Posted by SLS on October 11, 2005, at 13:21:20
In reply to SLS? Your input please., posted by Maxime on October 10, 2005, at 14:40:35
Hi Maxime.
I agree with Blueberry. I think adding a drug for immediate palliative relief makes sense. Blueberry mentioned the ones I would have suggested. I am partial to Zyprexa. I think it is a good drug to help bring someone out of the anxious catastrophic state that produces suicidality.
Since you are already on Parnate, I would look to optimize its use and build a regime around it. The sulpiride might be worth exploring. When I tried it, I was not on any antidepressants. It provided significant relief for a few days before it pooped-out on me. Dosages of 50-100mg were suggested to me when sulpiride is to be used as an antidepressant. Some people will go higher, but I don't think there is any real data to demonstrate a dose-response curve.
If you haven't already tried adding Lamictal to Parnate, I would consider doing so. Of course, lithium is still the drug with the most established track record as an augmentor of Parnate. That might be because it has been around the longest and studied the most. It may not really be the best, but it does work.
If it were me, these are the things I would consider doing:
1. Add Zyprexa 5-10mg
2. Increase Parnate dosage to over 100mg
3. Add Lamictal 200mg and/or lithium 300-600mg
4. Add nortriptyline 75mg or desipramine 200mg
Of course, you might already have tried these things and have been without success.I wouldn't know where to place the sulpiride. I think it makes sense to try, but you might want to optimize your mood as much as possible with these other things first. Some people use S-AMe for temporary relief. I really don't think it would interact adversely with the Parnate. Adderall might be worth considering, but it might help for only three days or so.
I still think that Zyprexa is a good anti-suicide drug that might be the very first thing for you to try. You can use it temporarily while waiting for the sulpiride to arrive. However, I would not wait to treat the suicidality. Even Klonopin might help, but I still favor the Zyprexa.
Before discontinuing the Parnate, see if your doctor would be willing to go with adding a TCA. Unless he has personal experience with using any of the others, I would recommend either nortriptyline or desipramine. These two avoid the dangers of serotonin syndrome and are milder in terms of side effects.
Just take one thing at a time. Immediate relief should be your priority at this juncture. I would recommend Zyprexa. If it works really well at preventing suicidal states, and you are not happy with its potential weight gain, you can try crossing over to either Seroquel or Abilify. I would probably add Abilify 10mg to the Zyprexa for two weeks, and then discontinue the Zyprexa. This will help you avoid the discomfort of any akathisia-like phenomena that Abilify might produce as a startup side-effect.
- Scott
poster:SLS
thread:565262
URL: http://www.dr-bob.org/babble/20051010/msgs/565669.html