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The suicide of a patient is a painful experience for many physicians and mental health professionals, and may contribute to the earlier and more frequent development of professional burnout. To reduce this risk in the primary care settings in which many suicidal patients are seen prior to their attempt, the authors presented concepts regarding the course of suicidal ideation and typical ways in which suicidal individuals communicate their experiences. These issues are explored through theoretical viewpoints, available records, research on suicide notes, and a review of the literature. The research findings presented can contribute to suicide prevention particularly when the risk of death is severe.

In this report, we identified a case with positive evidence of this antidepressant combination relieving the symptoms of treatment-resistant MDD, which is otherwise difficult to manage. This case report may serve to help clinicians and clinical pharmacists as a new treatment option for treatment-resistant MDD, although further research is needed to confirm this practice.

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