[Rapunzel]

Cam,

Thanks for all the information. I wish that I could get my T to actually tell me a diagnosis. I told him last spring that I thought I had a seasonal pattern, and he seemed to agree, and didn't seem to disagree when I asked if I should get a light box. My previous diagnoses were dysthymic disorder and social anxiety, but he hadn't really seen me much in winter. First evaluation was in spring - waited a year for approval from a funding source - started therapy in spring - quit in late fall (because he cancelled on me too many times and I gave up) - a year and a half later an incident involving SI and being pretty close to suicide prompted starting therapy again - spring. He never said whether my diagnosis changed, but I'm assuming it probably did.

I also started SJW last spring, and did very well through summer and early fall, but not doing so well now. The light therapy might work better if I actually got out of bed in the morning and did it instead of not being able to get going until about 10, and then not having time for it. I've gone off the SJW a couple of times (in May and also a couple of weeks ago) and the depression came back both times. I also overdosed on SJW (usually aim for 600-900 mg per day but got up to 3000mg for about a week) (in April) and became hypomanic - the only time I have experienced that, which stopped when I went back to 600-900 mg.

Besides photosensitivity and mania, what other possible effects could overdoses of SJW have?

Last week my T suggested geting on medication. I reminded him that I was using SJW and told him I had stopped, and he said to get back on it and not stop if it was working. I don't have access to a pdoc (except for my sister but she's too far away), the GPs around here are known to do a pretty bad job when they try to deal with psychotropic meds, and I don't have time to wade through side effects and stuff like that. With SJW I don't notice anything at all unless I stop taking it.

Why is SJW not recommended for major depression? Not strong enough? It's fairly obvious why it's not recommended for bipolar disorder.

Your link for SAD worked - thanks - good information, but the links about using light and about SJW don't seem to have shown up.

Thanks!
Wendy (or Rapunzel or Rap or whatever)

p.s. I've got to get my homework finished. It's late in an hour, and it's already an hour past my bedtime, but it's pretty hard to care right now.

<blockquote><font size=1>In reply to:</font><hr>

Rapunzel - Here are "my" ideas about the following therapies.

1) Light Therapy - There does seem to be noticeable improvement in those with SAD (seasonal affecive disorder), but I have seen little encouraging evidence for it's use in treating other variations of the syndrome of depression.

Using Light in Treating SAD --->>><<<<---

a) Season Affective Disorder (SAD) - SAD is being recognized as a true sub-type of major depressive disorder (I think). If I had to guess, I'd say that "cabin fever" may have been loneliness exacerbated SAD (just thinking out loud).

Some Reliable Stuff About SAD --->>><<<---

2) St. John's Wort (SJW) - this drug is recommended to those with mild to moderate depression. It should not be used in major depressive disorder, nor in bipolar disorder.

Researchers (incl. government - Health Canada, NIMH, etc.) are starting to scientifically study SJW using the good old (good, but not perfect) large-scale, randomized, double-blind clinical trial.

Mild to moderate depressions usually do not require medications (ie. antidepressants). Talk therapies, with a psychologist or a counsellor (depending upon situation and needs) are very useful in mild to moderate depression.

My psychologist; who wrote her PhD thesis on grief after loss of a child. I wish that I had met here 10 years ago. She has shown me why I do what I do, and if I wasn't such a "stodgie old proot" I'd work more these areas.

A good therapist is able to get to the core of your problem, but even the best therapist cannot "make" you better; nor can just taking an anti-depressant "fix a depression". The hardest work, as usual is done by the person with the least amount of energy, those with depression.

Enough of my yapping. Here is NIMH's position on St.John's Wort (NIMH = National Institutes of Mental Health - US)

- Cam

<hr></blockquote>

<font color=green>"Someone may have stolen your dream when it was young and fresh and you were innocent. Anger is natural. Grief is appropriate. Healing is mandatory. Restoration is possible." -Jane Rubietta</font color=green>

[CamW]

Wendy - Doh! Sorry about the <A target="_blank" HREF=http://www.mentalhealth.com/book/p40-sad.html#Head_9>light therapy</A>, I guess that "http://http://" doen't work very well.

The main thing to watch for when one has taken an overdose of of St. Johns Wort is something called "serotonin syndrome" which is fairly rare, but I have seen cases of serotonin syndrome once when SJW was taken with Manerix™ (moclobemide) and have dealt with several cases where SJW was taken concomiitantly with various SSRIs, and a couple cases where it was combined with amitryptyline.

I have been involved with only one case where I thought that the serotonin syndrome was bad enough for me to consider it life-threatening. This was a case of a deliberate suicide attempt in a doctor's office, and I just happened to be there at the time.

Serotonin syndrome is defined as, "potentially dangerous oversupply of serotonin in the body, have been attributed to taking St. Johnís wort. Uncontrolled serotonin syndrome may result in coma, seizures, and death. Symptoms of serotonin syndrome include: confusion, euphoria, fever, hallucinations, inability to coordinate muscles, nausea restlessness, shakiness sweating, and vomiting. A good review of serotonin syndrome can be found on the website of the journal, <A target="_blank" HREF=http://www.currentpsychiatry.com/2003_05/0503_serotonin.asp>Current Psychiatry</A>

Other and <A target="_blank" HREF=http://www.drugdigest.org/DD/DVH/HerbsInteractions/0,3926,4049|St.+Johns+Wort,00.html>drug interactions, as well as are included on the enclosed website links. Also, on the same website, the webmasters have included <A target="_blank" HREF=http://www.drugdigest.org/DD/DVH/HerbsWho/0,3923,4049|St.+Johns+Wort,00.html>who should take SJW and <A target="_blank" HREF=http://www.drugdigest.org/DD/DVH/HerbsTake/0,3927,4049|St.+Johns+Wort,00.html>if you want to know if SJW is for you</A>.

SJW is not recommended for severe depression, as it has been shown only to definitively treat mild/moderate depression. Even proponents say that SJW does not work well in severe depression. This is probably due to the fact that as you increase the dose of SJW to amounts that would be effective in severe depression, the side effects of other chemicals in the plant become too pronounced.

SJW is not recommended in bipolar disorder for the same reasons that other serotonergic antidepressants are not recommended. There is a similar risk of developing hypomania from SJW as is seen with SSRIs.

If your depressive symptoms return when you go off SJW, you may still need to take it to stay in remission from depression. There is no need to take SJW year round if you are only having seasonal problems with depression.

If you are fairly certain that your depression is seasonal, the adverse effects that you are experiencing could potentially be serotonergic withdrawl symptoms. This is strictly a guess; I am thinking out loud right now. I have never seen <A target="_blank" HREF=http://www.preskorn.com/books/omd_s6.html>Serotonin Withdrawl Syndrome</A> (see the bottom of the page for SWS) with SJW, but theoretically it could happen.

I hope that this hlps somewhat - Cam

[Rapunzel]

Cam,

Thanks so much for the information. I really learned a lot, and I haven't even gotten to all of the links yet. One thing I didn't know was that a side effect of SJW is that it enhances the sedative effect of other herbs that have a sedative effect, including chamomile, valerian, kava, etc. There is an herb tea I used to use a lot (would still but my grocery store stopped carrying it - I ordered some online but they changed the formula now, omitting the Kava, so I don't know if it will be as good), for relaxation. When I had first started SJW, I tried the "Tension Tamer" tea and it knocked me out (at 2 in the afternoon). Tried it another day and the same thing happened, so I decided that was a bedtime tea. I actually appreciate that particular side effect, since I have had significant sleep problems and now chamomile works quite well, and chamomile with valerian is absolutely reliable.

I actually really hate to give that up, and I really like SJW because it has no side effects that bother me, and I did very well with it for several months. However, I've been struggling more with depression the last few weeks. It got bad. Today my T wanted me to make a deal with him that I would at least not attempt suicide until after finishing graduate school. I wasn't planning to anyway, but yeah, the thoughts have been there. He wants me to get on medication, and he says that my depression is not psychological but medical. In fact, although I haven't been manic (except for a little bit while overdosing on SJW onece), he says that he thinks I may be a true bipolar (even if my highs only approach normal), and that maybe the way my cycles are going just mimics SAD.

How does that affect what meds I should take? I have an appointment next week with a GP. My sister is a psychiatrist, and she said she was willing to consult but not prescribe for me. She really likes Effexor and that is what she has been recommending. I still don't think I want to switch to prescription meds. I'm afraid of side effects, don't welcome the expense, and I'm afraid of being stuck taking meds for the rest of my life. With SJW I could stop any time I like, but that's harder with a prescription med, and my T and my sister are both saying that I would probably just stay on it forever, since the depression has been pretty continuous for basically my entire life. And I really wanted to be able to beat it without drugs, but I'm tired of it, and tired of losing weeks or months at a time to it.

-Wendy

<font color=green>"Loneliness does not come from having no people about one, but from being unable to communicate the things that seem important to oneself, or from holding certain views which others find inadmissible" Carl Jung</font color=green>

[CamW]

Wendy - I try not to look at diagnoses; I know it has to be done to keep the books straight. Besides, I wasn't trained in diagnosis, so I can't do it; I really don't like labels. I do know that there are no cures in psychiatry only "bandages" that help us tolerate, and sometimes enjoy, life. We just have our symptoms treated, regardless of what we have to put on the "chronic illness" space on the insurance forms.

As for the SJW, if it ain't broke, don't fix it. If it works for you stick with it. You should (preferably) choose a brand that is "standardized" on the label; and use the same brand everytime (to ensure that you are getting a consistent dosage).

SJW is working at the exact same receptors that prescription antidepressants do (ie. block the reuptake of serotonin into the pre-synaptic neuron). If you have to go on prescription meds, keep the dose low, perhaps a "cleaner" antidepressant, like citalopram (Celexa™). It is "cleaner" in that it doesn't bind to many receptors other than the serotonin reuptake receptors. Some of the side effects of medication are the drug molecule "binding" to these other receptors. It is these differences in binding that make one SSRI different than another.

I hope that this is of some help. - Cam

[heidu]

Cam,
Sorry to butt in here but I have a few questions on SJW myself. Thanks for giving Wendy so much info. It's been a great source of knowledge.

I have taken SJW before but it made me sleepy so I took it at bedtime. I don't know what the dosage was. I took 2 like the bottle said .

I am currently on Paxil 10mg daily. I did take 20 for a week per docs suggestion from last time but found the blurred vision etc to be too much. I am doing better on just the 10 mg dose. Less anxious, more stable moods and actually a good mood on occasion. I am not looking for a miracle pill. I know what is causing my depression and I am working on the situation. I just need some help getting thru this time so that I don't get into a deep depression and give up. Been there, scared me.

Ok, this is wordy but sometimes your replies are too!!
I am currently taking the Paxil. If I discontinue that how long should I wait before starting the SJW? I don't know that I am gonna do that yet but I am thinking about it. I prefer no meds but it would be good if I could use something natural instead. Also do you know if the drowsiness side affect is something that the body adjusts to or if that is something one has to deal with while taking it.

Thanks in advance. Chime in here Wendy if you have any info. I am also interested about the taste of the SJW tea. Nasty? Tolerable? Pleasant? I know in some cases a liquid form of vitamin or herb works into the system faster...so they say anyway.

Heidu

There is a time in life when you stop existing and start living.
There is a time in life when you are given a new chance and new dreams.
There is a time in life when the old is to be forgotten and the new embraced.

There is a time in life......And that time is now.
Unknown

[CamW]

Heidu - Wordy?! ... ME?! .... I hadn't noticed.

The blurred vison that you are experiencing with Paxil is usually attributed to Paxil's antimuscarinic effects. The blocking of acetylcholine receptors (ie. the muscarinic-M1 receptor type, not the muscarinic-M2 nor the nicotinic family of receptors) is one of those "side effects" of Paxil™ (paroxetine) where it's molecules bind to receptors other than the serotonin reuptake mechanism (in theis case the "muscarinic/cholinergic-M1 - 'M/C-M1 - receptor').

Besides being (partially) responsible for the blurred vision (via a couple of different mechanisms), blockade of the M/C-receptor also is responsible for some of the weight gain that is often attributed to Paxil™.

On the other hand, muscarinic-M1 blockade is also the mechanism that makes Paxil™ the first choice of the SSRIs in treating anxiety states, such as panic disorder and (maybe) social phobia.

As for the possibility of adjusting to the drowsiness caused by Paxil, the body will adjust to a large part of it, but because of the muscarinic-M1 blockade, some people retain a little drowsiness for up to 6 months.

As for switching from Paxil™ to SJW, I would do a direct switch, without a washout. The half-life of Paxil™ is fairly short, and it you just stop the SSRI you risk serotonin withdrawl syndrome.

On the other hand, a direct switch from Paxil™ one day to SJW the next may result in serotonin syndrome (the opposite of serotonin withdrawl syndrome, in which the body is receiving too much of the neurotransmitter). Personally, I believe that the probability of either of these scenarios occurring is remote; and if they did occur the symptoms would most likely be mild.

Since SJW might have antimuscarinic activity. Of this I am not certain, but with the number of other chemical compounds in the SJW plant the probability is fairly high. If this is the case, the drowsiness induced by SJW should fade, for the most part.

LECTURE ALERT: <with wagging index finger>

"Natural" does not, cannot, and should not equated with "Safe"! ..... that isn't safe

Cyanide is found naturally in peach pits.

I say, "Anything that you ingest which you expect to elicit a medicinal effect of any kind has o be considered a drug". Water is a drug when you drink it to try to flush out a viral infection; several unripe crabapples are a laxative inducing a medicinal effect (whether you want it or not).

The reason that most herbal preparations have a low incidence of side effects is because the concentration of active ingredients is low. If you concentrated the active ingredients in SJW in order to (potentially) increase it's activity, there will more than likely be a corresponding in the incidence and severity of side effects.

The above is not directed at you, Wendy. The "natural=safe" myth is one of my pet peeves, and it is my mission in life to discredit it every chance I get. I hope that you do not take offense at my rant.

I hope that this answers some more of your concerns. - Cam
P.S. The above may make more sense if you read the text and ignore the stuff in parentheses until you get the gist of what I am trying to say .... I hope.

To fully understand a concept is to be unable to describe it verbal, only emotionally.

[Rapunzel]

Heidu,

SJW by itself doesn't make me sleepy. I'm not sure if it did when I started taking it or not - I was really a mess at that point and couldn't really say what was what. I was tired a lot, but I was not sleeping much at night and was just barely recovering from a bad depressive episode that had lasted at least 2 months. Anyway, now it doesn't make me sleepy. I take it in the morning most of the time.

I haven't been very consistent on which brand I use, largely because my grocery store hasn't been very consistent on what they have available - particularly with the teas. Now the grocery store has not restocked any of the three brands of SJW teas they used to have in several weeks. I ordered some on the internet, and it's another different brand (Alvita). This new one has SJW as the only ingredient listed, but doesn't say how much. I need to try to get a hold of the company and ask them. The one with all SJW smells like it would taste bad all by itself, so I use one SJW tea bag and one of a flavor I like (peppermint, or a fruit flavor or something), and then it's okay. The other brands all had other ingredients to make it palatable and they all tasted good to me. What I used included Celestial Seasonings Mood Mender (which is 800 mg and is peppermint flavored) and Yogi Tea - I think it was just called St John's Wort tea, but I'm not sure and I don't have any left to go check (850 mg of SJW and a cinnamony, spicy kind of flavor). Traditional Medicinals also has one, called St. John's Good Mood, and I don't remember if I tried it - it was only 200 mg of SJW per bag, so you would have to drink at least 3 cups of it per day to do much.

I don't sweeten my herb teas - most people like them better sweetened. I've gotten used to the bitterness that almost any herb tea seems to have I guess. Oh, the directions on the boxes say to drink 3-4 cups per day for like 3 months. That's too much for the ones with around 800 mg - I tried it and that's when I went hypomanic. The recommended dosages I have found say 600-900 mg per day. I also have gel-caps and they are 300 mg each, and most of the SJW pills of whatever form seem to be 300 mg. I switch back and forth between the tea and the pills, but I like the tea better and think it probably works better, probably mostly because it seems to me that they can get more of the plant into a tea bag than into a pill, and also that an infusion (which tea is) would release the medicinal substances (okay, drugs) from the plant and make it more usable, and it just seems to me that it would work better than just swallowing a bunch of leaves. But that is just how it seems to me - I don't know if there is any truth in it.

The Alvita brand has 24 bags and the total for the box says 41 g, but I don't know if it all should count for comparing the dosage. That would make each bag 1708 mg, right? I just don't know what is supposed to count. I really ought to write to them and ask.

Cam, thanks again for all the information. I appreciate it very much. I wouldn't have thought that the lecture on herbs being drugs was directed at me, and I am aware that I am using herbs as drugs. There are several that I use from time to time for various purposes. I like herbs because they generally seem to be milder than conventional drugs (for example, I can get to sleep with chamamile and valerian and not feel drugged the next morning, while if I take Tylenol PM it also puts me to sleep, but not any faster, and it takes at least 10 hours to wear off and I stay groggy all morning), and also because I like being able to have control over what I am using. I could even grow it in my garden. In fact, I have grown SJW and chamomile also, but never tried to put them in teas though. SJW is also a good dye plant, and that is what I grew it for when I did.

Well, it's past my bedtime and I think I'm starting to ramble now. We can all be wordy, right? Well, thanks for this great discussion. There was something else I was going to say, but now I can't remember it. Oh well. Maybe I will later.

Wendy


<font color=green>"Loneliness does not come from having no people about one, but from being unable to communicate the things that seem important to oneself, or from holding certain views which others find inadmissible" Carl Jung</font color=green>

[heidu]

Wendy,
I went to the healthfood store here and also the pharmacy (they carry all the OTC meds and some herbs and vitamins). The health food store only had some liquid stuff, a derivative of olive oil. It said how much to take but didn't say how many mg each "serving" was.

At the pharmacy they had one choice of capsules at 400mg. The directions said take 1 daily. I am thinking maybe 2 to make 800mg per day taken 2 times a day. What do you think?

The availability in this country really really irritates me sometimes but at least they have something. I do think I would like teas since I drink that numerous times a day anyway. Oh well. Things like that can't be shipped here. My mom tried to send me some antacids and vitamin C ones and it was stopped at customs and taken. :O/

Have you tried your local heath food store for the SJW? They may have some more options for you and a greater consistancy.

I used to not sweeten my tea but I started drinking english tea here or stuff from the grocery store and it wasn't very good so I got used to sweetener. I try to use honey and now I use it in all my teas. I don't drink the english tea anymore but found some good green tea. I love tea in the fall/winter.

Rambling.....but thanks for this thread!!
Heidu

There is a time in life when you stop existing and start living.
There is a time in life when you are given a new chance and new dreams.
There is a time in life when the old is to be forgotten and the new embraced.

There is a time in life......And that time is now.
Unknown

[heidu]

Cam,
Oh yes, the weight gain. Like I needed help with that. That is another concern and a reason I would like to switch to the SJW. I don't have severe anxiety or social phobia although I do get more anxious and I am less confortable in social situations. It isn't so much debilitating as uncomfortable. My main problem is the depression.

When I withdrew from Paxil before it was a few days of not feeling so great and then I was fine. I am on a low dosage so I think I will go straight to the SJW.

I agree that natural doesn't equal safe. I think that everything needs to be taken in moderation. That goes from something as simple and natural as butter. Too much is bad.

Thanks again for the info. Your such a dude.
I got the impression that things are tough for you right now and I wanted to send hugs your way. I know little about your situtaion but enough to know that it must be very trying. I wish you the best and peace to get thru the time ahead.
Hugs,
Heidu

There is a time in life when you stop existing and start living.
There is a time in life when you are given a new chance and new dreams.
There is a time in life when the old is to be forgotten and the new embraced.

There is a time in life......And that time is now.
Unknown

[Rapunzel]

Heidu,

We do have a health food store here, but they seem really expensive. I hardly dare to go in there. But that is a good idea and I ought to try looking in there, shouldn't I?

On the capsules, 2 per day sounds good to me. When I was taking the capsules I have, which are 300 mg each, I took 2 per day (morning and night). I was going to offer to try to send you some herb tea, but wasn't sure if it would go through. Sounds like it wouldn't. What if the box were just marked "herbal tea" or just "tea"?

Is SJW by prescription in Norway? I read that it is in most of Europe, but not the U.K. I assumed that in Norway it would likely be by prescription too.

I went to my doctor appointment yesterday and didn't get a prescription (see my thread under Depression). My T doesn't know yet - my husband says my T is going to throw a fit.

Oh, and Cam, thanks one more time for all your help. I understand that you are going through hard times yourself, and I've been following what you have posted about that but haven't said much since you don't seem ready to talk about it much, and that's up to you entirely, but if you want to talk of course we would all be happy to listen any time.

Best wishes to both of you, and anyone else reading this,
Wendy

<font color=green>"Loneliness does not come from having no people about one, but from being unable to communicate the things that seem important to oneself, or from holding certain views which others find inadmissible" Carl Jung</font color=green>

[heidu]

SJW and other herbs are not by prescription here. You can buy them at the pharmacy (they sell spices and lotions and all over the counter meds and pain killers. You have to go there to get antacids and tylenol) Actually to make my turkey dinner I needed sage and I could only find it at the pharmacy and heathfood store. SAGE for god sake!!!
Herbs and natural remedies are available at the heathfood store but like I said, the selection is minimal. They have alot of teas though so that's nice. I do think you could send tea as it would be tea and not considered for medicinal purposes. I'll check it out. Maybe we could do a tea/chocolate swap?

I have some weeks of the Paxil left so when that runs out I will get the SJW. It will cost me $42 for 60 capsules. How's that for price?

Thanks for the help!!!
Heidu

There is a time in life when you stop existing and start living.
There is a time in life when you are given a new chance and new dreams.
There is a time in life when the old is to be forgotten and the new embraced.

There is a time in life......And that time is now.
Unknown

[Rapunzel]

Wow, I thought mine was a little expensive. I get 200 capsules for $15. The SJW tea was around $4 for 24 tea bags on the internet, or just a little bit more in the grocery store but minus the shipping charge so it comes out about even. Does the socialized medicine system pay for prescriptions like Paxil?

I wish I could send you some. We could try sending some herb tea, and just indicating the contents as tea, and see what happens. I'd trade for chocolate or yarn or books, well, there are any number of things from Norway that I would love to have.

Would they confiscate my SJW when I travel to Norway? I'm still hoping to go in May. Would I get away with taking some to you in my luggage? Or would they get suspicious if I brought more than what I expected to use while I was there?

<font color=green>"Loneliness does not come from having no people about one, but from being unable to communicate the things that seem important to oneself, or from holding certain views which others find inadmissible" Carl Jung</font color=green>

[heidu]

The socialized heathcare subsidizes prescriptions. I pay about $50 for a 3 month supply. Still alot if you ask me.

I'll check about sending teas and let you know by pm. They won't confiscate your meds when you travel. You can bring enough for personal use with you. They don't know how much tea you drink so you should be able to bring what you want. A case might be too much :O)

Heidu

There is a time in life when you stop existing and start living.
There is a time in life when you are given a new chance and new dreams.
There is a time in life when the old is to be forgotten and the new embraced.

There is a time in life......And that time is now.
Unknown