Comparing TMS and Ketamine Therapy

Using all the metaphors

We all use analogies to understand our own minds. We have to; our brains can’t exactly examine their own neurons when they introspect.

We also use analogies for communication, because subjective experience can only be transferred through language, and the medium isn’t nearly as rich as the subject. We have to say that being in love is like watching the sunrise, or that fear feels like a cold hand gripping one’s intestines, because there’s no other way to communicate what we mean.

In explaining what depression is like, I’ve had to rely on analogies and metaphors, because explaining a brain-state to someone who’s never experienced it is like explaining sight to the blind. I even have to use an analogy to explain why I’m using analogies.

In any case, when comparing TMS and Ketamine therapies, I’ll have to resort to analogies and metaphors once again, because I don’t have the vocabulary or quantitative data necessary for anything more precise.

A Mind as Gears

I often imagine my mind as a bunch of gears, not unlike the transmission in a (non-electric) car. At its heart two gears connect, and this is how motive power (intelligence, motivation, etc.) is transferred from the depths of my mind to my thoughts and actions.

In this particular metaphor, my depression functions akin to rust or other wear and tear. The gears get rusty. They squeal and shriek and clang against one another. Tremendous amounts of energy are wasted in friction and excess heat. The whole system grinds to a halt.

So what do Ketamine and TMS do?

Ketamine

Ketamine therapy felt like a massive amount of oil being dumped on the whole system. Every gear got absolutely doused in lubricant after a single session.

Predictably, the whole system started working. Gears that had been jammed with gunk were suddenly free to spin given how frictionless everything became.

Those two important gears that connect could spin freely, sliding against one another without disruption or jerk - but the rust and the gunk weren’t gone, just neutralized, their ability to slow the system down negated by the drug.

This feeling was reinforced when, two weeks after I stopped the Ketamine treatment, the lubricant dried up and I was back where I started, only now with the full scope of the problem revealed to me in horrifying clarity.

(Note that I didn’t complete the fully recommended course of Ketamine therapy, so the treatment abruptly ceasing to work may not be normal.)

TMS

TMS was a very different - and generally less pleasant - experience. Where the Ketamine was a lubricant, making the gears slide across one another with little issue, TMS felt more like a giant wrench taken to one of the central gears. The whole system was forced to turn by the application of a massive external force.

I often turned to an analogy of physical therapy when trying to explain this. TMS felt like physical therapy for the brain: a painful, repetitive series of exercises that left me fatigued, but slowly built up my own strength.

In terms of the gears, having them forcibly turned wasn’t pleasant, but it actually started to grind the rust and gunk off of them. In the same way that a car’s brake pads wear smooth with enough friction, turning the gears of my mind wore away the built-up crap that was preventing them from turning of their own accord.

The TMS felt like it was actually addressing the problem, whether I conceptualize ‘the problem’ as an atrophied muscle or a rusty gear. By exercising my brain, the TMS was fixing the root of the issue.

Comparisons

In the gear metaphor, the reason why the Ketamine lost effectiveness and the TMS hasn’t is clear: the Ketamine addressed the symptom (accumulated rust/gunk) without actually fixing anything. The TMS actually cleared out the rust and gunk, albeit by shear torque forcing the whole system to move.

Some days it felt like I could hear the grinding and squealing of the gears in my head as they rubbed against one another, the metal wearing smoother and shinier with each treatment.

If we think instead of the treatments as analogous to other physical medicine, I’d say that Ketamine functions more like a shot of adrenaline: it allows even atrophied muscle to perform temporarily. TMS, on the other hand, felt like physical therapy: slow, painful, but ultimately restoring functionality to a muscle that had lost it.

Logistically, both therapies are involved. I found TMS easier to get on, but that might be a fluke of my insurance or the clinics I talked to. Ketamine is certainly more fun, but you’ve got to get someone to drive you to the clinic and back.

In the end, if you’re depressed, I’d recommend trying both (not at the same time). One way or another, you’ll learn something about yourself and how your mind works, and if either is effective, so much the better.