When Medications Don't Work

Dr. Peter Wagner, Alice Perez and Dr. Anthony Bassanelli
Alice Perez has struggled with depression and anxiety for most of her life.
“The day I gave birth to my daughter, my 16-year-old brother was being buried and I couldn’t be there,” the now-58-year-old Thermal resident recalls. “That was when I had my first episode of severe depression.
“By the grace of God, my strong belief in Him and family support, I survived throughout the years,” she continues. But she didn’t seek medical attention for the anxiety and panic attacks that continued to plague her.
“In the Mexican culture, we don’t ask for help,” Perez admits. “And as women, we tend not to get help; we’re afraid of being labeled as crazy.”
Then, seven years ago, she started experiencing harassment at work, which triggered even more severe and frequent anxiety along with a deep depression. With her family’s encouragement, Perez finally sought help from a psychiatrist.
Thankfully, she was referred to Anthony Bassanelli, MD. Board Certified in Adult Psychiatry, Dr. Bassanelli heads Eisenhower’s Behavioral Health services.
 “He has treated me for the past three-and-a half years,” says Perez. “When I started coming here, I was crying all the time. I had severe anxiety, depression and insomnia; I would sleep only two or three hours a night. I lost weight because I wasn’t eating. I had no interest in daily activities, I didn’t want to see anyone or have them see  me like that. I lost some friends because of it.”
Because Perez’s job situation was causing so much stress, Dr. Bassanelli agreed that she should no longer work in that environment, and he sought to find the right combination of medications to help manage her depression and anxiety.

“He and everyone at Behavioral Health understand my type of illness,” she says. “It’s a chemical imbalance; I’m not crazy. And just like a diabetic has to take medicine, so do I.”
But after trying ten different medications in various combinations, Perez still struggled to stay on an even keel. “They helped bring me up a little so I was sort of stable,” she says. But for Perez and many others who have what’s called treatment-resistant depression, it wasn’t enough.

Perez even considered electroconvulsive therapy (ECT, also called electroshock therapy); a procedure in which electric currents to the brain trigger a brief seizure, causing changes in brain chemistry that can reverse symptoms of diseases like depression. But the side effects, which can include memory loss, dissuaded her from going through with it.
Then, a new treatment option called Transcranial Magnetic Stimulation (TMS) became available at Eisenhower. And it immensely improved Perez’s life.
“TMS works in a way that’s so different from medications; it’s a totally different mechanism of action than all other depression treatments,” explains Peter Wagner, MD, Eisenhower’s TMS specialist who is Board Certified in Adult Psychiatry, Behavioral Neurology and Neuropsychiatry, and Brain Injury Medicine. “This leading-edge treatment was cleared by the Food and Drug Administration in 2008 for treating depression when standard approaches like medication and talk therapy aren’t effective.”
Eisenhower currently is the only hospital in the valley using the FDA-cleared NeuroStar TMS device. Importantly, TMS is covered by many major commercial insurers. Although TMS is covered by Medicare in several states, it is not currently covered by California Medicare.
“It uses magnetic fields, similar to those in an MRI scanner, to stimulate nerve cells in regions of the brain involved in mood control and depression,” Dr. Wagner continues. “We’re able to focus the magnetic fields in a very targeted way, and it doesn’t cause any of the bothersome side effects that medications can.”
TMS is performed on an outpatient basis, and requires daily (Monday through Friday) treatment sessions for four to six weeks. Each treatment session lasts about 40 minutes.
During treatment, the patient sits in a comfortable chair and the magnetic coil is placed against the head. The machine is turned on and the patient will hear clicking sounds and feel tapping on the forehead. Patients remain awake and alert during treatment, and can return to their normal daily activities immediately afterward.
“Patients may notice a difference in as soon as two weeks, but some need the entire six weeks to get a full response,” Dr. Wagner says. “Up to 40 percent of patients may have a relapse within six to 12 months; however, up to 90 percent of them will again have a similarly favorable response to reintroduction of TMS [as they did initially]. If provided in a timely manner, these repeat TMS courses (tune-ups) will typically achieve a good result in significantly fewer  treatments than the original TMS treatment course had required.”
At the time of her interview, Perez was completing her sixth week of TMS treatment.

“If we had had this conversation before [my TMS treatment], I would have cried throughout,” she says. “But now I’m laughing, I’m sleeping better, and I’ve even purchased a bike and am riding a bit for exercise.
“I’m out doing stuff with my grandkids, too,” she continues. “Just last week, they told me ‘You’re a different person.’ And I am.”
Perez feels tremendous gratitude to the entire team  at Eisenhower for their care and understanding. “Dr. Bassanelli, Dr. Wagner and the staff have been fabulous,” she says. “They treat you as the person you are.”
She’s also immensely grateful to her family for their support “and encouraging me to get the help I needed,” she continues, acknowledging that when she was in the throes of depression, her family suffered, too. She especially appreciates her husband driving her the 45 minutes each way to and from Thermal for her daily treatments.
“But every minute is worth it,” she says. “Sitting in that chair has made such a difference in my life.”
Perez urges anyone who is struggling with depression to seek help.
“Let’s come out of the darkness,” she says. “There’s no shame in saying you’re sick. Help is available. If we don’t get help, we remain in the same sad place. With TMS, there is hope. And if it worked for me, it could also work for someone else.”

Eisenhower Behavioral Health Services

Opening less than two years ago, Eisenhower Behavioral Health has nearly tripled in size, underscoring the need and demand for this type of resource in the valley.

“We are the only hospital-based outpatient behavioral health program in the desert,” says its Director Anthony Bassanelli, MD. With a staff of three board certified psychiatrists (Eric Woodard, MD, Peter Wagner, MD and Dr. Bassanelli) along with therapists, psychiatric technicians, nurses and support staff, the program provides one-on-one psychological counseling, group therapy, sychopharmacology/medication management and Transcranial Magnetic Stimulation (TMS).

The most common reasons people seek help from Eisenhower Behavioral Health are depression and anxiety.

“Given the demographics of the valley, the biggest percentage of patients we see are seniors,” Dr. Bassanelli notes, “so there are a lot of issues relating to the physical and psychosocial losses that come with aging, including coping with chronic health problems, neurocognitive decline and isolation.”

He also notes that despite the emotional pain that people suffering from depression or anxiety are feeling, some remain reluctant to seek professional help.

I think there’s still some stigma and misunderstanding about what mental health means, and a fear of being judged,” Dr. Bassanelli says. “But we understand so much more today that there are biological reasons for many of these problems, and there’s a range of medical interventions that we can provide to help if you’re struggling with depression, anxiety and similar issues.”

He notes that his program works closely with Eisenhower primary care physicians to help identify patients who may be dealing with such issues and can benefit from appropriate interventions.

“Part of every patient’s appointment includes depression screening questions,” he says. “Our primary care physicians are very aware of this issue and want to make sure patients get the help they need.”

That help is tailored to the individual needs of each patient says the program’s administrator, Maura Fisher, RN.

“There are a lot of choices here, and there is a lot of support,” she notes.

It’s a message that is resonating with a growing number of valley residents, given the dramatic growth of the program.

“We’re happy and excited that Eisenhower has been so supportive of developing such a broad range of mental health services, and look forward to expanding our program to meet the growing need,” adds Dr. Bassanelli.

For more information about Eisenhower Behavioral Health, or to make an appointment, call 760-837-8767.