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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Tepiaca on February 25, 2003, at 13:24:18
What kind of medicine is this ?
Posted by Ame Sans Vie on February 25, 2003, at 15:55:22
In reply to What is St Johns wort???, posted by Tepiaca on February 25, 2003, at 13:24:18
I could be wrong, but I believe it acts in a similar manner to SSRIs (i.e., Prozac, Paxil, Zoloft, etc.). It may have a mild MAO-inhibiting action... I'm really not quite sure.
Posted by Larry Hoover on February 26, 2003, at 8:42:03
In reply to What is St Johns wort???, posted by Tepiaca on February 25, 2003, at 13:24:18
> What kind of medicine is this ?
St. John's wort is an herb, species name Hypericum perforatum. The flowering tops (ideally) are collected in early summer (ideally), and processed for use as an antidepressant.
Most commonly, you'll find that SJW is sold as a standardized product. What that means is that a large quantity of the herb is pulverized, and using methanol or ethanol as a solvent, certain chemicals are extracted from the herb (like making tea, sort of). The "tea" is dried, and the amount of these chemicals is quantified (usually hypericin is the chemical measured). Then enough of these chemicals are put into a capsule so that the typical content is 0.3% hypericin in 300 mg of capsule; that means a standard capsule contains 0.9 mg of hypericin. It also contains lots of other chemicals which are themselves soluble in alcohol.
Recently, it's been discovered that there are other psychoactive chemicals in SJW. Some have argued that one of these, hyperforin, is the main active constituent. So, you'll find some products which standardized on both hypericin and hyperforin. One of those products is Perika, marketed by Nature's Way.
I personally believe that there are other active constituents, as well.
Early on, it was believed that SJW acted as an MAOI. Although it does, the experiment that demonstrated that effect used doses nearly 1,000 times what you'd be taking if you used this herb. You needn't worry about that at all.
Recent experiments have demonstrated some SSRI-like effects, but there are other effects which work via mechanisms unlike those seen in any known antidepressant drug. This has led to a vast array of new drugs currently in development, but that's another story.
You'll see numerous articles which suggest that SJW is only worthwhile in mild or moderate depression. The problem is that SJW has not often been tested in more severe depressions. There are European studies which demonstrate that higher doses are indeed effective in severe depression. Just like with any other antidepressant, you need to match the dose to symptoms.
There is no known overdose level for SJW. You can safely take as much as you need. Common side effects include headache and digestive upset, but these usually pass in a few days. In clinical trials, the side effect profile was similar to placebo. Some people become more sensitive to sunlight, but you should use sunscreen anyway, right? BTW, sun tolerance can be increase with B-vitamin supplements (as a redhead who used to burn in 15 minutes, this has been a good thing to learn).
There is one problem with SJW, probably unique to North America. There is no regulation of herbal products, and there is no guarantee that what it says on the label is what you'll get inside. Independent studies over the last decade or so have shown that as many as 1/3 of tested SJW products have little or no active ingredients in the capsules. Although this is fraud, it is not a violation of drug or herb regulations, as there are no applicable statutes. The pharmaceutical industry has actively lobbied against creating regulations of herbal products. Follow the money, and you'll understand why.
Lar
Posted by Ron Hill on February 26, 2003, at 9:57:03
In reply to Re: What is St Johns wort???, posted by Larry Hoover on February 26, 2003, at 8:42:03
Larry,
Thank you for taking time out of your busy days to post information regarding supplements and medications. We are fortunate to have someone with your expertise posting to this site. Thanks!
-- Ron
Posted by IsoM on February 26, 2003, at 11:44:09
In reply to Re: What is St Johns wort???, posted by Larry Hoover on February 26, 2003, at 8:42:03
Larry, (& any one else reading that is interested in compounds found in plants & herbs) I don't know if you already have this link or know of it but...
Jim Duke was a naturopath who wanted to know much more about plants he used & didn't want to rely just on often unreliable anecdotal data. He decided to return to university & earned a doctorate in (if I remember correctly) biochemistry. He has amassed a database of compounds found in plants, though not complete, is still excellent.
His site also has many links to other sources of info & other databases. On the possibility you don't know of this, I'd like to share it with you. You will know far more about these compounds than any of us could.
Posted by IsoM on February 26, 2003, at 11:46:49
In reply to Re: What is St Johns wort???, posted by Larry Hoover on February 26, 2003, at 8:42:03
Larry, am I correct in thinking that you're a fellow Canadian? Are you still actively working, & if so, do (or did) you work for the government? Seeing that toxicologists are used in many diff areas, I was curious in what capacity you used yours.
Posted by Larry Hoover on February 26, 2003, at 18:50:43
In reply to qucik question about you... » Larry Hoover, posted by IsoM on February 26, 2003, at 11:46:49
Before I get to the questions, did you catch my reply to your CLA inquiry? It's in the last archive, if you missed it.
> Larry, am I correct in thinking that you're a fellow Canadian?
Correct. I live about 1 hour's drive NE of Toronto.
>Are you still actively working, & if so, do (or did) you work for the government?
I'm not presently working in toxicology. I work part-time as a trucker, and otherwise receive federal and provincial disability pensions. I have several co-morbid conditions (e.g. chronic fatigue syndrome, post-traumatic stress disorder, irritable bowel, skin cancer) along with treatment-resistant major depression (actually, I think I'm dysthymic with superimposed major depression, so-called "double depression"). I've got most of my symptoms under control now, and I'm gradually increasing my endurance. With chronic fatigue, it can be a very long haul.
>Seeing that toxicologists are used in many diff areas, I was curious in what capacity you used yours.
I have always freelanced. I considered a federal gig at one point, but I've always worked for a major international NGO.
You may have seen news reports about pharmaceutical drugs being found in sewage and drinking water. I was working with one of the Canadian pioneers in that field, Dr. Chris Metcalfe, some years ago.
Posted by Larry Hoover on February 26, 2003, at 18:51:50
In reply to Re: Quick Note of Appreciation » Larry Hoover, posted by Ron Hill on February 26, 2003, at 9:57:03
> Larry,
>
> Thank you for taking time out of your busy days to post information regarding supplements and medications. We are fortunate to have someone with your expertise posting to this site. Thanks!
>
> -- RonThanks for your kind words. Much appreciated.
Lar
Posted by Larry Hoover on February 26, 2003, at 18:53:15
In reply to Phytochemical Database » Larry Hoover, posted by IsoM on February 26, 2003, at 11:44:09
> Larry, (& any one else reading that is interested in compounds found in plants & herbs) I don't know if you already have this link or know of it but...
> http://www.ars-grin.gov/duke/
I referenced it a few weeks back, and you were thrilled to get the link, as I recall. <wink>
Posted by IsoM on February 26, 2003, at 20:25:19
In reply to Re: Phytochemical Database, posted by Larry Hoover on February 26, 2003, at 18:53:15
Are you sure it was me? I've been using Jim Duke's site over a year now (not sure how long as I read about him before he got his degree). I tend to trust someone who thinks there's lots of value in medicinal plants but backs it up with solid hard science.
Posted by Larry Hoover on February 27, 2003, at 6:04:53
In reply to Re: Phytochemical Database » Larry Hoover, posted by IsoM on February 26, 2003, at 20:25:19
> Are you sure it was me?
Now that you mention it, no, I'm not. Somebody reacted happily to my posting about Duke's site, maybe 6 or 8 weeks ago. Sorry for the confusion.
Lar
Posted by IsoM on February 27, 2003, at 11:22:03
In reply to Re: Phytochemical Database, posted by Larry Hoover on February 27, 2003, at 6:04:53
Larry, I typed a long reply to your previous post abot CLA but my comp doesn't like PB. It frequently quits, dumps memory to disk, & restarts when I click on posting an answer. Most of the time, I compose my replies in Word & save but I didn't that time. I'll try agan but probably won't get it done for a couple of days. Lots to do in the next few days. Thanks for the reminder about your previous answer. I saw it & meant to save it for later. But after the memory is dumped, all previously read posts show blue like unread ones so I missed it & forgot.
I'd sure as heck like to know what's with PB as this is the only forum or site that triggers my comp to dump.
Posted by Larry Hoover on March 2, 2003, at 10:42:35
In reply to Re: CLAs » Larry Hoover, posted by IsoM on February 27, 2003, at 11:22:03
> Larry, I typed a long reply to your previous post abot CLA but my comp doesn't like PB. It frequently quits, dumps memory to disk, & restarts when I click on posting an answer. Most of the time, I compose my replies in Word & save but I didn't that time.
Why don't you email me at larryhoover@nexicom.net
Posted by johnj on March 2, 2003, at 20:46:24
In reply to Re: CLAs, posted by Larry Hoover on March 2, 2003, at 10:42:35
Hello Larry,
I have some questions maybe you can help me with. Some are about Mg again. I tried to read through the link, but I have had a hard week and just can't process much detail.You mentioned Mg chloride or citrate as a supplement. Do you know anything about collodial(not sure what this means) Mg? It seems like there is so much and different types have different amounts that are absorbed so I am a little confused.
Also, Do you know anything about picomilon in the thread below?
We have talked about B vitamins in the past so I am taking extra at noon and a little after dinner. They seem to help. Is it advisable to take a periodic break from supplements like this?
Here is a tuffy. I don't know what you know about TCA's but I helped a friend frame a basement and was so sore from the work and then worked out (yoga) 4 days later. the next day I had a horrible dry mouth, felt crappy, dizzy. It was like the meds side effects were worse. I have two theories and one is somehow excercise increases my AD level since that is what happens when I raise my dose. Or, it lowers the blood level, but that wouldn't explain the side effects. Any idea? or what type of doc could I consult. This is a very troubling problem for me as it limits me to what I enjoy and that is one piece of the puzzle for me getting back to health.
Lastly, any good herbs for an enlarged prostate? I see saw palmetto, then a mix of herbs(something called "prostate health". Sorry for the volley of questions. This just hasn't been my week.
Thank you and take care
johnj
Posted by jumpy on March 2, 2003, at 21:38:34
In reply to Hi Larry, I have a few questions » Larry Hoover, posted by johnj on March 2, 2003, at 20:46:24
Hey JohnJ,
Sorry to butt in, but what about it being the opposite ... exercise increase your lithium level and causes your side effects?
I have heard patients on lithium have to keep well hydrated and exercise can sometimes make people lithium toxic. I was reading Dr. Kay Jamison's book, and she mentioned that she got lithium toxic skiing (from the exercise and that high attitudes somehow increase lithium levels). Just a quick thought.
Posted by IsoM on March 3, 2003, at 2:26:08
In reply to Re: CLAs, posted by Larry Hoover on March 2, 2003, at 10:42:35
I will in a day or two, Larry (email you for further clarification on CLA & other things), but right now, I'm feeling a little under the weather. The first time in 6 years & I think I'm actually fighting a cold trying to start by the taste/smell in my sinuses. Feeling sorry for myself. I don't know how people can take having colds regularly - it totally sucks. But then, I'm used to headaches & don't give them much thought. Maybe it's like that for people who get colds.
Got a barrage of questions for you seeing you're a toxicologist & know the chemistry. You say you love giving info so you can share all the details you like.
Posted by johnj on March 3, 2003, at 8:46:26
In reply to Re: Hi Larry, I have a few questions » johnj, posted by jumpy on March 2, 2003, at 21:38:34
That is a thought. I have made sure I am well hydrated and have tried many things including taking extra salt. I guess the best thing to do is work out and when I feel like crap, however long that takes, go get my blood level taken. My doc seems to dismiss it but he doesn't realize how much I need to work out. No doubt it is a med effect though. Thanks for the thoughts!!
johnj
Posted by Ron Hill on March 3, 2003, at 9:53:51
In reply to Hi Larry, I have a few questions » Larry Hoover, posted by johnj on March 2, 2003, at 20:46:24
Hi John,
It might be helpful for Larry (and for others listening in) if you would post a list of all your current meds and dosages. I know you have done this in the past, but it might be worth posting again in this thread. In addition, what is your lithium blood level?
-- Ron
------------------------------------> Hello Larry,
> I have some questions maybe you can help me with. Some are about Mg again. I tried to read through the link, but I have had a hard week and just can't process much detail.
>
> You mentioned Mg chloride or citrate as a supplement. Do you know anything about collodial(not sure what this means) Mg? It seems like there is so much and different types have different amounts that are absorbed so I am a little confused.
>
> Also, Do you know anything about picomilon in the thread below?
>
> We have talked about B vitamins in the past so I am taking extra at noon and a little after dinner. They seem to help. Is it advisable to take a periodic break from supplements like this?
>
> Here is a tuffy. I don't know what you know about TCA's but I helped a friend frame a basement and was so sore from the work and then worked out (yoga) 4 days later. the next day I had a horrible dry mouth, felt crappy, dizzy. It was like the meds side effects were worse. I have two theories and one is somehow excercise increases my AD level since that is what happens when I raise my dose. Or, it lowers the blood level, but that wouldn't explain the side effects. Any idea? or what type of doc could I consult. This is a very troubling problem for me as it limits me to what I enjoy and that is one piece of the puzzle for me getting back to health.
>
> Lastly, any good herbs for an enlarged prostate? I see saw palmetto, then a mix of herbs(something called "prostate health". Sorry for the volley of questions. This just hasn't been my week.
> Thank you and take care
> johnj
Posted by johnj on March 3, 2003, at 13:11:49
In reply to Re: johnj's complete Rx and dosages » johnj, posted by Ron Hill on March 3, 2003, at 9:53:51
tranzene 22.5 mg
lithobid 600 mg
nortryptline 50 mgI am also unipolar depression. or so they tell me.
johnj
Posted by Ilene on March 4, 2003, at 22:37:09
In reply to Re: qucik question about you..., posted by Larry Hoover on February 26, 2003, at 18:50:43
> I I have several co-morbid conditions (e.g. chronic fatigue syndrome, post-traumatic stress disorder, irritable bowel, skin cancer) along with treatment-resistant major depression (actually, I think I'm dysthymic with superimposed major depression, so-called "double depression"). I've got most of my symptoms under control now, and I'm gradually increasing my endurance. With chronic fatigue, it can be a very long haul.
>Other than the PTSD, I'd say we were separated at birth.
I also have chronic fatigue syndrome. I was once "diagnosed" w/ irritable bowel, but now I see it is part of cfs.
My cfs is triggered by a dysautonomia involving control of blood pressure. It's strange but true; no one understands how it works. I can control the cfs by not getting hot and not exercising. Bad feet, can't take walks. (I can get you more info. if you are interested.)
I think I will get skin cancer (fair skin, grew up in southern California, both my parents had it). If I had more energy I'd get my keratoses frozen off.
I have something like double depression. Don't have a good diagnosis. Could be BPII. Definitely refractory.
Hard to say anything positive about living with a collection of hidden disabilities.
--I.
Posted by JaneB on March 5, 2003, at 8:50:37
In reply to Re: qucik question about you... » Larry Hoover, posted by Ilene on March 4, 2003, at 22:37:09
> > I I have several co-morbid conditions (e.g. chronic fatigue syndrome, post-traumatic stress disorder, irritable bowel, skin cancer) along with treatment-resistant major depression (actually, I think I'm dysthymic with superimposed major depression, so-called "double depression"). I've got most of my symptoms under control now, and I'm gradually increasing my endurance. With chronic fatigue, it can be a very long haul.
> >
>
> Other than the PTSD, I'd say we were separated at birth.
>
> I also have chronic fatigue syndrome. I was once "diagnosed" w/ irritable bowel, but now I see it is part of cfs.
>
> My cfs is triggered by a dysautonomia involving control of blood pressure. It's strange but true; no one understands how it works. I can control the cfs by not getting hot and not exercising. Bad feet, can't take walks. (I can get you more info. if you are interested.)
>
> I think I will get skin cancer (fair skin, grew up in southern California, both my parents had it). If I had more energy I'd get my keratoses frozen off.
>
> I have something like double depression. Don't have a good diagnosis. Could be BPII. Definitely refractory.
>
> Hard to say anything positive about living with a collection of hidden disabilities.
>
> --I.
>
>Never been diagnosed with CFS but all others mentioned, including skin cancer. What meds have you tried. Could you share good and bad responses to various meds? I'm trying to analyze my own situation and find solutions.
Thanks
JaneB
Posted by Ilene on March 5, 2003, at 17:14:17
In reply to What meds help you?, posted by JaneB on March 5, 2003, at 8:50:37
> Never been diagnosed with CFS but all others mentioned, including skin cancer. What meds have you tried. Could you share good and bad responses to various meds? I'm trying to analyze my own situation and find solutions.
> Thanks
> JaneB
>Sure, since you asked, but it's long and complicated, and my memory is sometimes fuzzy. My personal history continues to affect my responses to meds in at least three ways:
1) I would have done much better if my conditions had been diagnosed and treated sooner, esp. the depression. (The longer you are depressed the more likely you are to stay depressed.)
2) i've experienced more trauma than most people, so I've had more triggers. I have to leave these out, otherwise I would ramble on and on and on.
3) I'm not sure whether I ever had an accurate diagnosis, even though looking back I see I have been depressed or dysthymic nearly all my life. I'm not clearly unipolar or bipolar or anything else. I've gone thru several doctors.
Despite my constant depression, I was in my early 30s before I started on meds. The first AD I took was desipramine (nortramin, pertofrane) I stopped when I was trying to get pregnant. I was off it for at over a year, and I was very depressed. When I started again it had lost its effectiveness; I tried higher and higher doses (I don't remember what they were) until I couldn't stand the side effects any more: dry mouth, light-headedness (postural hypotension), diarrhea.
I started swimming regularly around this time. Worked up to a mile 2 or 3 times a week and then added weights. I never realized I wasn't supposed to be completely exhausted, overheated, and light-headed after swimming. These were symptoms of neurally mediated hypotension (the dysautonomia) but it took me about 11 years to figure it out. Exercise never helped the depression, either. Maybe it would if my autonomic nervous system didn't screw things up.
Then I tried fluoxetine (prozac), which was new at the time, and hadn't become the social phenomenon it is today. After a few years I had to up the dosage to 60 mg. I think that's the maximum dose. Then I tried sertraline (zoloft), might have tried paroxetine (paxil). Didn't work. Tried bupropion (wellbutrin), but it made me too anxious. Ended up with citalopram (celexa), don't remember dosage. I'm not sure if I was ever in remission, but it was a stressful time overall.
Moved to the east coast while I was taking prozac. The hot and humid summers that made me tired, short of breath, and headachy. Now I know heat makes my blood pressure plummet. It's another reason to hate living here.
Broke my pelvis (whoops) and took lots of percocet, which contains the narcotic oxycodone. I think that is in oxycontin. Made me fuzzy and sleepy. Can't say it improved my mood. Certainly wasn't any fun. I don't think other opiates would help me.
Had nasty dental surgery that might have been a consequence of dry mouth.
I don't know if I was fully in remission w/ Celexa, but I took it for a few years. Meanwhile my sleep got worse and worse, and my pdoc prescibed methylphenidate (ritalin) to keep me awake, and 10 mg. amitriptyline (elavil etc.) and 300 mg. gabapentin (neurontin) to help me sleep. I hated the ritalin; it felt like squirrels were running around in my brain, so I switched to dextroamphetamine (dexedrine, dextrostat) up to 40mg.(?) a day.
After a few months my pdoc decided I had a sleep disorder (I forgot this before). It has a few names; she called it "delayed sleep phase disorder". She recommended a light box, which helped the most, but I still took all the other stuff because I didn't want to upset what felt like a precarious balance.
It was always a hassle to get dexedrine: I needed new script (no refills) and the pharmacy didn't always keep it in stock. I really hated running around asking for a controlled substance. After a few months (maybe a year? longer?) I felt worse instead of better when I took it. I think it caused abrupt swings in my blood pressure.
(It's pathetic when "drugs of abuse" don't do anything for you.)
By about 1 1/2 years ago I had constant suicidal ideation.
I got a better pdoc. Added sustained-release wellbutrin. I didn't have side effects from the wellbutrin sr. I felt a little more energetic. Not much, but it was something. I switched to the regular wellbutrin because the maximum dose is 50mg. higher. No side effects this time. I'm still taking it.
Tried fish oil. Went to over 9 grams of EPA. Didn't do anything, was hard to swallow all those immense capsules, was costing money. Now I take one (contains 1100 mg. "molecularly distilled" [huh?] oils) or eat oily fish every day, if I can remember. I took vitamin e and selenium as antioxidants with the fish oil.
Tapered off celexa. Started titrating up extended-release venlafaxine (effexor xr). It's hard to remember *exactly* what side effects I had, but I eventually got to feeling so strange I decided to quit before I got to an effective dose. I felt twitchy, shaky, dizzy, headachy, wobbly, blurry. And *then* I had horrendous withdrawal, despite gradually titrating down.Somewhere in here I ditched the dexedrine and started modafinil (provigil). I feel both more awake and less weird at 200 mg. I didn't like 300mg.
I've been at 200 mg. lamictal (lamotrigine) for about 10 days-2 weeks. I've felt a little better for the past 2 or 3 days, but that happens every once in a while anyway.
The only side effect is it takes a long time to have an orgasm. I don't know if that's common. At least I still have them. I had the same problem with the ssri's and all the newer ADs except wellbutrin.
Now I take lamictal, wellbutrin, neurontin, provigil, elavil, and the occasional fish oil capsule. I get some dry mouth, but it's mild compared to what I got before. My sleep/wake problems are under control, but I'm still severely depressed.
I've also changed my diet. I eat more fat and less carb. Hardly any bread, pasta, or potatoes; no table sugar to speak of. I don't feel shaky and irritable when I'm hungry, I don't eat to the point of feeling bloated, and I've lost a little weight. It's a slight improvement in my symptoms but again, doesn't address the underlying illness.
Feet? Inherited them. Had surgery, got orthotics, still fatigued after a short time. It's almost impossible to find shoes. The really ugly orthopedic shoes I used to wear most of the time aren't being manufactured anymore.
Skin? Congenitally melanin challenged? I think I said both parents got skin cancer. I've gotten a sunburn in less than 20 minutes. I got one between 6 and 7 pm one time during the fall or spring. That was *before* I started taking meds that increase sun sensitivity.
About 15-20 years ago a pricey derm. told me to wear sunscreen every day. If I hadn't listened to him my skin would be much worse! All I have now are a few actinic keratoses that are taken off w/ liquid nitrogen.
I have most of the risk factors for malignant melanoma, but I try to keep my skin "paranoia" within bounds. I wear regular high-spf sunscreen unless it's raining or snowing. I try to remember to keep it on my hands. I have some sunscreen with titanium dioxide that's supposed to block *all* UV but it is expensive and looks really strange. White and greasy. I reserve it for sunny days when I'm going to be outside for more than an hour or so. I keep myself covered (long sleeves, long pants or skirt, hat) when I'm out that long.
BTW, I took accutane and didn't become intensely depressed and suicidal.
I think I've forgotten something. Remind me if you recall what it is.
--I.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
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