Posted by tecknohed on October 23, 2007, at 12:05:26
In reply to Severe depression and suicidal ideation., posted by Galen on October 23, 2007, at 3:07:21
I'm a fan of MAOIs, but as others have said they are usually reserved for multiple failed attemps with other meds. Nardil in particular has (for me) a calming & 'optimistic' effect right from the start, long before it really kicks in. But they are particularly dangerous in overdose.
SSRIs ARE NOT all the same. Your friend may do alot better on citalopram, escitalopram or paroxetine, which I've found alot more calming. Compared to these three, fluoxetine (Prozac) & sertraline seem more activating.
A short course of clonazepam (or possibly another benzo), whilst your friend is waiting for the antidepressant to begin working may also be helpfull. From http://en.wikipedia.org/wiki/Clonazepam :
"Clonazepam appears to also have a secondary effect on the neurotransmitter serotonin.[8] It has shown itself to be highly effective as a short-term (3 weeks) adjunct to SSRI treatment in obsessive-compulsive disorder and clinical depression in reducing SSRI side effects with the combination being superior to SSRI treatment alone in a study funded by the manufacturers of clonazepam, Hoffman LaRoche Inc.[9] Similar results have been found with some other anxiety disorders, but the role of the serotonergic effects enhancing the action of the SSRI treatment remains unclear in these cases due to clonazepam's primary anxiolytic mechanism of action."
I'm also wondering if your friend my have comorbid OCD with the depression, possibly explaining her 'obsession' with suicide. What do others think? The SSRIs I mentioned above may be especially good for this.
Finally, although you (nor your friend) probably wont want to here this, she may be safer in hospital until she responds effectively enough to a med.
I wish you & your friend luck in your search for an effective remedy.
poster:tecknohed
thread:790756
URL: http://www.dr-bob.org/babble/20071019/msgs/790826.html