Paul Nuedling

Paul Nuedling, 34, knows what it's like to fight the same battle from two directions at once. Major depressive disorder (MDD) was already raging inside him when he turned to substances for relief — a decision he now compares to tossing "gasoline on a fire." For years, addiction and depression fed each other, and his life spiraled out of control. 

Even after he got sober, the depression didn't ease up. It got worse. That's what eventually brought Paul to the WVU Rockefeller Neuroscience Institute (RNI), where he began transcranial magnetic stimulation (TMS) treatment — the foundation he needed to finally start rebuilding his life. 

Depression From an Early Age 

Paul grew up in Wisconsin, and depression found him early. He started counseling in second grade, and by middle school he was on antidepressants. His family was supportive every step of the way. But even with that support, plus medication and counseling, Paul didn't feel much better. 

At 17, he turned to substances instead. 

"I wanted the relief now," Paul 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." 

When Addiction Took Over 

The relief was an illusion, and the addiction only deepened his depression. Paul had once been an active member of his church and his community. Now he was breaking the law, wrecking his relationships, and unable to hold down a job. 

"Everything that comes with active addiction," he said. 

He tried rehab. He spent years cycling in and out of sobriety. He was exhausted. 

"I really didn't think I would get better," Paul said. There were times he believed his purpose might be to die. 

A New Foundation 

Paul moved to West Virginia and entered a six-month recovery program at Jacob's Ladder in Aurora, where he finally stabilized his substance use disorder. But even with medication and regular counseling, he still felt like he was barely hanging on mentally, and 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," said Jourdan Aromin, M.D., assistant professor in RNI's Department of Behavioral Medicine and Psychiatry. Psychiatric medications have come a long way, he said, with more options and fewer side effects than in years past — but finding the right one can still take trial and error, which can be frustrating for patients. 

For some patients, that trial and error doesn't lead anywhere. Dr. Aromin explains that a patient is considered treatment-resistant once they've gone through at least two different medication trials and a course of psychotherapy without relief from their symptoms. "That opens the door to start thinking about interventional modalities," he said. 

MDD, or depression, is one of the most common mental illnesses in the country. The Substance Abuse and Mental Health Services Administration reported that 22.5 million American adults had depression in 2022. It's marked by persistent, intense sadness or loss of interest in daily life, often alongside changes in appetite or sleep, low self-worth, fatigue, trouble concentrating, or thoughts of death, lasting more than two weeks. For patients like Paul, whose depression didn't respond to standard treatment, medication and psychotherapy alone weren't enough. 

Discovering TMS 

One such interventional treatment is TMS: a noninvasive, targeted therapy that uses magnetic pulses to stimulate specific areas of the brain and help normalize brain activity. It's well-tolerated and safe, and it doesn't require medication, sedation, or anesthesia. TMS is often used alongside other therapies to treat obsessive-compulsive disorder or treatment-resistant MDD. 

Unlike oral medications, which circulate throughout the body, TMS targets only the specific brain regions involved in a patient's condition — part of why it doesn't carry many of the side effects patients often see with pharmacological treatment, like brain fog, sedation, or difficulty with balance and movement. 

At the suggestion of his doctors at Jacob's Ladder, Paul decided to visit RNI and explore TMS. 

Solid Footing 

Paul's TMS treatment was coordinated with Dr. Aromin, while his primary psychiatrist continued managing his medication. As his symptoms have fluctuated, his TMS frequency has been adjusted to help keep his mood stable. 

Paul was about halfway through his initial six-week treatment program when he noticed a positive shift in his mental health. By the end of those six weeks, his care team noticed it too — improvements in his posture and his sociability. 

Today, as part of his maintenance plan, Paul receives TMS a few times each week. He's become a strong example of what's possible when TMS is used alongside other therapies, and his providers say he continues to do well. 

Recently, Paul reached a milestone: his 400th TMS treatment. 

"I'm so thankful I found TMS," he said. 

Building on That Foundation 

Paul says TMS has been a crucial part of his recovery because it gave him solid footing to try additional therapies, like Healthy Minds Chestnut Ridge’s dialectical behavior therapy, a type of talk therapy that has helped 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." 

Paying It Forward 

Paul is now a certified peer recovery support specialist, and he uses his own experience to help others find their way. 

"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. 

Helping others is something he's always wanted to do, he added — and it's improved his own mental health along the way. 

"I don't want to do those things again, especially in active addiction," Paul said. "And I don't want to be stuck in the pit of depression or despair. But those experiences have 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."