Update:
I have been back in therapy for about 5 sessions. A couple weeks before I went back, my psychiatrist asked me to take the Beck's Depression Inventory because my insurance company demanded it for my TMS appeal. I scored as Severe this time. My diagnosis has always been MDD, Moderate.

As far as returning to therapy goes, I think taking a break had a neutral effect on me (other than the effect on my wallet being a positive). I've been gradually cutting people off and becoming isolated, it's been creeping in since the beginning of this year. When I went back last month, I told her right away about aspects of my behavior that are concerning me - the outbursts and total indifference towards friends and family - and we have continued to discuss it. Wish I could remember what she said other than it's totally understandable given my level of depression and to be kind to myself, but it all goes in one ear and out the other. She tells me isolating myself is not doing me any favors, but I'm not interested in engaging with anyone. I think I'm pretty unreachable to any chance of therapeutic benefits unless I find some other medication solution because I'm pretty despondent.

3 weeks ago, the insomnia brought on by my MAOI dose finally broke me and I actually started having anxiety at such levels that it was interfering with basic daily activities. I had to reach out to my therapist for a "talk down" call. Not suicidal, but just feeling totally helpless and out of control and unable to concentrate. She talked me for about 25 minutes and then talked to my psychiatrist, who called in a sleeping pill prescription which did not work for me but I appreciated the try anyway. I saw my pdoc the next week and I asked to come down on my med because this side effect was becoming a quality of life issue. My sleep improved almost instantly after I dropped down. Unfortunately I am dealing with the bad timing of a back injury (due to lying in bed depressed all of these months on a bad mattress) but now if I do wake up, it's back pain and not the activating effects of my EMSAM. Also, I have no idea how long it takes to "right the ship" after 9 months of sleep deprivation but I'm dealing with horrible fatigue from the fallout of all of this.

Wish I had an update that was more conclusive.