Fastest or best meds to treat suicidal ideation - Social Anxiety Forum
 
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post #1 of 11 (permalink) Old 03-20-2017, 04:47 PM Thread Starter
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Fastest or best meds to treat suicidal ideation

So I'm having a rough go and am really having strong suicidal thoughts. I'm on Remeron right now which helps calm me a little and helps sleep. I need another AD but my biggest fear is adding something that'll just make me worse at least at first. Lately I've tried going on Zoloft, Effexor, and Celexa but couldn't tolerate them because of the extreme anxiety and suicidal thinking.

Is there anything with quick onset of action in reducing these thoughts and calming me?
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post #2 of 11 (permalink) Old 03-20-2017, 06:46 PM
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No question: Ketamine. Nothing else comes close. You have a few options:
1) pay thousands of dollars to fly to a Ketamine treatment center and do IV treatment there;
2) admit yourself to an ER and say you are acutely suicidal, if you are lucky they administer Ketamine;
3) If your Dr. is willing, you can get Ketamine as a sublingual formulation from a compounding pharmacy. Most doctors are irrationally terrified of Ketamine though.

Dx Bipolar II.
Medications: 450mg Lithium xl, 150 mg Lamotrigine, 150 mg Tranylcypromine, 100 mg Noritryptiline, 100 mg Buproprion SR
With delicious Ketamine icing on top of that cake. 200 mg/ sublingual 2x week
I am NOT a doctor. Consult your physician on all medical decisions.
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post #3 of 11 (permalink) Old 03-20-2017, 06:52 PM
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I had horrible issues with Zoloft.. I did nothing but lay down and stare at the ceiling and cry and think about dying. I felt like a zombie with celexa... but Paxil gives me energy and makes me feel calm. Not saying to try it... just letting you know all ssris really are different. I've found they all have pretty awful side effects, but if you really need help they might be worth it.
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post #4 of 11 (permalink) Old 03-20-2017, 07:47 PM Thread Starter
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Originally Posted by Gillman fan View Post
No question: Ketamine. Nothing else comes close. You have a few options:
1) pay thousands of dollars to fly to a Ketamine treatment center and do IV treatment there;
2) admit yourself to an ER and say you are acutely suicidal, if you are lucky they administer Ketamine;
3) If your Dr. is willing, you can get Ketamine as a sublingual formulation from a compounding pharmacy. Most doctors are irrationally terrified of Ketamine though.
I have been doing Ketamine infusions since November and it helps, but I need to be on the right antidepressants with it. I started making med changes in December and that threw everything off. I have a Ketamine infusion scheduled for tomorrow so hopefully that'll help. I just wish I could do Ketamine every couple days instead of every three weeks.
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post #5 of 11 (permalink) Old 03-20-2017, 07:57 PM
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I dont know which meds help, but try to remind yourself that this is only a temporary feeling, and you have a whole life ahead of you. These suicidal urges only last a short while and when they are gone, you'll be very glad that you didnt give in to those urges.
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post #6 of 11 (permalink) Old 03-20-2017, 09:11 PM
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Originally Posted by Iwillovercomeanxiety1 View Post
I have been doing Ketamine infusions since November and it helps, but I need to be on the right antidepressants with it. I started making med changes in December and that threw everything off. I have a Ketamine infusion scheduled for tomorrow so hopefully that'll help. I just wish I could do Ketamine every couple days instead of every three weeks.
See suggestion 3. These clinics say that "the best" way is IV infusions... but that is thousands of dollars, which won't be paid for by insurance. I pay $80 for a month's worth of Ketamine, 200 mg / mL sublingual solution, taken once a week. Actually just met with my Dr. and we are going to double the dose. Mainly to get more benefit out of Parnate... it is a long story, read my thread if you are interested.

Honestly I think they are taking advantage of you if they continue giving you IV infusions without at least giving you the option of cheaper maintenance therapy.

Dx Bipolar II.
Medications: 450mg Lithium xl, 150 mg Lamotrigine, 150 mg Tranylcypromine, 100 mg Noritryptiline, 100 mg Buproprion SR
With delicious Ketamine icing on top of that cake. 200 mg/ sublingual 2x week
I am NOT a doctor. Consult your physician on all medical decisions.
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post #7 of 11 (permalink) Old 03-20-2017, 09:16 PM
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Quote:
Originally Posted by Iwillovercomeanxiety1 View Post
So I'm having a rough go and am really having strong suicidal thoughts. I'm on Remeron right now which helps calm me a little and helps sleep. I need another AD but my biggest fear is adding something that'll just make me worse at least at first. Lately I've tried going on Zoloft, Effexor, and Celexa but couldn't tolerate them because of the extreme anxiety and suicidal thinking.

Is there anything with quick onset of action in reducing these thoughts and calming me?
I tried all the meds you tried as well and I experienced the same effects. For something really fast acting I would go with a benzodiazapine. I have tried a few, the one that worked for the best was 60 mg of oxazepam.

...Deep in my soul, I've been so lonely
All of my hopes, fading away
I've longed for love, like everyone else does
I know I'll keep searching, even after today
So there it is girl, I've said it all now
And here we are babe, what do you say?
We've got tonight, who needs tomorrow?
We've got tonight babe
Why don't you stay?...


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post #8 of 11 (permalink) Old 03-20-2017, 10:33 PM
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Unfortunately Starting new Anti Depressants and suicidal thoughts come hand in hand research indicates thoughts can last even after the initial 4 weeks in which they usually tell you it takes full effect... cymbalta is what im on and its pretty good if you keep to the right time frame everyday. If your looking for something that is fast acting, you might need to get on some anti anxiety meds.
I was on remeron, once for a couple weeks. And it increased my appetite rapidly. I do not like that A.D

If your ever feeling suicidal and need someone to talk to just feel free to p/m me.
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post #9 of 11 (permalink) Old 03-21-2017, 12:50 PM Thread Starter
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See suggestion 3. These clinics say that "the best" way is IV infusions... but that is thousands of dollars, which won't be paid for by insurance. I pay $80 for a month's worth of Ketamine, 200 mg / mL sublingual solution, taken once a week. Actually just met with my Dr. and we are going to double the dose. Mainly to get more benefit out of Parnate... it is a long story, read my thread if you are interested.

Honestly I think they are taking advantage of you if they continue giving you IV infusions without at least giving you the option of cheaper maintenance therapy.
My insurance covers the majority of the Ketamine infusions but I'm really interested in how you get these sublingual solutions of Ketamine? How do I get that prescribed and for that price and from where?
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post #10 of 11 (permalink) Old 03-21-2017, 01:05 PM
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ketamine

see KetamineAdvocacyNetwork.

DEA agents, being on par with Nazi war criminals, should be executed for crimes against humanity. They are guilty of inflicting mass suffering upon legitimate patients.
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post #11 of 11 (permalink) Old 03-21-2017, 02:27 PM
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Even if your insurance covers the "majority" you are still paying hand over pocket, most treatment centers give you a more convenient maintenance drug by now. If they try to give Nuedexta, punch them in the face or refuse. I tried it and was not impressed.

Last I checked, Ketamine Avocacy Network was "against" any form of Ketamine other than IV drip, because IV drip is the most potent. Well ****, I think Mercedes Benz (or whatever) is the best car, but most people don't walk on bare feet until they can afford one.

Who can prescribe? Any medial doctor. That doesn't mean they will. They have to understand the difference between. ACTIVE INGREDIENT and SAFETY.

Most psychiatrists under no circumstances are ever going to put an IV drip into your arm, ever. Ketamine in IV is absorbed rapidly which can make it have more dramatic effects, which gives them liability concerns. This is based mainly on liability concerns but also because they would have to buy equipment etc.

Ketamine sublingual is the same ACTIVE INCREDIENT but it does not have the same SAFETY profile because it absorbed much more slowly. Hence there doesn't need to be a Dr, a Nurse, an orderly, a Priest and a Rabbi on hand all waiting for you to have an accident. You just need to monitor blood pressure before and after taking the drug. If you have not had any dangerous reactions to Ketamine 40mg IV b(normal dose), you should start with 50 mg sublingual and titrate up to 100 mg, see how that affects you.

Here is a thought experiment: the first doctors that invented stimulants for ADD only used IV administration. This is a dangerous enough method that the ACTIVE INGREDIENT acquires a bad reputation and requires all sort of safety measure. IV amphetamines would rapidly spike blood pressure. Ketamine is the same, in that its history of use as an IV drug affects its perceived SAFETY profile.

Any doctor can prescribe, any compounding pharmacy can make the necessary formula of 100 mg / mL Ketamine Solution, accompanied with an oral syringe. Anaesthesiologists routinely Rx Ketamine. You have to choose which flavor you want.

Read the book Ketamine for Depression by (Steven, I think) Hyde. Sublingual is not new, it just is not in as widespread use. Unfortunately most doctors do not consider "reading" part of their job description, (or don't have the time), you might have success with a book report.

Bioavailability matters because if Ketamine hits your stomach it is rapidly metabolized into Norketamine, which gives inebriation side effects without therapeutic effect. IV bioavailability is close to 100%, so a 40mg dose IV is equivalent to 40mg total. Sublingual bioavailability is about 30%, so a 100 mg sublingual dose will give you only the equivalent of 30 mg IV.Increasing the dose (the amount of liquid in your mouth) rapidly hits diminishing returns. You only have a bit of sublingual tissue, once that is coated with Ketamine adding more into your mouth will just end up being oral (i.e. it is metabolized through your stomach) with a low bioavailability of about 10%. My doctor is going to ask about higher concentration Ketamine, like 200 mg / mL solution.

You may find the potency a bit lacking, 200 mg / 2x / week works for me and for my purposes of lowering my Parnate tolerance. Depends on the IV dose you were using. If you were at 100 mg for IV there is no way that sublingual can substitute. But you can also dose as frequently as you want.

IMO IV is ultimately more potent, but this is true of a lot of drugs and convenience almost always wins out over theoretical optimum setup. IV Ketamine is thousands of dollars, sublingual has cost me $80 for a month's supply of the drug. Sublingual is a good compromise.

Dx Bipolar II.
Medications: 450mg Lithium xl, 150 mg Lamotrigine, 150 mg Tranylcypromine, 100 mg Noritryptiline, 100 mg Buproprion SR
With delicious Ketamine icing on top of that cake. 200 mg/ sublingual 2x week
I am NOT a doctor. Consult your physician on all medical decisions.
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