After 10 year of being dx’ed with PD, I though I was pretty well adjusted to it mentally.
Over the past few weeks, I have been having these weird little thoughts creeping into my head. This past Saturday, my wife and daughter were gone for most of the day. I found myself sitting here with a loaded gun at my head. Luckily, I am taking an antidepressant. I was smart enough to call my brother for help. Before he arrived the thought had already passed but it really scared the hell out me. I had my brother collect all my guns and ammo and take them home with him.

As of right now, I can’t explain why or how this happen. I started out having a really good day. I will be starting therapy Monday morning. I will try to keep you informed.

GregD

Greg, are you taking Stalevo? It is a little known fact, but a fact nevertheless, that Stalevo causes suicidal thoughts. On my first follow-up neuro appointment after starting on Stalevo and dropping selegiline was: "Do you think about death often?" And, surprisingly enough, I do. It had never happened to me while I was on Sinemet and selegiline. So, the meds you take have a lot to do with it. Make sure you have your drug regimen adjusted immediately and quit fooling around with guns.
Why the **** you want a gun in the house, anyway? (scold, scold... )

Teresa,
No I'm not taking Stalevo. However, I am taking Comtan which is the drug mixed with Sinemet in Stalevo. I also take Sinemet. I hadn't heard about Stalevo causing suicidal thoughts until your post. I had never even thought of suicide until this last Saturday. As for the guns, I used to be a quite avid hunter. Since my PD dx they have remained locked in the gun safe without a thought. At least they are out of here now.

GregD

European Parkinson's Disease Association

Contra-indications (When Not To Use)

* If you are allergic to levodopa, carbidopa or entacapone, or any of the other ingredients of Stalevo®.
* If you have narrow-angle glaucoma (an eye disorder).
* If you have a tumour of the adrenal gland.
* If you are taking certain medicines for treating depression (selective MAO-A plus MAO-B inhibitors, or non-selective MAO-inhibitors).
* If you have ever had neuroleptic malignant syndrome (NMS - a rare reaction to medicines used to treat severe mental disorders).
* If you have ever had non-traumatic rhabdomyolysis (a rare muscle disorder).
* If you have a severe liver impairment.


Possible Undesirable Effects of Stalevo®

Most people take Stalevo® (levodopa/carbidopa/entacapone) with no adverse effects; however, as with any medication some people do experience undesirable side effects as a result of Stalevo® treatment. If you experience any of these side effects, talk to your doctor as soon as you can. Many of the side effects can be relieved by adjusting the dose.
Most common effects include:

* Uncontrolled movements
* Feeling sick (nausea)
* Mental changes including paranoid and psychotic symptoms, depression (possibly with thoughts of suicide) and problems with memory or thinking.
* Urine turns reddish-brown (this is harmless).

Should you wish to stop taking Stalevo®, always talk to your doctor first. Withdrawal of treatment may need to be done gradually, and your other medications may need to be adjusted to compensate for this change.

redline.jpg

Drugs.com

Stalevo

Generic Name: Carbidopa/Entacapone/Levodopa Tablets (KAR-bi-DOE-pa/en-TA-ka-pone/lee-voe-DOE-pa)
Brand Name: Stalevo

Stalevo is used for:

Treating symptoms of Parkinson disease.

Stalevo is an antidyskinetic combination of dopamine enhancing medicines. It works by increasing the amounts of dopamine in the brain. By increasing the amounts of dopamine in the brain, the chemicals of the brain become more balanced and the symptoms of these diseases are lessened.
Do NOT use Stalevo if:

* you are allergic to any ingredient in Stalevo
* you have narrow-angle glaucoma, skin growths of unknown cause, skin cancer, or a history of skin cancer
* you have taken furazolidone or a monoamine oxidase (MAO) inhibitor (eg, phenelzine) within the last 14 days

Contact your doctor or health care provider right away if any of these apply to you.
Before using Stalevo :

Some medical conditions may interact with Stalevo . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

* if you are pregnant, plan to become pregnant, or are breast-feeding
* if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
* if you have allergies to medicines or other substances
* if you have a history of heart problems or heart attack, blood pressure problems, lung problems (eg, asthma), kidney or liver problems, or mood or mental disorders
* if you have stomach or intestinal problems (eg, ulcers) or biliary or gallbladder problems

Some MEDICINES MAY INTERACT with Stalevo . Tell your health care provider if you are taking any other medicines, especially any of the following:

* Ampicillin, chloramphenicol, cholestyramine, erythromycin, probenecid, or rifampicin because side effects of Stalevo may be increased
* Furazolidone, MAO inhibitors (eg, phenelzine), selegiline, or tricyclic antidepressants (eg, amitriptyline) because serious side effects (eg, headache, very high blood pressure, abnormal heartbeat) may occur
* Apomorphine, butyrophenones (eg, haloperidol), hydantoins (eg, phenytoin), isoniazid, metoclopramide, papaverine, phenothiazines (eg, chlorpromazine), or risperidone because effectiveness of Stalevo may be decreased
* Sympathomimetics (eg, phenylephrine) because side effects may be increased by Stalevo
* Digoxin and iron salts (eg, ferrous sulfate) because effectiveness may be decreased by Stalevo

This may not be a complete list of all interactions that may occur. Ask your health care provider if Stalevo may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
How to use Stalevo :

Use Stalevo as directed by your doctor. Check the label on the medicine for exact dosing instructions.

* Stalevo may be taken with or without food. If upset stomach occurs, take with food to reduce stomach irritation.
* Swallow Stalevo whole. Do not break, crush, or chew before swallowing.
* Take Stalevo at least 4 hours before or after taking iron salts (eg, ferrous sulfate).
* If you miss a dose of Stalevo , take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Stalevo .

Important safety information:

* Stalevo may cause dizziness or light-headedness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Stalevo . Using Stalevo alone, with certain other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks.
* Avoid drinking alcohol or taking other medications that cause drowsiness (eg, sedatives, tranquilizers) while taking Stalevo . Stalevo will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants.
* Diets high in protein may prevent your body's ability to absorb Stalevo . Dietary protein should be eaten evenly throughout the day.
* Gradually increase physical activity as your symptoms improve.
* Stalevo may discolor the saliva, urine, or sweat a dark color (red, brown, or black). This is normal and not a cause for concern.
* Neuroleptic malignant syndrome (NMS) is a potentially deadly syndrome sometimes associated with Stalevo . Symptoms may include increased body heat; rigid muscles; altered mental abilities, including lack of response to your surroundings; fast or irregular heartbeat; sweating. Contact your doctor at once if any of these symptoms occur.
* Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using Stalevo .
* Diabetic patients - Stalevo may cause false test results with some urine glucose tests.
* LAB TESTS, including complete blood cell counts and heart, liver, and kidney function tests, may be performed to monitor your progress. Be sure to keep all doctor and lab appointments.
* Use Stalevo with extreme caution in the ELDERLY because they may be more sensitive to its effects.
* This medicine is not recommended for use in CHILDREN. Safety and effectiveness have not been confirmed.
* PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Stalevo during pregnancy. It is unknown if Stalevo is excreted in breast milk. If you are or will be breast-feeding while you are using Stalevo , check with your doctor or pharmacist to discuss the risks to your baby.

Possible side effects of Stalevo :

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Change in taste; constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; loss of appetite; nausea; upset stomach.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; confusion; dark urine; depression with thoughts of suicide; fainting; fever; hallucinations; increased or irregular heart beat; lack of response to environment; mental changes; paranoia; rigid muscles; seizures; severe abdominal pain; severe or persistent diarrhea; stomach pain; trouble sleeping; unusual or painful movements of face, eyelids, mouth, tongue, arms, hands, or legs; unusual sweating; vomiting; yellowing of skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions or need medical advice about side effects, contact your doctor or health care provider. You may report side effects to the FDA at 1-800-FDA-1088 (1-800-332-1088) or at http://www.fda.gov/medwatch.
If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org/findyour.htm), or emergency room immediately. Symptoms may include agitation; confusion; dark urine or trouble urinating; fast or irregular heartbeat; high blood pressure; insomnia; muscle spasms; restlessness.
Proper storage of Stalevo :

Store Stalevo at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Protect from heat, moisture, and light. Keep in a tight, light-resistant container. Do not store in the bathroom. Keep Stalevo out of the reach of children and away from pets.
General information:

* If you have any questions about Stalevo , please talk with your doctor, pharmacist, or other health care provider.
* Stalevo is to be used only by the patient for whom it is prescribed. Do not share it with other people.
* If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Stalevo . If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Hi Greg,

How frightening. My ex-husband began having extreme panic attacks. He always was a nervous person as long as I have known him. One day my youngest son, Tim, who is a paramedic went to vist him and found him nude with a gun to his head. He was able to talk him out of suicide and took him to a mental health hospital where he remained in lock down for two days.

A few years later, he was changed to a different health insurance and dropped his conseling and drug therapy. The day my middle son arrived home from his tour of duty in Iraq, his father called him while he was enroute and he again rushed him to the hospital for another lock down.

My ex-husband is not a hunter, but likes to target shoot to relieve stress. My youngest son took all the guns to my house and locked them up.

The world we live in has a whole different type of stress than a hundred years ago. Most of the stress required manual labor which allowed the body to perspire out of their system some of the bad chemicals. The work week was 40 hours, mothers were home with the children, dads could kick up their feet for a few hours and weekends were family time. Now due to health care costs, those who work are stuck behind computers working 60 to 70 hour work hours a week, much of it on weekends so employers won't have to pay health benefits. The average worker has to sit most of his working hours and as the years go by their girth increases.

Americans may live in the most productive society, but is the chronic stress worth the bucks?

Vicky

Greg,

Lord knows we have many reasons to end up where you did that night. But nevertheless, you don't want to go there again. I just want to toss in a thought about violent crime, which you were almost a victim of recently.

I was burglarized a couple of times many years ago and it made me do weird things afterward, like stand out on the lanai and point a rifle (there was just field and woods behind me but I suspected a neighbor.}

I had no idea how to use the rifle! It wasn't loaded. But I used to imagine shooting someone in my home. Only time in my life where I actually wanted to shoot someone; it was such an invasion.

There may be no connection. But it's not you to behave in that manner, so how about analyzing the chemicals (meds) going in and the thoughts you are having with someone who can give you some professional advice. One more thing to do I know - that's how I look at everything these days, one more thing to do. But important.

paula

for sharing this experience, greg. realy good that you were able to call your brother in the middle ofit.

i,ve had experience with acute depression and it iis no party. be good to yourself and know that people love you and care about you.

hang in there,, buddy and seek help.

First, I want to thank everyone that has responded to this thread. Your advice, suggestions, and support are greatly appreciated.
Next, I want you to know that I have been in contact with my MDS’s office and I am waiting on a return call from them. Also, this morning I went and started getting professional help for this situation. I hope we can figure out what happened. I have too much to live for.
What I still don’t understand, is how did this happen? The last thing I really remember is going online to the forum here at neurotalk and reading some of the postings that I skipped over earlier in the week then going to a woodturning website. The next thing I knew I was sitting here at the computer with a gun to my left temple. It was almost like someone turned a switch off and on. I don’t remember unlocking the gun safe, the gun case, or the ammo box. That’s three locks that I had to unlock. The last time I was even in the gun safe was like eight years ago. I can’t even tell the combination if asked right now. I’d have to look it up.
As for calling my brother in the middle of things, like I said, all of a sudden I knew what I was doing. I put down the gun and called him. By that time I was just freaked out. Did my experience a couple of weeks earlier trigger something? I don’t think so because I was having the weird little thoughts creeping into my head before that. So what were these weird thoughts? Yes, they had to do with death in general. I guess I didn’t really consciously give them much thought. My subconscious must have liked them. So could it have been the combination of Comtan and Sinemet? I really wouldn’t think that after eight years on the drugs they would suddenly do something like that. Wouldn’t Comtan and Sinemet be the same as Stalveo? I would think yes except for some filler.
At this point, I just don’t know. Maybe I’ll never know. Just all you other folks out there taking the drugs be careful. We are messing with the brain, strange things can and do happen. I know I'll pay closer attention from now on.

GregD

I have had a great deal of stress in the area and it can be our very own
anti-depressants, right now I feel much better, and I am only taking
a very small dose of zoloft

here's an article from the British Medical Journal -BMJ

http://www.bmj.com/cgi/content/full/330/7488/373

here's abit of the article:


BMJ 2005;330:373-374 (19 February), doi:10.1136/bmj.330.7488.373

Editorial

Suicide, depression, and antidepressants

Patients and clinicians need to balance benefits and harms

Unipolar depression, one of the most important causes of disability worldwide,1 is characterised by depressed mood, hopelessness, helplessness, intense feelings of guilt, sadness, low self esteem, thoughts of self harm, and suicide.

Up to 15% of patients with unipolar depression eventually commit suicide.
2 Although clinical guidelines recommend treating moderate to severe depression with antidepressant drugs,
3 debate persists on whether some antidepressant drugs, in particular the selective serotonin reuptake inhibitors (SSRIs), cause the emergence or worsening of suicidal ideas in vulnerable patients. New insights on this key issue have been provided by three articles published in this issue.

_________________________________



Change Suicide Warning On Antidepressants FDA Asks Drug Makers
03 May 2007

The US Food and Drug Administration (FDA) has asked makers of all antidepressant drugs to change the existing "black box" labels on their products to warn about increased risk of suicidality (suicidal thinking and behaviour) among young adults aged 18 to 24 in the first few weeks of treatment.
The FDA has also asked the drug companies to revise the existing warning to show there is no evidence this risk exists for adults over 24, and indeed for those aged 65 and older the scientific data suggests the suicidality risk is decreased.

The update request is welcomed by psychiatrists and other health professionals.

The American Psychiatric Association (APA) said:

"The FDA's new labeling acknowledges, for the first time, that untreated depression puts people at risk for suicide."

They said studies showed that the old label issued in 2004 was associated with a steep drop in use of antidepressants and was followed by an increase in the rate of suicide "reversing a decade-long decline in suicide deaths in the United States".

The FDA said the emphasis on the new labels should be that depression and other serious psychiatric illnesses are themselves the most important causes of suicide.

Director of FDA's Center for Drug Evaluation and Research, Dr Steven Galson said yesterday that:

"Today's actions represent FDA's commitment to a high level of post-marketing evaluation of drug products."

"Depression and other psychiatric disorders can have significant consequences if not appropriately treated. Antidepressant medications benefit many patients, but it is important that doctors and patients are aware of the risks," he explained.

The FDA recommends that people who are currently taking antidepressants should not stop taking them as a result of hearing this news. If you are worried about it, talk to your doctor, is their advice.

The warning revision applies to all antidepressants and comes in the wake of controlled trials that showed a reasonably consistent risk of suicidality across most of the antidepressant drug categories. The FDA said that the evidence does not support excluding any antidepressant medication from this update request.

This update request follows the labelling changes made in 2005 to warn of increased suicidality in children and adolescents taking antidepressants.

Since then, the FDA undertook a comprehensive review of 295 drug trials examining the risk of suicidality among adults taking antidepressants.

The trials included over 77,000 adult patients with major depressive disorder (MDD) and other psychiatric conditions.

The results was that in December last year, the FDA's Psychopharmacologic Drugs Advisory Committee said labels should be changed to tell doctors about the increased risk of suicidality among younger adults taking antidepressants.

The Committee also said the labels should remind doctors that the disorders themselves present the greater risk, and that among older adults the antidepressants do not carry the suicidality risk and have an apparent beneficial effect.

The FDA is preparing drafts of patient guides and wording for the labels. The manufacturers have 30 days to submit their own versions for FDA review.

The drugs affected include:

-- Anafranil (clomipramine)
-- Asendin (amoxapine)
-- Aventyl (nortriptyline)
-- Celexa (citalopram hydrobromide)
-- Cymbalta (duloxetine)
-- Desyrel (trazodone hydrochloride)
-- Elavil (amitriptyline)
-- Effexor (venlafaxine hydrochloride)
-- Emsam (selegiline)
-- Etrafon (perphenazine/amitriptyline)
-- fluvoxamine maleate
-- Lexapro (escitalopram hydrobromide)
-- Limbitrol (chlordiazepoxide/amitriptyline)
-- Ludiomil (maprotiline)
-- Marplan (isocarboxazid)
-- Nardil (phenelzine sulfate)
-- nefazodone hydrochloride
-- Norpramin (desipramine hydrochloride)
-- Pamelor (nortriptyline)
-- Parnate (tranylcypromine sulfate)
-- Paxil (paroxetine hydrochloride)
-- Pexeva (paroxetine mesylate)
-- Prozac (fluoxetine hydrochloride)
-- Remeron (mirtazapine)
-- Sarafem (fluoxetine hydrochloride)
-- Seroquel (quetiapine)
-- Sinequan (doxepin)
-- Surmontil (trimipramine)
-- Symbyax (olanzapine/fluoxetine)
-- Tofranil (imipramine)
-- Tofranil-PM (imipramine pamoate)
-- Triavil (perphenazine/amitriptyline)
-- Vivactil (protriptyline)
-- Wellbutrin (bupropion hydrochloride)
-- Zoloft (sertraline hydrochloride)
-- Zyban (bupropion hydrochloride)

The APA said:

"We believe the new label, which still contains important warning information, reminds physicians and patients that antidepressants save lives. Physicians and patients need all the facts in order to make appropriate, informed decisions about any proposed course of treatment."

Click here for FDA.

Click here for A-Z of drugs on the Internet Drug Index (RxList, run by WebMD, commercial site).

Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
Article URL: http://www.medicalnewstoday.com/heal...p?newsid=69688


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Dear Greg, I'm very glad to hear that you put those guns away. And yes, Comtan and Sinemet combined make Stalevo. I'm very seriously thinking about going off Stalevo, because it really makes me listless and melancholy and I do think about death quite often, as an ultimate relief. It had never happened to me before, as I said. A few weeks ago, while driving home on the expressway, I suddenly thought how easy it would be not to take the next curve, but drive straight ahead off the bridge...
In fact, I believe if I sat down and went over my posts of the last couple of years, I could pretty much tell when exactly I started taking Stalevo, because I immediately became much more pesimistic about my situation and life in general.
Brain chemistry is very complicated and we have to make sure we get the right meds in the right dosage.

Hugs
Teresa