from treatment-resistant depression and substance use disorder.
Posted on 5/20/2025
MORGANTOWN, W.Va. – With major depressive disorder (MDD) already raging within him, Paul Nuedling, 34, said turning to substances for relief was like tossing “gasoline on a fire.” Despite attempted treatment, his life spiraled out of control for years.
When he finally found sobriety, his depression only worsened. Nuedling sought help from the WVU Rockefeller Neuroscience Institute (RNI) to begin transcranial magnetic stimulation (TMS) treatment, which provided the solid foundation he needed for his recovery.
MDD, or depression, is one of the most common mental illnesses in the United States. In 2022, the Substance Abuse and Mental Health Services Administration reported that 22.5 million adults had depression.
MDD is characterized by persistent and intense feelings of sadness or loss of interest in activities, with additional symptoms like changes in appetite or weight, sleep disturbances, low self-worth or excessive guilt, fatigue, trouble concentrating, or thoughts about death or suicide. For a clinical diagnosis, the symptoms must last longer than two weeks.
Nuedling, who grew up in Wisconsin, faced depression at an early age. He started counseling in second grade, and by middle school, he took antidepressants. His family was very supportive, but despite the support, medication, and counseling, Nuedling didn’t feel much better.
At age 17, he began using substances because his medication, he said, was not providing the relief he expected.
“I wanted the relief now,” Nuedling said. “Once I found that illusion of relief with substances – because it was so quick – I was all in on that. The antidepressants weren’t doing what I thought the substances were helping me with.”
Unfortunately, his addiction to substances only made his depression worse. Once an active member of his church and community, Nuedling began breaking the law, destroying his relationships, and struggling to hold a job. “Everything that comes with active addiction,” he explained.
He attempted rehabilitation and spent the next few years in and out of sobriety. He was exhausted. “I really didn’t think I would get better,” Nuedling said. He felt perhaps his purpose was to die.
Nuedling moved to West Virginia and entered a six-month recovery program at Jacob’s Ladder in Aurora, where he stabilized his substance use disorder. Despite taking medication and receiving regular counseling, he still felt like he was barely hanging on mentally. He feared he’d turn back to substances for relief.
“With a lot of our conditions, we usually recommend a combination of medication management plus psychotherapy,” Jourdan Aromin, M.D., assistant professor in the RNI Department of Behavioral Medicine and Psychiatry, said.
He noted that psychiatric medications have significantly evolved with more options and fewer side effects, but finding the right medication can take trial and error, which can be frustrating for some patients.
Dr. Aromin added that some patients are treatment-resistant – they’ve found no relief from their symptoms after attempting at least two different trials of medications and after attempting psychotherapy.
“That opens the door to start thinking about interventional modalities,” he said.
One such interventional treatment is TMS, a noninvasive, targeted therapy that uses magnetic pulses to stimulate targeted areas of the brain and help normalize brain activity. The therapy is very well-tolerated, safe, and does not require medication, sedation, or anesthesia. TMS is used in combination with other therapies to treat obsessive-compulsive disorder or treatment-resistant MDD.
At the suggestion of his doctors at Jacob’s Ladder, Nuedling decided to visit RNI and explore TMS treatment.
“The real benefit of TMS as compared to pharmacological treatments is that TMS only targets the part of the brain that is involved in that medical problem,” Umer Najib, M.D., TMS Program director and vice chair of operations in the RNI Department of Neurology, said.
“That helps prevent the unwanted side effects that patients often see with other pharmacological therapies – brain fog, sedation, difficulty with ambulation, and so on. And with TMS, we do not see any of those unwanted side effects.”
Dr. Najib and Aromin worked together to coordinate Nuedling’s TMS treatments, while his primary psychiatrist continued medication management. As his clinical symptoms fluctuate, his TMS treatment frequency can be adjusted to best stabilize his mood.
Nuedling was about halfway through his initial six-week treatment program when he felt a positive change in his mental health. At the end of six weeks, he said Najib noticed an improvement in his physical posture and his sociability.
As a part of his maintenance treatment plan, Nuedling now receives TMS a few times each week.
“Paul is a great example of TMS used in combination with other therapies,” Najib said. “He’s been doing really well.”
Recently, Nuedling reached his milestone 400th TMS treatment. “I’m so thankful I found TMS,” he said.
Nuedling added that TMS is a crucial part of his recovery program, because it’s given him solid footing to try additional therapies, like Healthy Minds – Chestnut Ridge Center’s dialectical behavior therapy, a type of talk therapy that helps him accept who he is and make positive changes.
“In recovery, there’s a phrase, ‘Don’t give up five minutes before the miracle happens,’” he said. “Not giving up, trusting the process, and having people support me has made all the difference.”
Nuedling is now a certified peer recovery support specialist, and he uses his experience to help others.
“Any way I can share any of my experience, if I can help the next person, I’m more than willing to do it,” he said.
He added that not only is helping others something he’s always wanted to do, but he’s also seen an improvement in his own mental health by doing it.
“I don’t want to do those things again, especially in active addiction,” Nuedling said. “And I don’t want to be stuck in the pit of depression or despair. But those experiences – it’s turned into something, and that’s being able to help. And there’s no better gift than to see somebody grow and to empower somebody to empower themselves. That has been the greatest gift.”
Follow Nuedling as he shares his story and receives TMS treatment in this video.
For more information about the WVU Rockefeller Neuroscience Institute’s TMS Program, visit WVUMedicine.org/TMS.
