Posted by Questionmark on October 24, 2007, at 0:47:32
In reply to Severe depression and suicidal ideation., posted by Galen on October 23, 2007, at 3:07:21
I used to think about and fantasize, more or less, about suicide all the time. The only THING (drug or otherwise) that changed this was Nardil. This is actually sad imo, but it's a fact.
First of all, she needs to know that sometimes these stupid drugs can make her feel much worse-- temporarily or semi-continually. SSRIs in particular can cause horrible depression during the startup or quitting periods, but since the depression doesn't start right away people don't realize it's due to or exacerbated by the SSRI and feel hopeless. Try to remember that.
But... I personally don't think Zyprexa or any antipsychotic is a good idea at all unless she is schizophrenic or otherwise psychotic (EVEN if she has OCD!). I don't think benzos are a good idea unless she has Some kind of anxiety contributing to her depression or has a very restless activated depression. Benzos can aggravate depression big time, especially in certain people. None of this crap will likely be of any help. But wait...
Severe depression needs a good, knowledgeable, compassionate doctor and, ideally, therapist. I totally understand her not wanting to tell her pdoc or therapist about her suicidal ideation b/c they very well might throw her into a mental institution for a time (which could be helpful or extremely detrimental) and tell her parents. But hopefully she could-- and should-- at least tell her docs/therapists that she is terribly depressed, etc. and needs more help while still lying about feeling suicidal.
(Some would disagree but i would almost encourage lying about that if one didn't want to risk losing the time etc to being involuntarily confined to a hospital [and i'm not saying that b/c i've ever been-- i've always lied myself]. I would of course, however, say that you should tell them about your suicidal thoughts etc before actually going through w/ ending your life.)
But she needs to find a *good* knowledgeable psychiatrist who will treat her depression aggressively and with whatever unique drugs or combinations will help. Screw Prozac. If it's not helping she needs something else. And screw (w/ caveats) combinations like Wellbutrin and SSRI, or SSRI plus antipsychotic, or SSRI plus dull mood stabilizer (although I agree that lithium could be helpful). OK not necessarily but probably, unless her *individual makeup* seems to be needing that sort of combo. But if she is going to stay on an SSRI and Prozac is not helping her much, she is going to need something else, NOT just a different SSRI: maybe a benzo if she has too much anxiety; maybe a good stimulating catecholaminergic drug if she feels to zombified. Maybe a drug that acts on opioid receptors in some way would be ideal, I don't know, but you would be hard pressed to get prescribed that. My suggestion: get on an MAOI. Nardil if you have anxious and/or serotonin-deficient-like depression (so to speak); Parnate if you have lethargic, anhedonic depression. Nardil first probably. It may be the greatest truest antidepressant medication in existence. It has some significant side effects (all drugs do). It requires a few diet and drug restriction. It changes you (?). But it often works, and when it does it works miraculously.
I have much more i want to say and clarify but i can't write a book in this post. Sorry i've rambled so much already. But there are ways to feel... not in intense suffering.
Tell her I wish her luck. And, at least to some extent, I really sympathize.
The world loses far too many good people to suicide.
poster:Questionmark
thread:790756
URL: http://www.dr-bob.org/babble/20071019/msgs/791037.html