The helmet was heavy, but its weight no longer surprised Juliette DePalo. She had come to expect the pressure on her head during the treatments, and the loud tap-tap-tap on her skull that followed.
It lasted 20 minutes, but by the time she completed a week’s worth of sessions, the change in Juliette would last far longer.
“It’s not scary,” Juliette, 21, said of the treatments. “It’s about [creating] a normal, functioning life for me.”
And sure enough, it wasn’t long before Juliette said she was able to approach life with a zest she’d found eluded her for so long, all because of the tapping helmet.
This isn’t a scene from a science fiction novel, but the work of Deep Transcranial Magnetic Stimulation Treatment.
Deep TMS is a breakthrough in technology that has made it possible to treat depression and anxiety without medication, and advocates for the brain stimulation technique say it works.
Juliette is one of its biggest proponents.
“It gave me a result that I was not able to achieve with a multitude of medications over six years,” she told InsideEdition.com. “You just feel less hopeless.”
Anxiety came for Juliette when she was 13. Depression followed at 14.
“I didn’t understand why I felt so fearful to leave my house. … You don’t quite understand what’s wrong,” Juliette said. “It came up in bouts of anger and irritability. … It impedes on your social relationships, your academics.”
Socializing with friends and navigating school became nearly impossible for the Long Island teen, who struggled with the everyday moments people not dealing with anxiety and depression may take for granted.
“My academics really took a hit; attendance … doing assignments, getting out of bed every morning,” she said. “It just sort of makes everything sort of pointless.”
It didn’t take long for Juliette’s mother to recognize her daughter needed help.
“My older daughter has experiences [with depression] as well. … Because she had a sister, I think it was easier for her to tell me and ask for help,” Lorelei DePalo said. “I reached out and found her an excellent therapist.”
Juliette began seeing Dr. Aleksandra Krunic, a board-certified psychiatrist whose practice specializes in establishing comprehensive and individualized plans to treat mental health.
When she was 15, Juliette began taking medication to treat her depression and anxiety, and while it helped at times, she said she often found herself slipping backward and dealing with the same thoughts and feelings that landed her in Krunic’s office in the first place.
“It doesn’t cure everything; it helps me for a bit, but I would always have to change medications, or I would plateau,” Juliette said. “It would become disheartening at a certain point. I would be frustrated.”
It was difficult for Juliette to come to terms with the idea of forever needing to take medicine to feel somewhat better, especially when it wasn’t working, she said. As a result, it was often hard for her to stay motivated to take her medication regularly.
“It’s really kind of a thing, there’s a whole psychology to this; you don’t really want to be on medication,” Lorelei said. “So when she was getting ready to go off to college, that was a huge concern for me. I didn’t want to deny her that experience … but I was worried about Juliette taking her pills.”
Lorelei’s concerns weren’t unfounded.
At Northeastern University in Boston, Juliette was drowning in school work and fighting a losing battle to leave her dorm room in time for class.
“I was really struggling and trying different medications without success.”
Her experience is unfortunately not unique, according to Krunic.
“Juliette is a good representative of young patients with depression,” Krunic said.
On top of dealing with myriad side effects that can manifest as a result of medication, young persons working to improve their mental health sometimes struggle with regularly taking their medication, and even those that do can find their symptoms remain.
“They still might have 30 to 40 percent of the symptoms they [previously] listed,” Krunic said. “If you think about the average psychiatric patient, about one-third don’t get better at all, two-thirds get better, but only one-third [of that group] are really good. So 70 percent … still have a lot of symptoms.”
For years, there was little doctors could do to help bridge that gap besides head back to the proverbial drawing board and prescribe a different medication.
But that finally changed in 2008 when the U.S. Food and Drug Administration approved of rTMS, or Repetitive Transcranial Magnetic Stimulation, as a safe and effective treatment for those with depression. In 2013, the FDA approved of Deep TMS, a technique built on the same principals as rTMS, but one that takes less time to administer and was constructed by brain disorder treatment company BrainsWay.
While rTMS treatments take 37 minutes to complete, the technology utilized in Deep TMS sessions more deeply and widely stimulate the brain and, as a result, last 20 minutes.
“Deep TMS uses pulse magnetic fields to stimulate certain brain areas,” Krunic said. “The same way we try to stimulate these areas with medication.”
But unlike medication, Deep TMS has no reported side effects, she said.
Though the treatments have been on the market for years, insurance companies were slow to provide coverage, and as a result, few patients had the means to access them, Krunic said.
According to those familiar with the industry, individuals looking to undergo Deep TMS sessions without insurance coverage could expect to pay between $9,000 and $12,000, as the cost varies depending on factors including the practice offering them and the services provided.
“The majority of depressed patients can’t work, earn less and weren’t able to get it,” Krunic said. “Insurance companies are starting to approve it … but so much has to happen before they actually approve it.”
Deep TMS is now covered by most insurance providers, and generally patients can expect to pay an average copay of about $20 per session. Since a course of treatment is about 36 sessions, patients should plan to spend about $700 out of pocket for the full course, experts said. But officials who advocate for the treatment say this is far less than a person would spend on copays for medication they would likely take for a significant, if not the full length, of their life.
Insurance providers often require a patient to have failed at least two to three medications before they will be approved to try Deep TMS, according to Krunic.
Juliette fit that bill, and when she returned home from college last spring, she and Krunic discussed giving it a try. Nervous for what was to come, Juliette was slightly unsure but eager to see if this would be the treatment that would finally make a difference. And so, she strapped on that heavy helmet and hoped for the best.
As she had often done since she was 15, Juliette made her way to Krunic’s office for treatment last May. But unlike previous appointments, Juliette was guided into a room where she was instructed to sit in a chair connected to a funny-looking contraption.
“They put this belt sort of thing [on] to protect your head, then you put on this big helmet,” she said. “They first have to find the spot in your brain that would be most conducive to your treatment.”
That first session lasted 40 minutes, as doctors must pinpoint the specific location in a person’s brain that will be targeted for stimulation. Then each subsequent session lasted 20 minutes.
“It feels like someone’s kind of knocking on your scalp,” Juliette said. “It’s definitely a weird sensation.”
It can also be loud, but not deafening.
“I wore headphones and watched Netflix,” she said. “I got through almost all of ‘Brooklyn Nine-Nine’ during my treatment.”
The sessions were quick and uneventful, much to the relief of Juliette and her family, who were unsure of what to expect before they learned more about the treatment.
“I was a little bit nervous about it,” Lorelei said. “I said, ‘Juliette, I don’t know if I want someone in there fooling around.’ But it’s no different than what the medicine is doing.”
Krunic has often dealt with misnomers when it comes to introducing technological advances in dealing with mental health, including the effectiveness of certain treatments like Deep TMS.
“I have a lot of physicians I talk to who don’t know the [details surrounding Deep TMS] … and think it’s a sham, that it’s not working,” Krunic said.
Unlike in other fields of medicine, convincing the mental health community at large to accept technology and its benefits has sometimes been an uphill battle, she said.
“I spend a lot of time talking to highly educated people, trying to explain technologically and medically why this makes sense,” Krunic said. “There’s a lot of stigma associated with it.”
But as it becomes a more widely accepted form of treatment and more widely available in communities that currently have little access, Krunic hopes that will change.
“FDA approval indicated that if you fail one medication trial, you should be able to get the TMS,” she said. “Research shows that actually if you are very new to depression, your responsiveness to TMS is much higher. The illness is new, and … in an ideal society, it would actually be much better to consider this treatment early on, to get the good results and then hopefully never have to get it again.”
Juliette underwent treatment five days a week until 36 treatments were completed.
“My first two weeks, I was worried, because I started feeling more anxious than usual, but that’s typical with TMS, I learned,” she said. “They switched the side of my brain that was being treated and then I noticed something different.”
A few weeks after beginning her treatment, Juliette began to feel better.
“It was like a weight was lifted off,” she said. “A big one was, I was able to get out of bed easier in the morning. I felt a lot less lethargic. I had a lot more energy. I was eating more — when I’m depressed I’ll stop eating. And I just felt less hopeless.”
Her mother and doctor noticed the difference as well.
“Patients say I just don’t know how and why, but I just feel like I want to do more,” Krunic said. “Juliette never had such a strong start and strong year [at school] than after TMS.”
Juliette returned to Northeastern University, where she spent one semester in class full time and the next successfully completing a co-op, in which she worked full time as part of a program the university runs.
“When she went back to school I was really relieved; I didn’t have to worry about her not taking her meds,” Lorelei said. “That was something that could let me sleep a little bit at night. To me it’s a lifesaver.”
Juliette spent six months medication-free before getting sick in December.
“It affected my mood, and things took a dip,” she said. “I was really struggling, but sometimes you need to get boosters with Deep TMS, and that will help.”
Unable to find a doctor who her insurance would allow to provide the treatments in Boston, Juliette went back on medication. When she returned home from college this spring, one of her first stops was at Krunic’s office.
“I’m really excited,” she said. “For me, medication is not the thing [that works] … and if medication isn’t working for you, it’s not the end of the line.”