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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by Phillipa on August 27, 2010, at 13:41:30
What happens if you combine these together. I don't think you're supposed to do it but my pdoc didn't see why not as she put it? Don't you get serotonin syndrome? Phillipa
Posted by Phillipa on August 27, 2010, at 13:50:05
In reply to St Johns Wort Combined with SSRI's, posted by Phillipa on August 27, 2010, at 13:41:30
Med checker says ST Johns wort is an Maoi A Med? Thought an herb? Phillipa
Posted by morgan miller on August 27, 2010, at 14:06:06
In reply to St Johns Wort Combined with SSRI's, posted by Phillipa on August 27, 2010, at 13:41:30
You may have to lower your SSRI dose and also give a few brands of SJW trials before you find the right one.
I just recently tried to replace Prozac with Perika SJW and I was experiencing pins and needles sensation in my arms and face. I did not have this reaction to New Chapter's SC27 and I took it at the same time I was taking Prozac. Your mile can vary greatly with different brands of SJW. Some of the best brands are Kira, Perika, and New Chapter's SC27 and New Chapter's Serofin.
Posted by linkadge on August 27, 2010, at 14:48:05
In reply to Re: St Johns Wort Combined with SSRI's, posted by morgan miller on August 27, 2010, at 14:06:06
Yeah, the combination is not a good idea. I had serotonin syndrome when combining SJW and celexa.
There is some MAOI like effect with SJW, but also, SJW inhibits the serotoin uptake mechanism differently than SSRIs do. Therefore the effect could be additive.
Linkadge
Posted by bleauberry on August 27, 2010, at 17:03:02
In reply to St Johns Wort Combined with SSRI's, posted by Phillipa on August 27, 2010, at 13:41:30
I combined 600mg SJW with 20mg prozac and 5mg zyprexa for about 2 months. After 2 weeks it was actually surprising me in terms of renewed interest, motivation, and social comfort. I wasn't very depressed prior since prozac and zyprexa did a decent job on that, but I had that typical ssri flatness. SJW brought some life into it and was strongly anti-anhedonia.
The only drawback with SJW is the way it affects the metabolism of other substances. Most of them it will decrease their blood levels, thus difficulty in cancer patients, implant patients, HIV, etc, and such unless blood levels are monitored and adjusted. Some meds will actually see an increase of blood levels, as I experienced with zyprexa. Toward the end of that 2 months I was getting mild but bizarre movement disorders that were clearly antipsychotic in nature....twisting tongue, tics, twitches, etc. I didn't know at the time, but SJW was gradually increasing the blood level of zyprexa by about 300%.
In terms of serotonin syndrome, I dunno, anything is possible, but with a careful approach I doubt it.
I am a fan of SJW, but it has to be kept in perspective...the dose can vary anywhere from 75mg a day to 1800mg a day, it should be a clinical brand such as Kira or Perika with 600mg to 900mg being most common; mileage varies; no guarantees. It has its place. Honestly I think if most people started with it, as in Germany, many would never need a pharmaceutical drug.
It has pros and cons. My doctor had no problem with it.
IMO it is safe to combine with ssris but must be done so in a responsible manner. In other words, the first dose is not 300mg, 600mg or 900mg. It is a quarter of a dose, 75mg. For a few days. And then increase it as needed every 4 days or so in 75mg steps. That is a responsible way to combine it with an ssri as I see it.
Posted by sewerrat on August 28, 2010, at 4:12:14
In reply to Re: St Johns Wort Combined with SSRI's, posted by bleauberry on August 27, 2010, at 17:03:02
That is one of the biggest not to does in meds. Im surprised the poster even wrote it
Posted by ed_uk2010 on August 28, 2010, at 14:16:56
In reply to Re: St Johns Wort Combined with SSRI's, posted by sewerrat on August 28, 2010, at 4:12:14
I tried the SSRI + SJW combination. I experienced no side effects but it wasn't beneficial.
Posted by morgan miller on August 28, 2010, at 21:50:24
In reply to Re: St Johns Wort Combined with SSRI's, posted by sewerrat on August 28, 2010, at 4:12:14
> That is one of the biggest not to does in meds. Im surprised the poster even wrote it
Really not that big of a no no. What's the difference between taking 60 or 80 mg of Prozac and a low dose of SJW with 20 mg of Prozac? People often do take as much as much as 60 mg of Prozac. I've experienced mild symptoms of serotoning syndrome on 200 mg Zoloft, another fairly common dose prescribed by doctors.
Posted by sewerrat on August 29, 2010, at 4:05:45
In reply to Re: St Johns Wort Combined with SSRI's, posted by morgan miller on August 28, 2010, at 21:50:24
Two compleatly different meds, may give you a clue.
Posted by morgan miller on August 29, 2010, at 10:18:14
In reply to Re: St Johns Wort Combined with SSRI's, posted by sewerrat on August 29, 2010, at 4:05:45
> Two compleatly different meds, may give you a clue.
That may be an even better reason to combine them for some different mechanisms that compliment each other. There are people that take SSRIs and Nortriptyline, Parnate or Nardil and Nortriptyline, two SSRIs at low doses, etc. These medications can be combined and may be very effective, just like SJW can be combined with SSRIs when dosage adjustments are made.
Posted by sewerrat on August 29, 2010, at 12:38:29
In reply to Re: St Johns Wort Combined with SSRI's, posted by morgan miller on August 29, 2010, at 10:18:14
lets just say, if you went in a heath store an asked for SJW. An the assistant asked are you on any ssri,s , an you said yes. Do you think she would sell them you.
Posted by morgan miller on August 29, 2010, at 12:46:18
In reply to Re: St Johns Wort Combined with SSRI's, posted by sewerrat on August 29, 2010, at 12:38:29
That's a health food store assistant. My psychiatrist had no problem with me taking a little SJW with Prozac, and I had no negative reactions. Do some real research and you will find that it is ok to combine antidepressants in many instances.
Posted by sewerrat on August 29, 2010, at 14:42:47
In reply to Re: St Johns Wort Combined with SSRI's » sewerrat, posted by morgan miller on August 29, 2010, at 12:46:18
Less is more,?? you are talking about your shrink. Does he also put diesel in his petrol car.
Posted by morgan miller on August 29, 2010, at 15:40:09
In reply to Re: St Johns Wort Combined with SSRI's, posted by sewerrat on August 29, 2010, at 14:42:47
> Less is more,?? you are talking about your shrink. Does he also put diesel in his petrol car.
Bad comparison. Did you get the part where I said that it might be necessary to lower the dose of one antidepressant if another was added?
Less is always ideal, but not always more or better. That would have been like me saying that 100 mg of Zoloft was simply too much and I would have felt better on 25 or 50 mg. The fact was that 100 mg was my sweet spot where I felt the best and experienced no negative side effects.
Like I said, do some hard research, and put a little more thought and consideration into this before you jump to such simple generalized conclusions about treating depression. What is believed in convention is not always the truth.
My psychiatrist did not tell me to take SJW with Prozac, I told him I was going to try it. He decided to lower the dose of Prozac and told me to watch out for any signs of serotonin syndrome. He was not too concerned though. When I was transitioning from Zoloft to Symbyax, he kept me on 100 mg of Zoloft for the first 3 weeks on Symbyax. I was on both Zoloft and Symbyax for just over a month without any problems.
The reality is, serotonin syndrome can happen to anyone that is on an antidepressant alone. Who really knows why some are more prone to it than others. If you are careful about what you do, and pay close attention to how you react, you will be able to keep yourself safe.
If you have read one of the lasts posts here, you would have seen that Scott was experiencing sighs of serotonin syndrome when he replaced Parnate with Nardil, in a regimen that included both Lithium and Nortriptyline. He figured out that Lithium may have been the variable that was pushing his brain into this state. He removed the Lithium and was fine. He is still taking Nardil, Nortriptyline, Lamictal, and Abilify. Oh and btw, if you didn't know, Lamictal probably boosts serotonin through some mechanism as well. That makes 3 medications in his regimen that boost serotonin. Are you going to tell him that he shouldn't be doing this?
Posted by sewerrat on August 30, 2010, at 4:26:22
In reply to Re: St Johns Wort Combined with SSRI's, posted by morgan miller on August 29, 2010, at 15:40:09
Yes ,from what i have read of scotts posts, he takes far to many different meds. His choise of course ,just my opinion.He never seems to get much remission on these cocktails only more side effects. SJW is a MAOI so i hope you have started you new diet to fit in with your abscure choise of meds.Of course i have read every interation with sjw an ad,s , plus it tells you on every leaflet you get with your meds. Your shrink has put you on it your happy.Have a read through other med forum,s an you are a trail blazzer, ie the only one i can find in your serotonine syndrom high rate choise
Posted by SLS on August 30, 2010, at 5:51:33
In reply to Re: St Johns Wort Combined with SSRI's » morgan miller, posted by sewerrat on August 30, 2010, at 4:26:22
> Yes ,from what i have read of scotts posts, he takes far to many different meds.
According to whose paradigm?
> His choise of course ,just my opinion.He never seems to get much remission on these cocktails only more side effects.
Yup. I guess I should stop looking, right? Where is the logic in that?
> SJW is a MAOI so i hope you have started you new diet to fit in with your abscure choise of meds.
I know that there was great debate about this 10 years ago. Can you produce a recent citation that offers evidence of pharmacologically significant MAO inhibition by SJW?
Thanks.
"Early in vitro studies of various components of St. John's Wort extract led to the establishment of MAO inhibition as the possible mechanism for Hypericum's antidepressant effects. [ 10,11 ] However, more recent investigation in this area suggests that, although MAO inhibition does occur with high concentrations of Hypericum constituents, it does not in the amounts found in commercial extracts."
http://www.chiro.org/nutrition/ABSTRACTS/St_Johns_Wort_Clinical_Effects.shtml
Unfortunately, this is not a citation of the original work. It is a paraphrase. I am still trying to find abstracts on Medline that support MAO inhibition as a property of SJW. All I can find are abstracts that refute this notion.
http://www.ncbi.nlm.nih.gov/pubmed/15536462
- Scott
Posted by ed_uk2010 on August 30, 2010, at 7:21:25
In reply to Re: St Johns Wort Combined with SSRI's » sewerrat, posted by SLS on August 30, 2010, at 5:51:33
Well, I knew about the alleged interaction, but I decided to add SJW anyway (to a high dose of an SSRI). Unfortunately, it didn't help. No side effects though, except maybe slight drowsiness. I tried if for about one month. Maybe I should have given it a bit longer.
Posted by sewerrat on August 30, 2010, at 13:06:17
In reply to Re: St Johns Wort Combined with SSRI's, posted by morgan miller on August 29, 2010, at 15:40:09
Posted by SLS on August 30, 2010, at 15:04:35
In reply to There are hundreds of articles like this, posted by sewerrat on August 30, 2010, at 13:06:17
I would like to see a citation offering investigative evidence rather than a paraphrase without references that SJW acts as an antidepressant through MAO inhibition.
- Scott
Posted by ed_uk2010 on August 30, 2010, at 15:44:01
In reply to Re: There are hundreds of articles like this, posted by SLS on August 30, 2010, at 15:04:35
>I would like to see a citation offering investigative evidence rather than a paraphrase without references that SJW acts as an antidepressant through MAO inhibition.
It seems to me that in psychiatry (and perhaps medicine in general), ideas become 'established' through repetition and quoting of others, not due to investigative evidence.
Posted by SLS on August 30, 2010, at 16:06:53
In reply to Re: There are hundreds of articles like this » SLS, posted by ed_uk2010 on August 30, 2010, at 15:44:01
> >I would like to see a citation offering investigative evidence rather than a paraphrase without references that SJW acts as an antidepressant through MAO inhibition.
> It seems to me that in psychiatry (and perhaps medicine in general), ideas become 'established' through repetition and quoting of others, not due to investigative evidence.
Exactly.
- Scott
Posted by morgan miller on August 30, 2010, at 17:04:58
In reply to Re: St Johns Wort Combined with SSRI's » morgan miller, posted by sewerrat on August 30, 2010, at 4:26:22
> Yes ,from what i have read of scotts posts, he takes far to many different meds. His choise of course ,just my opinion.He never seems to get much remission on these cocktails only more side effects. SJW is a MAOI so i hope you have started you new diet to fit in with your abscure choise of meds.Of course i have read every interation with sjw an ad,s , plus it tells you on every leaflet you get with your meds. Your shrink has put you on it your happy.Have a read through other med forum,s an you are a trail blazzer, ie the only one i can find in your serotonine syndrom high rate choise
Please, please do more research before making statements about having to get on a tryptamine free diet because SJW is an MAOI. If SJW has any MAOI action, it is very very week. Millions of people are taking SJW and NEVER have to watch their diet due to concerns over adverse reactions.
Morgan
Posted by morgan miller on August 30, 2010, at 17:08:12
In reply to There are hundreds of articles like this, posted by sewerrat on August 30, 2010, at 13:06:17
Please give us a real legitimate source like a recent pubmed study. I couldn't even access that article you linked. Also, make sure you don't link an article with someone's opinion.
Posted by Phillipa on August 30, 2010, at 21:12:27
In reply to Re: There are hundreds of articles like this, posted by morgan miller on August 30, 2010, at 17:08:12
Just my thought buy if ST Johns Wort sold over the counter was really an maoi would that be legal? As the side effects would be dangerous to those that just see take st johns wort for depression. All I know is it states for mild to moderate depression. My nephew says it takes it and it eliminates anxiety which runs in my family. Any truth in that as couldn't turn up much in googling. Thanks Phillipa
Posted by morgan miller on August 30, 2010, at 21:36:43
In reply to Re: There are hundreds of articles like this, posted by Phillipa on August 30, 2010, at 21:12:27
Good point Phillipa
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