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Suicidal ideation, adding lithium

Posted by Tabitha on February 19, 2016, at 0:40:20

I finally told my pdoc the degree of suicidal ideation I'd been having and he added lithium 300 mg for two weeks, then 600 mg. Apparently it's the only drug that has good evidence it reduces suicide risk.

I am already on 150 mg lamotrigine, Fetzima (a new SNRI), and triazalam for sleep. The triazalam has worked consistently, but with the others, I get good relief from depression for six months to a year, then a slow slide back. This time it was so gradual and my dark thoughts were so convincing that I kept it secret.

I used to think suicide was off the table because a family member did that and I swore never to do the same. Over time, I moved from hating what she did to feeling forgiving, then thinking it was an OK decision, given the amount of misery she was feeling (chronic pain mixed with severe depression). Lately I have felt impressed that she survived as long as she did, and thought I may not even make it to the same age as her when she died (which would be another three years for me).

Besides not wanting to follow her footsteps, I used to feel determined to be a responsible adult and stay on meds no matter what. Lately though it was seeming pointless. Go on meds, get relief, relapse, try something else, repeat. Overall I still felt like crap at least half the time, and it's so draining to get hopes that this regimen will stick, then have the same result as every other combo. I was ready to just go back to low dose, half-assery.

I observed that my brain was perhaps removing the barriers to suicide one by one. There's still one big one, my spouse. But I found myself thinking well, someday he may die or we might split up, then I won't have that last barrier. My remaining family would just have to deal with it. I'd write them nice letters, unlike my family member did.

So this was a pretty messed up line of thinking, and somehow I decided I'd better share it with my pdoc. I told my spouse about it first, so I'd be less likely to once again not tell my pdoc in our checkup. I told my pdoc, and now the lithium.

I was sad about having to take it, even more than other meds, since it sounds scary, and is a med for people who have failed other meds. But my mood has lifted since I started on it (just 5 days) and I had that transition where you go from not being able to feel pleasure or hope to feeling pleasure, then hope. Have you taken that trip? That transition is always quick, in contrast with the experience of losing hope and pleasure, which is slow enough to be imperceptible, which tends to convince me that I'm just failing at life, so of course I feel bad.

I'm hoping the 600 mg lithium will be enough, then I want to taper off the Fetzima and bump the lamotrigine up to 200 mg. I feel like I'm just done with SSRI's and SNRI's. They always work, then they always quit working. They all wreck my sexual functioning too. Sure it's fine for the first couple months when I'm just happy to not be suicidal, but it's tough to face that as a permanent condition.

Wish me luck and please share your thoughts on these meds.




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