Posted by bleauberry on October 23, 2007, at 19:29:29
In reply to Severe depression and suicidal ideation., posted by Galen on October 23, 2007, at 3:07:21
First off, make sure you have drawn plans to prevent suicide. Keep a close eye and close contact. The hospital is the worst place to be, so do all you can do to avoid a trip to the emergency room. Worst case scenario, a hospital stay would at least save one's life.
For meds, it is so hard to predict. I saw zyprexa mentioned, and I agree with that one. Especially in combo with prozac. Good combo usually. Benzos were mentioned. Could at least sedate the patient for a while. Some like xanax actually do have some pronounced antidepressant effects to them. The others too, though I've heard it more with xanax. Benzos can worsen depression too though, so it's a careful balance with low dose and short term in mind. Lithium was mentioned. That could help but I'm not well schooled on it.
Prozac does not look like the one to stay with. On pubmed there was a meta analysis of all antidepressants to see if there were any that were superior to the others. Overall, lexapro turned out superior. Surprise, prozac was actually the least effective. The differences between them all were not huge however, and there is no way to predict who will respond best to what drug. I'm just saying if we have to roll the dice and go for the best odds of success, then lexapro came up tops in the meta analysis. Some people do terrible on lexapro, some great. The results of the study were overall, not on an individual basis.
A good psychiatrist or doctor will be needed in the short term. Longterm however, I think it is extremely important to hunt down a really good integrative doctor (one who does natural and conventional medicine) and get some testing done to find out where this vicious depression is coming from. It could be thyroid, adrenal, heavy metals, allergy or intolerance to something, or a chronic infection (yeast, bacteria, fungal, viral) that is spewing toxins in the blood. All of these things wreak total havoc on the brain. I have come to my own conclusion over the years that the primary hidden cause of depression that is overlooked 99% of the time is heavy metals. Too much lead. Too much mercury. Only with a book called Amalgam Illness can you understand why these things are overlooked, misdiagnosed, and treated improperly. And why so many people on the best psychiatric meds, herbs, and supplements never get well until the metals are dealt with.
But control of symptoms should be an achievable goal in the short term, no matter what the cause of the depression. Just a matter of the right meds and/or supplements to counteract whatever is awry.
This might sound strange, but a reduction of prozac dose could actually help. Personally I would not keep taking a medication where I am feeling suicidal despite it. For all I know, it could be the medication doing it. Been there done that.
First order of business...protect the patient and speed up the time to get to a doctor. Seeing one today or tomorrow would be best. Suicidal ideation is risky and could be carried out at any moment.
poster:bleauberry
thread:790756
URL: http://www.dr-bob.org/babble/20071019/msgs/790936.html