So, I was recently prescribed the antidepressant Lexapro for my suicidal depression and have a few questions: 1) I know there's a greater risk of committing suicide in the first few weeks, but is it expected that I'll actually think more about suicide? I thought it was just a greater risk from the energy boost, but I feel like I'm constantly thinking about how I could die. 2) Is it normal for my libido to surge? I thought the expected side effect was sexual dysfunction, but hornier than I've been in ages.
Hm ... that's interesting. Obviously, I have no sweet clue. I hope that the medical advisor comes here soon.
The key clue is "constantly thinking". You're having a side effect from the drug. You need to let your doctor know so that he can consder switching you to a different drug. One of ironies of SSRIs and SNRIs is that they can make you very horny, can make you have very firm erections but they can also make it difficult for you to come. If you're having these side effects and you find it unpleasant, then talk with your doctor about trying another drug. There's about a dozen drugs of this type and each one has a slightly different effect. It sounds like Lexapro isn't the best choice for you. Your doctor may also want to consider trying you at a lower dose to see if that makes a difference, too.
Another way the black-label-warning happens is that, in depression patients, they typically do not have much motivation to do anything, including suicide. SSRIs can improve motivation, which unfortunately can make them motivated to commit suicide. But yeah, if you're constantly thinking about it, contact your doctor. As for your number 2, basically what Karabulut said.
As Karabulut said, SSRI's do tend to mess around with one's sexual functioning. I was on Lexapro for 7 years, and noticed a lot of odd sexual issues when my dose went high. In terms of the higher risk of suicide, take a look at this.
I know a LOT of people in their teens and 20s that have had trouble with Lexapro specifically. The sorts of side effects you describe, plus weight gain, loss of energy, etc. Apparently a number of psychiatrists have documented these symptoms in letters to JAMA and other medical journals, as well as in studies. I have not personally read the studies so don't feel qualified to comment on them. However, I will say this: If it were my friend I was talking to about this, I would advise him/her to ask for somethign other than Lexapro, simply given that I know a bunch of people that have had problems and very, very few that have found it really helpful. There are other alternatives. Depending on the severity of your depression and whether you consider yourself at risk for suicide, there are some non-drug interventions that in some cases appear to be as effective or more effective. The most reliably documented one is the use of certain amino acids (notably 5-HTP) which for a significant group of those who have tried it seems to provide very, very rapid improvement in mood, with none of the side effects. There is other data (less rigorous) that indicates that a combination of gingko biloba and st john's wort, used together, can be extremely effective with a significant portion of those who have tried it. Both have the advantage of being really inexpensive in comparison to Lexapro, with far less side effects and toxicity. But as I said, it depends on the severity of your condition; if you are suicidal, then you need to work on getting your mood stabilized first and then look at alternatives. You may want to get a copy of the book "The Diet Cure" which, although poorly named, talks extensively about the use of amino acid supplements in mediating mood. It's written in a very accessible format that pretty clearly describes what the author's research and experience is in the use of various amino acids for depression and other issues. Whatever you do, talk to your doctor. Don't take supplements without telling him/her. But if you decide you want to try using the supplements instead of the drugs, and the doctor is resistant, you have the wrong doctor and should consider another one. The vast majority of doctors (both generalists and psychiatrists) have no training or blatantly incorrect training/knowledge about the use of supplements, so don't expect a lot of help, but you can find one who is open to letting you try alternatives and will do his/her best to guide you.
I have been on the anti-depressant Pristiq since late March/early April. It has really helped...although I still do have a few "rough" spots here and there, but that comes with life. All I know is that I has helped my overall mental state. Pristiq is one of the newer ones I think, and many of the newer ones are less harsh that the older ones like Lexapro. I've been on it for 3 months and have noticed no real side effects. I was worried about sexual dysfunction (because I had like no sex drive already) but like you it seems to have caused my libido to surge...although it does take me longer to come. But also, one of the symptoms of clinical depression is loss in sex drive, so I guess that by brining the chemicals in your brain in balance it brings everything else in balance too. It is also important to note that anti-depressants do carry some risk of increased suicidal behavior when you first start taking them...why I have no idea...I guess it's your body getting used to it. It's important to give these things time to work...most of the time it takes 4-6 weeks to feel the full effect. If you still feel the same way after this time period you need to talk to your Dr. about changing medications or your dosage. Sometimes it's hit or miss with these things, and some people have to try different meds before they find the right one that works. But always follow your doctors instructions EXACTLY. Don't ever stop taking any anti-depressant cold turkey.
