I had my family get St. John's Wort for my brothers depression.

[Crocoshark]

St. Johns Wort pros; According to wikipedia it's similarly effective to antidepressants, and other sources say it's good for mild to moderate depression. And it has only half the side effects of modern antidepressants. Also, my family is strongly opposed to psychiatric drugs, so this is a compromise, it's the only antidepressant they'd be willing to try.

St. Johns Wort cons: Obvious lack of quality control. I'm aware of the LA times study showing that the St. Johns Wort you get in stores is wildly varying in potency. And what's worse, most St. Johns Wort supplements are made of the ground up herb which, according to this page http://www.hbcprotocols.com/products-HV280.html,
"does not contain hyperforin. Of even greater concern, grind contain zanthrones found in the stems which are the source of the controversial MAO inhibitors. MAO inhibitors were the number one cause of drug overdoses in the early days of prescription antidepressants. NIH research indicates that St. John's wort must contain both hypericin and hyperforin if is to be an effective mood modulating protocol. Hyperforin is only found in its red and white dots in the flowers"

The problem is, the LA Times listed only one of the brands it looked at.

Is there any list of the brands they tested and how they did?

My mom called me while I was still researching all this and said she was already in the health shop, so I just told her to just buy it than since she was already there.

She got some from a brand called "Natural Factory" which is a canadian based company.

Are there any independant organizations that would list an evaluation of the manufacturing practices of Natural Factory I could look at? Anyway to find out whether this or any other brand is better quality?

'Cause all the LA Times article told me was to not go to Sundown Herbals.

[Tatyana]

It has been ages since I did any reading of the literature about this, but my memory tells me that people need to take at least 1500 mg/day, and most capsules in the UK are around 300 mg.

I will have a peek in the BNF tomorrow night to see if there are any contraindications.

[nmgaucho]

Have him take 1000-2000 mg of Niacin per day, works much better than prescription meds or St John's wort.

[Pantaz]

Originally Posted by nmgaucho

Have him take 1000-2000 mg of Niacin per day, works much better than prescription meds or St John's wort.

"Researchers are also studying the use of vitamin B3 [niacin] in treating ADHD, migraines, dizziness, depression, motion sickness, and alcohol dependence. But there is no evidence that it helps treat any of these conditions."
Source: http://www.umm.edu/altmed/articles/v...-b3-000335.htm

[pakeha]

While we're waiting for a more informed opinion:
http://www.institute-shot.com/St.%20John%27s%20Wort.htm

A question for the OP- How old is your brother?

[nvidiot]

Similar effectiveness for depression as antidepressants?

I doubt it. But even if that were true, I recall reading (fsm knows where) that most antidepressants aren't that effective for mild to moderate depression in the first place.

[Dancing David]

Hi,

SJW has no trial that shows its effectiveness as high as ADs, I tried it for about a month, I found it had a calming effect but gave me headaches.

The main problem is the quality control.

[Michael C]

Originally Posted by nvidiot

Similar effectiveness for depression as antidepressants?

I doubt it. But even if that were true, I recall reading (fsm knows where) that most antidepressants aren't that effective for mild to moderate depression in the first place.

Here are a couple of sources:
http://www.ahrp.org/cms/content/view/658/110/
http://www.futurepundit.com/archives/005034.html

Googling for such terms as antidepressant clinical study or antidepressant meta-analysis should bring up more.

Antidepressants may help a bit but therapy is more likely to bring lasting relief. You need to learn to change certain negative thought patterns. Drugs won't help a learning process much: what you need is practice, guided by a competent therapist.

[jasonpatterson]

St. John's wort isn't known to have many serious side effects on its own, but it does interact strongly with a number of commonly taken medications. Your brother probably isn't on hormonal birth control pills, but if he is taking any other sort of medication it's worth checking out.

[Crocoshark]

Originally Posted by Michael C

Here are a couple of sources:
http://www.ahrp.org/cms/content/view/658/110/
http://www.futurepundit.com/archives/005034.html

Googling for such terms as antidepressant clinical study or antidepressant meta-analysis should bring up more.

Antidepressants may help a bit but therapy is more likely to bring lasting relief. You need to learn to change certain negative thought patterns. Drugs won't help a learning process much: what you need is practice, guided by a competent therapist.

Absolutely agreed. I only reluctantly brought up St. Johns Wort in the first place.

How would you suggest finding the best therapy? Would you reccomend any?

I looked up evidence based suicide prevention strategies and found a type of cognitive behavior therapy that looked like a possibility.

Originally Posted by jasonpatterson

St. John's wort isn't known to have many serious side effects on its own, but it does interact strongly with a number of commonly taken medications. Your brother probably isn't on hormonal birth control pills, but if he is taking any other sort of medication it's worth checking out.

He's taking Zolpidem (under the brand name Ambien). I found one source saying SJW increases its sedative effects (which my brother would like and might be prone to mususe) and another tiny, non-randomized study saying it diminises its effects.

I said he should talk to his doctor about it.

[Silly Green Monkey]

I heard that those taking St John's wort should stay out of the sun as much as possible.

[Cainkane1]

Take him to a psychiatrist. St. Johns wsort is quackery.

[Pixel42]

Originally Posted by Cainkane1

Take him to a psychiatrist. St. Johns wsort is quackery.

There is quite a bit of evidence - not from anecdotes, from clinical trials - that St John's Wort has an effect over and above placebo.

Edzard Ernst has spent 20 years demonstrating that most alternative remedies are ineffective, when he says this one probably does work I pay attention:

http://www.dr-bob.org/tips/split/St-Johns-wort.html

The concerns about long term safety, interaction with other drugs and quality control are, however, valid.

[Michael C]

Originally Posted by Crocoshark

Absolutely agreed. I only reluctantly brought up St. Johns Wort in the first place.

How would you suggest finding the best therapy? Would you reccomend any?

I looked up evidence based suicide prevention strategies and found a type of cognitive behavior therapy that looked like a possibility.

As far as I know, CBT has the best success rate in cases of depression. A lot depends on the choice of therapist, though. A few ideas:

- Call the psychology department of a university, or a large clinic, and ask for a list of therapists who are trained in CBT.
- Look for recommendations from friends who have undergone therapy or who have professional knowledge of it.
- When you have found a few names of therapists who seem to fit the bill, make appointments to see them yourself, explaining the situation. It's fine for a close family member to help in the choice of therapist.
- Make a list of all the questions you want to ask. Describe your brother's case to them: if you're afraid he is in danger of committing suicide, tell them. Ask them how much experience they have of this sort of case.
- If you get the impression that the therapist is sympathetic and that they are really listening to you, there's a good chance that your brother will feel the same way.

[Professor Yaffle]

If he hasn't already, try to persuade him to have a physical check with the docs. Sometimes physical problems like anaemia, or thyroid problems present with similar symptoms to depression.

[Tatyana]

Originally Posted by Crocoshark

Absolutely agreed. I only reluctantly brought up St. Johns Wort in the first place.

How would you suggest finding the best therapy? Would you reccomend any?

I looked up evidence based suicide prevention strategies and found a type of cognitive behavior therapy that looked like a possibility.

He's taking Zolpidem (under the brand name Ambien). I found one source saying SJW increases its sedative effects (which my brother would like and might be prone to mususe) and another tiny, non-randomized study saying it diminises its effects.

I said he should talk to his doctor about it.

This is a fairly good article with a list of the most common contraindications with drugs.

http://www.patient.co.uk/doctor/St-John's-Wort.htm

[Tatyana]

Originally Posted by Professor Yaffle

If he hasn't already, try to persuade him to have a physical check with the docs. Sometimes physical problems like anaemia, or thyroid problems present with similar symptoms to depression.

Hyperparathyroidism as well.

There are a tonne of biochemical abnormalities that can present with depression or psychosis.

[Dancing David]

Originally Posted by Crocoshark

Absolutely agreed. I only reluctantly brought up St. Johns Wort in the first place.

How would you suggest finding the best therapy? Would you reccomend any?

I looked up evidence based suicide prevention strategies and found a type of cognitive behavior therapy that looked like a possibility.

CBT usually shows the best results. However suicidal behavior is something to get help with from professionals. Actual threats with plans are very serious.

Quote:

He's taking Zolpidem (under the brand name Ambien). I found one source saying SJW increases its sedative effects (which my brother would like and might be prone to mususe) and another tiny, non-randomized study saying it diminises its effects.

I said he should talk to his doctor about it.

If they are taking zolpidem then they need an evaluation for why their sleep is so disturbed. It can be a long process with some trial and error.

[23_Tauri]

Originally Posted by Silly Green Monkey

I heard that those taking St John's wort should stay out of the sun as much as possible.

Which considering many cases of mild depression can be alleviated by a dose of the sunny stuff, seems somewhat unfortunate.

[Crocoshark]

Some good responses and thoughts, but nobody's actually addressed my original question, which was about finding a St. Johns Wort with assured quality control

Is there any list or website I can look at?

How does this company look to you guys?
http://www.amoryn.com/formula_assured.html

[sleepy_lioness]

Here's my anecdote, FWIW: I tried SJW for a month or two, it made me drowsy and confused and gave me prickly skin, especially in sunlight. It didn't appear to have much, if any, effect on my mood. And was nowhere near as good as Zoloft. I don't have any ideas about checking up on potency, purity etc, sorry.

The thing that really helped in the long term was CBT, so I second the recommendation for that. Ideally your brother should see a competent physician for a proper physical and mental check, and he might need antidepressants. But that may not be practical, as you hint. If your family are opposed to psychiatric drugs, might it be worth giving therapy a try?

[Sackage]

I've rarely been more suicidal in my life than when on SJW. It got worse every single day. After a couple weeks, the only way I could relax enough to get to sleep was to imagine I was lying in the fetal position while a group of people kicked me in the head until I died.

After a particularly bad night, I just threw the rest of the bottle away. I went back on real antidepressants and I'm fine now.

[ferj]

I took st johns wort for only 3 days and it made my skin sensitive to sunlight. I got sun spots on my hands and face and looked like I had a tan even in weak sunlight. This was at least 10 years ago so the effects have worn off but are still noticeable. I used to have naturally clear skin but not after SJW.

[TubbaBlubba]

Originally Posted by Michael C

Antidepressants may help a bit but therapy is more likely to bring lasting relief. You need to learn to change certain negative thought patterns. Drugs won't help a learning process much: what you need is practice, guided by a competent therapist.

There's always the problem, however, that people who would be willing to partake in therapy would be those that are "better" and more likely to recover anyway. The worst wouldn't be likely to partake in therapy in any meaningful manner.

[JeanFromBNA]

Originally Posted by Crocoshark

Some good responses and thoughts, but nobody's actually addressed my original question, which was about finding a St. Johns Wort with assured quality control

Is there any list or website I can look at?

How does this company look to you guys?
http://www.amoryn.com/formula_assured.html

St. John's Wort in the U.S. is an herbal dietary supplement, and not subject to FDA approval nor quality control. There are no assurances.

I would challenge your family's idea that "psychiatric drugs" are not acceptable, yet an uncomfirmed herbal remedy and a prescription sleep aid are okay to use. Dancing David can speak to this topic more eloquently than I, but in my opinion, St. John's Wort, as you propose to use it, is a psychiatric drug.

Anti-depressants and St. John's Wort are intended to be mood elevators. Strenuous exercise can also accomplish this, if you are stuck on natural. At least you will know what you are getting, and you won't have to shell out hard-earned cash for a bottle of questionable contents.

[Dancing David]

Originally Posted by Crocoshark

Some good responses and thoughts, but nobody's actually addressed my original question, which was about finding a St. Johns Wort with assured quality control

Is there any list or website I can look at?

How does this company look to you guys?
http://www.amoryn.com/formula_assured.html

It is unregulated so dosage and quality would be manufacturer's information only.

[Sackage]

Originally Posted by JeanFromBNA

Anti-depressants and St. John's Wort are intended to be mood elevators. Strenuous exercise can also accomplish this, if you are stuck on natural.

I haven't found this to be true for me. In fact, if anything, there's a negative correlation. The last time I was really in shape, I was also really depressed.

[RandomElement]

I took St John's Wort for many months a decade or so ago. As I did not keep a personal log on my mood, I did not notice any changes, but two different friends who were unaware I was taking anything both commented on my improved mood.

Assuming this was a real result, I would say it takes 3- 4 weeks to have a noticable effect. BTW, there is no sense of being drugged as some report on pharmaceuticals such as Effexor.

[Jr1985]

Originally Posted by Cainkane1

Take him to a psychiatrist. St. Johns wsort is quackery.

Lolz. Psychiatrists don't even know what actually causes depression (it's not low serotonin), or why the drugs work (assuming they actually do) and sometimes the side effects are worse than the disease it's used to treat. Eg SSRI's increasing risk of suicide, antipsychotics causing diabetes and tardive dyskinesia.

Although I am slightly biased. My first psychiatrist completely dismissed the idea that I have Aspergers, which was then diagnosed by a psychologist after months of assessments. Recently I came off my antidepressants (effexor) - my psychiatrist said I could taper over one month, which is what I did. I had horrific anxiety, which was much worse than any I've experienced before. I also had burning nerves, inner sense of restlessness (akathisia?), suicidal thoughts, loss of appetite, etc. I reinstates the Effexor and felt better after 2 weeks. The psychiatrist insisted it was my "old symptoms" resurfacing, even though it felt nothing like my "old symptoms". I was put on it for social anxiety and depression, not akathisia and burning nerves, etc! It was pretty obvious to me that it was withdrawal... Sorry, SSRI Discontinuation Syndrome, which is completely different from withdrawal, even though a study found the symptoms to be identical to benzo withdrawal...

I joined an online peer support group for people experiencing antidepressant withdrawal. Some of those people have suffered for 2+ years after cold turkeying Paxil/Effexor (two of the worst offenders due to short half-lives). Most of us get no real support from our doctors, who refuse to acknowledge ssri withdrawal exists or is as bad as it really is. I imagine the same thing happened with benzo's.

Of course, it's anecdotal, but you could argue the evidence the drug companies rely on in ssri clinical trials is also anecdotal - you still have to ask the patient how they feel (subjective). Although, I admit I probably would have thought they were nuts if I hadnt experienced it for myself.

Anyway, sorry for that rant but I guess I'm trying to say I wouldnt recommend the antidepressants. CBT is very good, I have done it myself and found it much more beneficial than the drugs, which basically numb all of your emotions (including happiness). I believe it really helped with my social anxiety, to the extent where I don't really have it anymore.

[Agatha]

Originally Posted by ferj

I took st johns wort for only 3 days and it made my skin sensitive to sunlight. I got sun spots on my hands and face and looked like I had a tan even in weak sunlight. This was at least 10 years ago so the effects have worn off but are still noticeable. I used to have naturally clear skin but not after SJW.

Likewise. I have permanent sun sensitivity after taking St John's Wort over fifteen years ago; I get a itchy, uncomfortable rash like nettlerash on any exposed areas which I never used to get. I can't go outside in the sun unless fully covered in high-factor suncream, long sleeves, and long skirt or trousers, I can't swim in the sea or in a pool on holiday unless I have access to antihistamines to damp down the skin reaction. Taking St John's Wort all those years ago continues to really damage my quality of life every summertime.

I would not recommend it unless prescribed by a doctor who monitors the patient for side effects. There is no way to tell what quality or dosage is in the pills other than what the manufacturer chooses to disclose, there's no quality control. It would be better for your brother to see a GP to rule out any physiological causes for his symptoms, and for him to follow the GP's advice with regards to medication, CBT, and/or counselling.

[JeanFromBNA]

Originally Posted by Sackage

I haven't found this to be true for me. In fact, if anything, there's a negative correlation. The last time I was really in shape, I was also really depressed.

I was referring to the release of endorphins after strenuous exercise, which is an established correlation. I have no idea if people who are physically fit are less depressed.

[Sackage]

Originally Posted by JeanFromBNA

I was referring to the release of endorphins after strenuous exercise, which is an established correlation. I have no idea if people who are physically fit are less depressed.

I guess I should've specified that I was doing a lot of strenuous exercise at the time.

(What? You don't know me personally and don't know that strenuous exercise is necessary to keep me from being a blob of jelly? For shame. )

[Dancing David]

Originally Posted by Jr1985

Lolz. Psychiatrists don't even know what actually causes depression (it's not low serotonin), or why the drugs work (assuming they actually do) and sometimes the side effects are worse than the disease it's used to treat. Eg SSRI's increasing risk of suicide, antipsychotics causing diabetes and tardive dyskinesia.

And the reason SSRI's increase the risk of suicide?
An individual has suicidal ideation and low energy and low motivation and energy. Give them a medication which increases energy and motivation and they can still have suicidal ideation. The same is true of TCAs.

The side effects of all medications are an issue, if you met anyone with untreated psychosis, you would know that the cost benefit ration is to be considered.

Quote:

Although I am slightly biased. My first psychiatrist completely dismissed the idea that I have Aspergers, which was then diagnosed by a psychologist after months of assessments.

That is too bad, it is a tough differential diagnosis and hard to gather in the history, what was your reason for presentation. ASD is a hard one to catch in an initial interview.

Quote:

Recently I came off my antidepressants (effexor) - my psychiatrist said I could taper over one month, which is what I did. I had horrific anxiety, which was much worse than any I've experienced before. I also had burning nerves, inner sense of restlessness (akathisia?), suicidal thoughts, loss of appetite, etc. I reinstates the Effexor and felt better after 2 weeks. The psychiatrist insisted it was my "old symptoms" resurfacing, even though it felt nothing like my "old symptoms". I was put on it for social anxiety and depression, not akathisia and burning nerves, etc! It was pretty obvious to me that it was withdrawal...

Obvious to you does not withdrawal make, it could be, but that is unlikely. I would suggest a tapered dose if you really want to get off the medication. Restlessness is not the same as akathesia, akasthesia is again a tough differential to make.

And it is not the re-emergence of 'old symptoms' it is the emergence of symptoms. Had it been withdrawal then you would likely have had relief at the first dose.

Quote:

Sorry, SSRI Discontinuation Syndrome, which is completely different from withdrawal, even though a study found the symptoms to be identical to benzo withdrawal...

Data evidence ?

Quote:

I joined an online peer support group for people experiencing antidepressant withdrawal. Some of those people have suffered for 2+ years after cold turkeying Paxil/Effexor (two of the worst offenders due to short half-lives).

I am suspicious of the self sample error potential.

Quote:

Most of us get no real support from our doctors, who refuse to acknowledge ssri withdrawal exists or is as bad as it really is. I imagine the same thing happened with benzo's.

Another assertion without evidence. The addiction profile for benzos is well established.

Sorry 12 weeks for any effect of the medication causing discomfort. maybe your sample is biased, most psychiatrists are aware of it, and the adverse paradoxical side effects when people start treatment. So maybe it is a bias issue in the sample, I suggest you find another doctor.

Quote:

Of course, it's anecdotal, but you could argue the evidence the drug companies rely on in ssri clinical trials is also anecdotal - you still have to ask the patient how they feel (subjective). Although, I admit I probably would have thought they were nuts if I hadnt experienced it for myself.

I am sorry for your increased effects during the discontinuation of the medication, did you try tapering the dose?

Quote:

Anyway, sorry for that rant but I guess I'm trying to say I wouldnt recommend the antidepressants. CBT is very good, I have done it myself and found it much more beneficial than the drugs, which basically numb all of your emotions (including happiness). I believe it really helped with my social anxiety, to the extent where I don't really have it anymore.

Good CBT is a great thing and medications are really not a good first line of treatment.

[Dancing David]

Originally Posted by JeanFromBNA

I was referring to the release of endorphins after strenuous exercise, which is an established correlation. I have no idea if people who are physically fit are less depressed.

And the data set you are looking at? I think you will find that many of us with depression do not find benefit directly from exercise, it is part of a good health routine and highly recommended.

[Professor Yaffle]

Originally Posted by Dancing David

Good CBT is a great thing and medications are really not a good first line of treatment.

Most times I first see a doctor for a depressive episode, I am too ill to get any benefit out of CBT. I need medication to dig me out of the pit a little before I can engage with any kind of therapy.