Depression treatment helped put a Houston man 'in the driver's seat' of his mental health

Depression treatment helped put a Houston man ‘in the driver’s seat’ of his mental health

Dated: 05/23/2023

Dr. Ahmed Bayoumi never realized how much his depression was affecting his life until his father provided a wake-up call six months ago.

Bayoumi, 30, knew he’d been struggling to manage his symptoms since he was first diagnosed with clinical depression in 2016. He tried various medications over the next six years, but all of them worked for a few months before they gradually became less effective.

The cycle of low moods and sleepless nights seemed normal to Bayoumi by the time he visited his family in Egypt at the end of last year. He hadn’t seen them since he moved to the U.S. in 2020 to further his career as a neuroscientist. His father, who also works in health care as an orthopedic surgeon, told him that he was worried.

“He was telling me that I felt like a different person and not necessarily a better person. He was alarmed,” Bayoumi said. “That felt even more alarming for me because he’d never noticed me going through anything before.”

Bayoumi, a research fellow at UTHealth Houston, decided to try something new when he returned to the U.S. at the beginning of 2023. That’s when he found Dr. Joao L. de Quevedo, the director of the Treatment-Resistant Depression (TRD) Program at UTHealth Houston and McGovern Medical School.

De Quevedo suggested transcranial magnetic stimulation (TMS), a noninvasive form of brain stimulation in which magnetic energy is directed toward the part of the brain that is associated with depression. Bayoumi had 35 outpatient sessions over nine weeks, each lasting 18 minutes.

Those sessions, coupled with therapy and lifestyle changes, helped to alleviate Bayoumi’s symptoms. He said he’s feeling calmer and more in control of his thoughts. He’s also feeling less irritable and less annoyed than he was prior to treatment.

“My mood is sort of more stable,” he said. “Even if one gets the normal bad days, they are not as intense and not as destabilizing as they used to be.”

Bayoumi’s struggle to find an effective treatment for clinical depression is not uncommon. Studies have estimated that up to 30 percent of cases of clinical depression are classified as treatment-resistant. Patients often become discouraged when they try several medications and none work for them, de Quevedo said.

“The major issue that I face when I see patients for the first time is the lack of hope because they’ve already tried treatment A and B and C and D,” de Quevedo said. “The first challenge is rebuilding hope.”

A recent CVS Health/Harris Poll survey found that 60 percent of respondents aged 18-32 said they were concerned about their mental health, with two-thirds saying they know a lot of people in their community struggling with mental health issues. Despite that, the survey found that only 10 percent of Americans regularly see a mental health professional such as a psychologist or psychiatrist.

Although Bayoumi is a neuroscientist, he said he put off trying to find a treatment that worked for him for too long. May is Mental Health Awareness Month, and he hopes that he can inspire others to keep trying — particularly other health care workers, who are often stubborn about their own health.

“This life can be a stressful life, and we sort of signed up for this. But we’re not beyond pathology,” he said. “What afflicts our patients are the same things that will afflict us.”

An ‘incredibly frustrating’ cycle

Bayoumi said he’s always been prone to depressed moods, but his symptoms started to worsen during his medical residency in neuropsychiatry in Egypt. He began having trouble sleeping, which interfered with the rest of his life, he said.

“It felt like being followed by a gray cloud all the time, where I’d bring my own rain,” he said. “It’s just something that’s dreary and gray.”

He was diagnosed with clinical depression and prescribed an antidepressant. It worked for about nine months before its effectiveness started to wane.

By 2017, he began to experience more severe symptoms, such as suicidal thoughts. He began to overthink everything, always fearing the worst-case scenario in any situation. He continued to struggle with sleeplessness and lost his appetite.

Bayoumi tried several more types of medication, but nothing seemed to work for him. He began to see his depression as just an inescapable part of his life.

“It’s incredibly frustrating,” he said. “It gets to a point where you start cementing in the belief, more and more, that there’s something wrong with you, and it’s not something you can address.”

That feeling may be familiar to others who’ve experienced mental health issues, particularly in the wake of the COVID-19 pandemic, said Cara McNulty, the president of behavioral health and mental well-being at CVS Health.

A CVS Health/Harris Poll survey from last year found that nearly two-thirds of Americans were dealing with anxiety and depression, and that trend has continued into 2023, she said.

“This is becoming more normal, and so they’re used to their mental health being impacted,” McNulty said. “They’re used to feeling less than great when it comes to their mental health because they’re used to dealing with a lot.”

Finding treatment

Bayoumi vowed to keep trying to find something that worked for him after he spoke with his father in Egypt. He committed to going to sleep and waking up at the same time every day, which helped with his sleeplessness and improved his mood.

He decided to look into other types of treatment and found the Treatment-Resistant Depression Clinic. He wasn’t sure he had treatment-resistant depression, but he figured it wouldn’t hurt to go in for an assessment. De Quevedo quickly confirmed the diagnosis.

De Quevedo suggested TMS, which the U.S. Food and Drug Administration approved as a treatment for depression in 2008. The clinic has been offering TMS since 2018.

The treatment involves the use of a magnetic field that targets the dorsolateral prefrontal cortex, the area of the brain that’s associated with depression. It stimulates neurons in the brain, which triggers other processes that help to alleviate symptoms, he said.

The treatment doesn’t hurt; de Quevedo tells his patients that it “just feels weird.” The most common side effects are mild to moderate headaches and scalp discomfort.

“You have a sensation that something’s happening, but it’s not painful,” he said. “It’s just magnetic.”

The effect of the treatment typically lasts at least one year, and patients can receive another round of treatment once those effects begin to wane, he said.

De Quevedo said he prefers TMS because it’s less invasive than other treatments, such as deep brain stimulation and electroconvulsive therapy (ECT). It is also effective — 70 to 80 percent of patients see an improvement in their symptoms, while 50 percent see their symptoms go into remission, he said.

“Having this option gives us more tools, and therefore, it’s more likely that patients will benefit from those tools,” de Quevedo said.

Building mental resiliency

While the treatment provided tremendous benefit, Bayoumi said other lifestyle changes have also helped to improve his mental health. He’s kept his regular sleep schedule and committed to healthful eating and regular exercise.

Other things can also be beneficial to your mental health, McNulty said. Studies have shown that being outside in the sun can improve your mood. Deep breathing, meditation or yoga can also help, she said.

On the other hand, social media can have a detrimental effect. McNulty said people tend to post their “best” photos on social media, which can make someone feel like everyone else is doing well when they’re not. The CVS Health/Harris Poll survey found that 58 percent of Gen Z and young millennials said social media negatively impacted their mental health.

If you’re feeling lonely or isolated, talking to friends and loved ones can also be helpful, McNulty said.

“It’s really small actions and small steps,” she said. “We’re building not only that mental well-being but that mental resiliency.”

Although more people — and particularly young people — are more willing to seek mental health services than compared to the past, there are still barriers to treatment, McNulty said. There is still a stigma associated with seeking treatment because TV and movies often portray individuals with mental illnesses as being “broken,” she said.

Many people also “don’t know what they don’t know” and may not recognize a mental health concern, McNulty said. She said it’s important to get an assessment if you have any concerns. CVS Health offers a range of mental health services at its MinuteClinic locations, including depression screenings and mental health counseling.

Bayoumi said he’s grateful he decided to keep trying to find an effective treatment for his clinical depression because he’s feeling much better than he was six months ago. He hopes he can inspire others to do the same.

“I have to continue being in the driver’s seat of my mental health,” he said. “I think that is probably the most important thing.”

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