FARGO — Sometimes Heidi Ruff feels like Rip Van Winkle.

Just like the story of the amiable farmer who dozed off and woke up 20 years later, the Fargo woman feels like she lost years and years of her life to Major Depressive Disorder.

Since 1996, Ruff says she’s tried numerous medications and electroconvulsive therapy in attempts to feel happy and whole again.

During that time, depression clouded every corner of her life — forcing her to drop out of college, become agoraphobic and eventually rely on disability benefits to live.

But, as Rip had to eventually wake up, so has Ruff.

Her awakening stemmed from a new, non-invasive treatment, which the FDA has approved to treat particularly stubborn forms of major depression.

Every weekday since early December, Ruff has come to Upper Midwest TMS at 5621 36th Ave. S. in Fargo to receive transcranial magnetic stimulation, a treatment that delivers powerful magnetic pulses through a coil to reactivate the nerve endings in our brain that govern depression and mood.

Study results vary, although a common statistic is that TMS has a success rate of anywhere from 60 to 70% — meaning the majority of individuals find significant relief after treatment, says Dr. Jonathan Olivas, a psychiatrist who co-founded Upper Midwest, the only TMS practice in North Dakota and western Minnesota. This can be especially promising for individuals who don’t respond to antidepressants or are unable to tolerate them.

“Most of our patients have been on eight, nine medications,” Olivas says. “So I think if a patient is committed to drive here everyday for the treatments, this is a reasonable treatment modality.”

In Ruff's case, she was ready to try anything after taking more than 20 different antidepressants over the years. During her daily TMS sessions, Olivas says the doctors and technicians at the clinic explained to her that she probably wouldn’t notice much improvement until week four. Until then, she took comfort in knowing that treatments were helping to carve new, healthier neural pathways.

After finishing her last TMS treatment last week, Ruff says she feels more alive than she has in a long time. At age 50, she is considering a return to school to finish up the last few classes needed for her social work degree.

“I’m scared to go to school without a notebook and pen and book,” she says, referring to today’s digital classrooms. “But it’s also exciting. I’m just grateful some of the fog has lifted.”

Tucked in a strip mall, Midwest TMS opened the doors to its unassuming suite of offices last May.

Drs. Jonathan Olivas and Lisa Schock are general psychiatrists at Sanford who started the business as a side project to give local people another “tool in the toolbelt” for hard-to-treat depression, says Dr. Joel Schock, Lisa’s father. Drawing on the advice of Dr. Simon Kung, a TMS expert at Mayo Clinic, they invested in a $90,000 TMS machine, took the required courses and squeezed in their first TMS clients before 8 a.m. and after 5 p.m. during the week, Olivas says.

Several months ago, the doctors sold the business to Lisa’s father, Dr. Joel Schock, a long-time general practitioner in Fargo and co-founder of Plains Medical Clinic. He plans to travel to Duke University in early April to take the required TMS courses, but will continue his day job at Plains Medical Clinic. Lisa has stepped away from the practice, although Olivas and another psychiatrist will continue to do periodic, after-hours consulting work for the TMS clinic.

A typical course of treatment starts with a consultation with one of the psychiatrists. Patients learn that the therapy has minimal side effects — besides occasional, localized scalp pain in the treated area, headache and dizziness. Some recipients experience mild eye and facial twitching, but it’s temporary. “It’s nothing really but mild annoyances,” Schock says.

He adds that a tiny percentage of patients may experience seizures, “but that is extraordinarily rare.”

People who aren’t candidates for TMS include anyone who has implanted metal in their skull or brain, has tattoos on the head or neck or has cochlear implants, according to clinic materials.

A typical course of treatment consists of 30-minute sessions five days a week for six weeks. After the initial consultation session, the doctor kicks off the series of treatments with a “brain-mapping” procedure to determine the ideal location for the treatment and the appropriate “dose” of electromagnetic pulses for that particular patient.

This helps the provider pinpoint the left dorsolateral prefrontal cortex (DLPFC), a spot located above the left temple where TMS is applied. This part of the brain processes a variety of cognitive functions, including our emotional responses to the people and world around us. In people suffering from depression, the DLPFC tends to be underactive, according to the National Institutes of Health.

Once the treatment area is targeted, a device containing a metal coil is placed against the head in the desired area to deliver the appropriate level of electromagnetic pulses.

During the treatment, the patient will hear a series of loud clicks and experience a tapping sensation from the device.

Some patients report a slight lightening of mood within two weeks of daily TMS, although the majority don’t report significant results until they’re at least four weeks into treatment, Olivas says.

So far, the providers been pleased with their results. Olivas estimates that of the 30 patients they’ve treated locally, 21 or 22 have reported improvement.

The approximate out-of-pocket cost for 30 treatments is around $5,000. However, most major carriers will now cover TMS to some extent — as long as patients can show they have tried at least four different medications without success, Olivas says.

Olivas believes TMS can be used in conjunction with existing medications and psychotherapy. “There is good data that this may be synergistic, meaning sometimes with other medications along with this, things can be more effective,” he says.

He also believes it can be an effective tool in people who no longer respond well to medications. Studies show that only 10 to 12% of depressed patients will get better after trying two or three medication trials, he says.

TMS also offers a viable option to electroconvulsive therapy (ECT), in which electric currents are sent through the brain to induce a seizure and "reset" the brain," Olivas says.

Today's ECT is much more refined and gentle — and traditionally is one of the most powerful weapons against particularly deep, persistent and debilitating depressions. However, it is expensive, must be performed in a hospital and requires anesthesia, which turns away some of the people who might benefit from it, Olivas says.

“And then what’s the next step? That’s ECT (electroconvulsive therapy) and that’s such a big barrier, which very few will get referred to that. So now we’ve got another treatment modality that people can use,” Schock says.

Research suggests depression could be just the tip of the iceberg when it comes to the usefulness of TMS. The FDA has already approved its use for smoking cessation, migraines and obsessive-compulsive disorder, although that requires a “deeper coil” and concentrates on a different location of the skull.

In addition, TMS has been studied to alleviate symptoms of everything from anxiety and bipolar disorder to ADHD and Parkinson's Disease.

But at this point, the most established, evidence-backed research has zeroed in on what Upper Midwest TMS specializes in: severe depression."

That's something for which Ruff is extremely grateful. "I’m excited for those young people who don’t have to do this for 25 years and struggle," she says. "They don’t have to lose decades of their lives.”

Learn more about Upper Midwest TMS at uppermidwesttms.com .