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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by McPac on August 19, 2003, at 5:55:51
Lar,
I know I asked you this question one time before (I don't believe I understood your answer at that time). Regarding SJWort, why is it okay to take, for example, 1800 mg a day of SJW along with, say, 60 (or more) mg's of Remeron (high doses of both the SJW & the Remeron)....Yet, someone is NOT supposed to take ANY SJW (even a low dose) with 25 mg of Zoloft (a low dose of that med)?.......Just because Zoloft is called an ssri and Remeron is not?<(they still BOTH effect serotonin, Remeron simply affects norepinephrine also). Why is the serotonin syndrome risk of the SJW/Zoloft-low dose combo much greater than the high dose SJW/Remeron combo? (To take it even further, 2400 mg SJW + 100 mg Remeron (HIGH doses of both) would still be fine but 300 mg SJW + 10 mg Zoloft (PUNY doses of both) would not be allowed? That makes no sense yet that seems to be what the going logic is, i.e. SJW + ANY ssri is NOT allowed, YET if a drug is not called an ssri (but still effects serotonin, it just affects something else too) then you can take HIGH doses of both it and SJW? Makes no sense....thanks for any explanation Lar (please, please try to make it clear...my brain is rebelling against complexity right now, lol) As always, much appreciated Lar!!
Posted by Larry Hoover on August 19, 2003, at 8:07:39
In reply to Larry Hoover, SJW Question, posted by McPac on August 19, 2003, at 5:55:51
> Lar,
> I know I asked you this question one time before (I don't believe I understood your answer at that time).I don't think you ever asked me just what you're asking here.
>Regarding SJWort, why is it okay to take, for example, 1800 mg a day of SJW along with, say, 60 (or more) mg's of Remeron (high doses of both the SJW & the Remeron)....
Where'd you get those numbers from?
> Yet, someone is NOT supposed to take ANY SJW (even a low dose) with 25 mg of Zoloft (a low dose of that med)?.......Just because Zoloft is called an ssri and Remeron is not?<(they still BOTH effect serotonin, Remeron simply affects norepinephrine also).
The issue is the mechanism. SJW is a serotonin reuptake inhibitor (among other things it does). SSRIs are defined as serotonin reuptake inhibitors. Combining two drugs that do the same thing gives an additive effect. Remeron (mirtazapine) does not block serotonin reuptake. It binds to different components of the serotonin regulatory system altogether.
> Why is the serotonin syndrome risk of the SJW/Zoloft-low dose combo much greater than the high dose SJW/Remeron combo?
That issue is also something that comes out of real-life experience. Some (perhaps foolish) people have taken SSRI/SJW combinations and have gone on to develop serotonin syndrome. Therefore, it's not recommended that others follow in the foolish peoples' footsteps.
>(To take it even further, 2400 mg SJW + 100 mg Remeron (HIGH doses of both) would still be fine but 300 mg SJW + 10 mg Zoloft (PUNY doses of both) would not be allowed?
I don't know where you're getting these dose numbers from. I've used 2400 mg SJW, but I've never seen that dose in medical journals (books yes, journals no). And I didn't combine it with anything.
> That makes no sense yet that seems to be what the going logic is, i.e. SJW + ANY ssri is NOT allowed, YET if a drug is not called an ssri (but still effects serotonin, it just affects something else too) then you can take HIGH doses of both it and SJW?
You have to look at exactly what the different drugs do, not just that they affect serotonergic processes. The specific processes that are affected matter. Some combinations have proven to be safe (you can take Remeron with an SSRI, for example), whereas others have proven to be risky. With all the people in the world struggling with depression, and all the available drugs and herbs and such, someone has probably tried any possible combination you can think of. We only hear about the ones that are dangerous. Then, doctors and scientists try to suggest reasons certain combinations have proven to be dangerous, and warn against any similar combination.
At some point in time, some doctor "did the experiment", and combined Remeron with an SSRI. It may have been dangerous (and I'm sure the subject was closely monitored), but it wasn't. It could have been dangerous. It wasn't.
Manerix (moclobemide) is supposed to work in a way that avoids the tyramine reaction (huge increase in blood pressure), but some people still get it. We only know that because of people showing up in the emergency room. Theory is one thing, but reality is the proof.
>Makes no sense....thanks for any explanation Lar (please, please try to make it clear...my brain is rebelling against complexity right now, lol) As always, much appreciated Lar!!
I hope I helped. Try again, if not.
Lar
Posted by McPac on August 19, 2003, at 12:44:24
In reply to Re: Larry Hoover, SJW Question » McPac, posted by Larry Hoover on August 19, 2003, at 8:07:39
THANK YOU Lar!
Great explanations (as usual).
I understand!
Hey Lar---does it make a difference whether SJW is taken with or without food?
I've read to drink a full glass of water with each dose.
Thanks!!!!!!!!!!!!!!!!!!
Posted by Larry Hoover on August 19, 2003, at 20:36:56
In reply to Re: Larry Hoover, SJW Question, posted by McPac on August 19, 2003, at 12:44:24
> THANK YOU Lar!
> Great explanations (as usual).
> I understand!I'm glad. Now, where did you get those dose numbers from (the combinations of SJW and Remeron)?
> Hey Lar---does it make a difference whether SJW is taken with or without food?
Not that I know of.
> I've read to drink a full glass of water with each dose.
You should drink a whole glass of water after swallowing any pills. It's far too easy to have pills fail to reach the stomach, unless you swallow enough water to wash them all the way down.
> Thanks!!!!!!!!!!!!!!!!!!
Welcome,
Lar
Posted by McPac on August 19, 2003, at 22:00:16
In reply to Re: Larry Hoover, SJW Question » McPac, posted by Larry Hoover on August 19, 2003, at 20:36:56
"Now, where did you get those dose numbers from (the combinations of SJW and Remeron)?"
>>>>>>>>>>> From me! lol.
What I was trying to convey was that the general advice I recall hearing/reading was, "If you are on an SSRI then SJW is totally OFF LIMITS. But if you are on other types of AD's then you can take both (not the maoi's though)...due to serotonin syndrome (too much serotonin).... so, I thought (big problem! lol) "why would it be worse (i.e. cause too much serotonin) taking a PUNY dose of SJW with a PUNY dose of, say, Zoloft (ssri)---(<2 PUNY doses combined)...how can that be worse than taking, say, a BIG dose of SJW + a BIG dose of a non-ssri med (like Remeron, for example)....I didn't see why the latter example wouldn't produce more serotonin than the first....my brain has been thinking too much lately, lol....I'm trying to stick with Remeron as my AD so that I can use SJW....IF I have to ditch the Remeron (due to inefficacy) then I'll no doubt have to go back to the ssri's and then WON'T be able to use SJW. Take care LH!
Posted by matthhhh on August 21, 2003, at 20:02:47
In reply to Larry Hoover, SJW Question, posted by McPac on August 19, 2003, at 22:00:16
Anyone notice any benefits of tryptophan over 5 htp. I ve taken 5 htp didnt really do anything for me, but ive heard that tryptophan is an alternative. Does anyone know?
Posted by McPac on August 21, 2003, at 22:49:43
In reply to Re: Larry Hoover, SJW Question, posted by matthhhh on August 21, 2003, at 20:02:47
Lar,
brother Matthhhh is looking for help on this question, could you help him out? Thanks!"Anyone notice any benefits of tryptophan over 5 htp. I ve taken 5 htp didnt really do anything for me, but ive heard that tryptophan is an alternative. Does anyone know?"
Posted by Larry Hoover on August 22, 2003, at 8:05:42
In reply to Larry Hoover, SJW Question, posted by McPac on August 19, 2003, at 22:00:16
> "Now, where did you get those dose numbers from (the combinations of SJW and Remeron)?"
>
> >>>>>>>>>>> From me! lol.OK. I thought maybe I'd been tossing numbers around earlier, and I couldn't think of a situation where I'd have used anything like the ones you used.
> What I was trying to convey was that the general advice I recall hearing/reading was, "If you are on an SSRI then SJW is totally OFF LIMITS.
Without medical supervision, yes.
> But if you are on other types of AD's then you can take both (not the maoi's though)...due to serotonin syndrome (too much serotonin).... so, I thought (big problem! lol) "why would it be worse (i.e. cause too much serotonin) taking a PUNY dose of SJW with a PUNY dose of, say, Zoloft (ssri)---(<2 PUNY doses combined)...
I'm understanding you better now. You're right, there may be safety in the puny + puny situation, but you need medical supervision as they may add together more like 1 + 1 = 4 (that's called synergy).
> how can that be worse than taking, say, a BIG dose of SJW + a BIG dose of a non-ssri med (like Remeron, for example)....
Well, comparing big + big and puny + puny has obvious limitations.
>I didn't see why the latter example wouldn't produce more serotonin than the first....my brain has been thinking too much lately, lol....I'm trying to stick with Remeron as my AD so that I can use SJW....IF I have to ditch the Remeron (due to inefficacy) then I'll no doubt have to go back to the ssri's and then WON'T be able to use SJW. Take care LH!
Well, if Remeron doesn't work, don't ditch it until you've also ramped up the SJW.
Lar
Posted by Larry Hoover on August 22, 2003, at 8:10:05
In reply to Re: Larry Hoover, SJW Question, posted by matthhhh on August 21, 2003, at 20:02:47
> Anyone notice any benefits of tryptophan over 5 htp. I ve taken 5 htp didnt really do anything for me, but ive heard that tryptophan is an alternative. Does anyone know?
If 5-HTP didn't do much, then tryptophan isn't likely to do much, IMHO. There is a major dosage difference, too. Typical 5-HTP caps are 50 mg, whereas I was using Tryptan (prescription tryptophan) at 2,000 mg. I think I get more response from the smaller dose of 5-HTP. Your baody may vary.
Lar
This is the end of the thread.
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