last year of his life, but it seems that just like me, the medications made his situation worse. I tried my best to persuade him to try TMS, but ultimately I think getting your brain stimulated to resolve a depression is a stigma within a stigma. Many people have no desire to have a treatment that aesthetically looks similar to ECT, regardless of the effectiveness. This needs to change.
Most importantly, others should get the same opportunity I did. Insurance carriers are starting to learn of the effectiveness of TMS, but they need to know just how powerful it can be. It shouldn’t be necessary to fail four medications before it’s covered. Doctors need to give their patients the best chances for success by adapting their treatment regimens to better match real world scenarios. Patients deserve to be informed of what this process looks like. As a start, I’d love to see all combat veterans suffering from PTSD and depression get free access to TMS. They need it the most, and the results would be highly educational for the general public.
I still have some road to travel to get back to where I was, but the rocky part is over. Being such a goal oriented person, it’s been difficult to not have the capabilities to go back to the career I worked so hard to build. But this experience has given me a better perspective on what matters. Every day, I feel like I’ve recovered from a terminal illness, and I am grateful. I attended a six week mindfulness course run by UCLA, and I’ve meditated every single day for almost two years now. Before this, I was always a future oriented person. I now strive to have a moment to moment perspective on living. I’ve learned that rather than chasing achievements to get that never-ending dopamine fix, I can take a breath and notice that no matter what is going on, things are fundamentally okay right now. I may not be jetting off to Japan six times a year, or managing big projects with stressful deadlines, but I can look at my sons at the park, focus on my experience, and appreciate the beauty that is in front of me so much more.
Yes, the environmental and genetic results of being a descendant of Holocaust survivors were a major factor in the deaths of my father and my uncle, and my own depression. I get this trait from both sides of the family. This may seem like a curse, but it also instills within me stock from people who experienced the absolute worst and lived through it. I now know that when I’m confronted with the worst, I do not curl up and quit. I fight with everything I have in me, and I have my genetics to thank for that too. Multiple mental health professionals noted how motivated I was to get better despite being in a depression. I think it’s because I view it like any other genetic disease (and not a personal failing of some kind), I have done voracious research on what needs to be done to keep it in check, and I’m committed to following through on that for the rest of my life.
That being said, severe depression is a brutal experience, and I probably won’t be what I was before it. Not to say I am “better” or “worse”, as much as I’ve refocused on what matters, and have a better perspective on who I am and what makes me tick. And once you’ve been in the deepest pit for far too long, getting out and back into the light is wonderful, even if it’s not always sunshine and rainbows. If you remember the darkness, you can maintain the proper perspective.
I’ve also grown to accept this is my “thing” to manage, and that’s okay. Granted, this is much easier to say when you are no longer drowning, but rather find yourself head above water, still ducking under from time to time for short spells, knowing you will come back up. On the genetic side of things, my family does not have a significant history of heart disease or cancer, or Alzheimer’s, or any other major ailments. Both sides of the family tend to live a long time, and we stay mentally sharp throughout, which is a blessing. Fortunately, I don’t have to battle obesity, addiction, issues with relationships or overspending and debt, chronic pain, or countless other obstacles that can be serious lifelong challenges for others. Everyone has their struggles, no matter what appears on the surface. This is mine.
Good fortune and access to the right resources were also a big factor in my recovery; I am keenly aware of this and overwhelmingly grateful. I should not be in the minority of those who get better when dealt these cards. We have the tools to do it, now it’s just a matter of education and proper implementation.