Depression with a twist
Marcus was diagnosed with bipolar II at twenty-nine. The hypomania wasn’t his problem — those were the weeks he felt almost normal, energetic, productive. The depressive episodes were the wrecking ball. They’d roll in every few months, last six to ten weeks, and take everything with them.
“When I’m depressed, I can’t coach. I can’t stand in a gym full of teenagers and pretend to care about a pick-and-roll when my brain is telling me nothing matters. I’ve called in sick for entire weeks. My athletic director has been more patient than I deserve.”
Lamotrigine was his primary mood stabilizer. It flattened the highs and took some weight off the lows, but the depressive episodes still broke through. His psychiatrist in Atlanta added quetiapine during bad stretches. It worked but knocked him out — not ideal for someone who needed to be at the gym by 6 AM.
Over eight years, Marcus tried lamotrigine, lithium (hated the side effects), quetiapine, lurasidone, and cariprazine. He found a regimen that was tolerable — lamotrigine plus low-dose lurasidone — but the depressions still came, just slightly less brutal.
His psychiatrist pitched TMS with a caveat
“She was straight with me. She said the evidence for TMS in bipolar depression is thinner than for unipolar depression. There’s a theoretical risk of triggering a manic switch, though the data suggests that’s rare. She said she’d monitor me closely.”
Marcus appreciated the honesty. He’d had enough doctors sell him on treatments as miracle cures. He read up on the research himself — the studies were smaller, but outcomes for bipolar II depression looked cautiously promising.
His clinic in Atlanta used NeuroStar equipment. Low-frequency right-sided stimulation — a protocol his psychiatrist specifically chose because evidence suggests it carries lower mania-switching risk than high-frequency left-sided protocols typically used for unipolar depression.
Insurance was a fight. His plan through the school district initially denied the claim, arguing TMS for bipolar depression was “experimental.” His clinic’s patient advocate filed an appeal with supporting literature. It took five weeks, but they got approval.
Thirty-six sessions of cautious optimism
Each session: 37 minutes, five days a week. Marcus went during his planning period and lunch break, which his principal approved.
“The tapping was annoying more than anything. Loud. I wore earplugs. The tech let me listen to podcasts through one earbud. I got through a lot of sports radio in those seven weeks.”
Side effects: moderate headaches the first four sessions, mild scalp discomfort throughout. His psychiatrist had him come in biweekly for mood monitoring, watching for any signs of hypomania. He stayed on lamotrigine and lurasidone the entire time.
The first real sign of change came in week three. His PHQ-9 had been sitting at 16 — moderately severe — and dropped to 12. Not dramatic. But he noticed he was staying after practice again to work with players on free throws, something he hadn’t had the energy for in months.
“My wife said I was ‘back in my eyes.’ She has this way of knowing before I do. She said my eyes go flat when I’m depressed. She noticed them change before I felt any different.”
Improvement — but not remission
By the end of treatment, Marcus’s PHQ-9 was 9. Down from 16. A meaningful drop, but still in the mild depression range. Not remission.
He was disappointed. He’d read Sarah’s story on this site about going from 18 to 3 and hoped for the same trajectory. His psychiatrist reminded him that bipolar depression is a different animal, and that a seven-point PHQ-9 drop represents real, functional improvement.
She was right. The improvement was real even if the numbers weren’t perfect.
He coached a full season without missing a game for the first time in three years. He started sleeping better — not great, but six hours instead of four during depressive stretches. He reconnected with his older brother, whom he’d been avoiding because depression made every phone call feel like a performance.
“I can function during the lows now. Before TMS, a depressive episode meant I was basically offline for two months. Now it’s more like… the volume is turned down. I’m still sad, still tired, but I can get through the day without white-knuckling it.”
Six months later — an honest assessment
Marcus had one depressive episode since finishing TMS, about four months post-treatment. It lasted three weeks instead of the usual seven. Shorter and shallower. His psychiatrist is considering maintenance TMS sessions to extend the benefit.
“I’m not going to tell you TMS fixed me. It didn’t. But it helped more than the last three medication changes combined. If you’ve got bipolar depression and you’ve been through the medication carousel, it’s worth the conversation with your doctor.”
His honest scorecard: energy improved about 40%. Sleep improved about 30%. The desire to isolate dropped significantly. He still takes his medications. He still sees his therapist biweekly. TMS didn’t replace any of that — it made the rest of his treatment plan work better.
Marcus’s advice
- Be honest about your expectations. If you have bipolar depression, the outcomes may not match unipolar depression success stories. That doesn’t mean it’s not worth trying.
- Fight the insurance denial. His initial denial was overturned on appeal. Don’t give up at the first no.
- Tell your employer. Marcus’s principal was accommodating once he understood it was a medical treatment, not elective.
- Stay on your mood stabilizer. Stopping lamotrigine during TMS would have been risky. His psychiatrist was firm about this and he’s glad she was.
- Track your own progress. Marcus journaled daily. Some days he couldn’t see the improvement, but looking back over weeks, the trend was clear.
Names and identifying details have been changed to protect patient privacy. This story is based on composite experiences reported by TMS patients and is presented for educational purposes only. It is not medical advice. Talk to a qualified specialist about whether TMS is right for your situation.