re inquiries as to specifics: both cases involved treatment-resistant depression with acute suicidal crises. One is a family member, the other a friend-of-frien

re inquiries as to specifics: both cases involved treatment-resistant depression with acute suicidal crises. One is a family member, the other a friend-of-friend. Many of you are aware that Ketamine has been used off-label for rapid treatment of depression and that one of its enantiomers, S-ketamine, has been (I think) approved for clinical treatment of depression. In these two cases, it was not possible to quickly access either a ketamine formulation or a physician who was familiar with its use. Google search showed that dextromorphan (yes, the OTC cough suppressant) has similarities to ketamine in its receptor targeting and is being tried in cases of treatment resistant depression. Combined with quinidine (as Neudexta, I think), it is used to treat a condition called pseudo bulbar affect. All the papers on use of dextromethorphan for depression were paywalled. Thanks to Sci-Hub, I was able to access and annotate 23 papers that together gave enough information (side effects, med interactions, etc.) for the two treating physicians to try dextro with their patients. Results are N=2, so obviously anecdotal, but both patients experienced recession of suicidal impulses within 48 hours and both continue to show decreasing depressive symptoms. I believe that neither of them would be with us now but for Ms. Elbakyan's work. I'm deeply grateful for what she's done.