... In wondering why gp's don't even mention St. John's wort for depression?

[Minifingers]

Been feeling very tearful, weird sleep patterns, shouty, negative, hopeless for a few months now for reasons mostly to do with family strife. Recognised that I was tipping back into a depressed state similar to one I was in a few years ago. Went to gp and asked if she could prescribe me a low dose of an AD which wouldn't make me fat and make sex rubbish. She said 'no - they almost all do this to a lot of people, and gave me a prescription for sertraline.

Anyway, after reading up about the side effects and thinking about how horrible it is when you start taking AD's I started to feel very reluctant to take them. Decided instead on the recommendation of a friend to give St. John's wort a go instead after doing a bit of research on its safety and effectiveness. Seems that in Germany it's often prescribed by gps for mild/moderate depression in preference to SSRI's and is considered completely mainstream.

Anyway, low and behold it's worked really well - a week on I feel so much better. Much less tearful, just miles better.

Why don't gps even mention it to those of us who haven't got any specific health reasons not to use it and are not on other non-compatible meds?

I'm amazed by how effective it is - for me as good as fluoxetine which I used a few years ago for a few months when I was depressed. And no unpleasant side effects that I'm aware of (I'm staying out of the sun).

[puffylovett]

Homeopathy and herbalism are two different disciplines

[MrsTerryPratchett]

bunch as puffy says, herbs are not homeopathy. Homeopathy is sugar and water and a heavy dose of reversion to the mean and placebo effect. I will use herbs and Chinese medicine where appropriate. For example the WHO stated at the time that the Chinese preventative for malaria was as good with less side effects than the Western version. Peppermint helps with IBS.

I will also drink water and eat sugar, just not 'prescribed' by a snake oil salesman. Your GP might send you there because s/he knows that you are mainly fine and just need a good listening ear and feeling cured but I don't think the NHS should fund this bollocks.

[KissesBreakingWave]

Yep. Herbalism is using chemicals made in growing plants instead of chemicals made in chemical plants (see what I did there?) while homeopathy is using sugar pills in which you're unlikely to find so much as a single molecule of the 'active' substance, the 'active' substance being one which is supposed to be (but often isn't) a toxin that causes the symptoms (not the disease, the symptoms) you're trying to cure.

Even by the standards of late 18th century medicine it's fucking ridiculous, and bear in mind this was a period where they were using mercury salts as antibiotics, sawing off limbs to prevent infection and thought a good oozy pus was a sign of healing.

[KissesBreakingWave]

And I'm not opposed to herbal remedies, by the way. A lot of them are good. I've had several good strong mugs of herbal stimulants today, and while I was on twenty doses a day of my favoured herbal epinephrine and acetylcholine stimulator, I've cut down a lot because they were wrecking my lungs.

[MrsTerryPratchett]

Too right Kisses I'm enjoying a grape-based depressant this evening.

[Minifingers]

Can I clear something up?

1. I haven't said herbal drugs are always safe. Or implied it.

1. I am not using homeopathy. St. John's wort is not used as a homeopathic preparation as far as I'm aware.

1. Yes, it can be difficult to ascertain an optimal and safe dose because of the way herbal drugs are produced.

1. I have a preference for taking St. John's wort over an SSRI prescribed by my doctor because it appears to be working and the side effects, for me, are massively less unpleasant (I have had fluoxetine before - this is what I'm comparing it to)

1. My belief that SJW can be effective for mild to moderate depression is supported by a Cochrane review of the clinical evidence.

[Minifingers]

Oh, and kisses - re homeopathy: a good placebo is a thing of beauty and a joy forever.

[Logg1e]

Anyone else thinking of the Mitchell and Webb sketch?

[NightFallsFast]

I watched the Mitchell and Webb sketch again last night. I still find it amusing.

[Minifingers]

Brilliant!

[SackAndCrack]

St Johns Wortt lover here too!

Ive used it twice for relatively long periods.

I have to warn though, if you use it for panic attacks it will help but once you start coming off it the PA's will come back so you really need to address the problem with something else and come off the STW ridiculously slowly. Or just keep taking it. Its not good in pregnancy though it can dilate the cervix which isnt what you want.

[Minifingers]

No panic attacks. Just low mood - mild to moderate depression.

I'm amazed how well the SJW has worked.

[SackAndCrack]

Oh no I didnt think you were OP I just thought Id mention it in case someone was reading it and thought it might help. It does help but its just a cover.

I suppose the same could be said for all AD's though in a sense.

[SackAndCrack]

And it works incredibly quickly doesnt it?? I agree there, I was surprised how quickly it worked when I was last on it.

Actually while Im here Im going to suggest something that may not help OP but its worth mentioning because it was mentioned to me when I was last on here feeling bad.

I came on here for very similar reasons, I didnt want to take sertraline but was feeling really low, unhappy, tired, couldnt sleep etc etc.

It was a relatively long thread and one person mentioned anemia and a light bulb went off. Id recently had polyps in my uterus which was causing very heavy periods and then an op which followed a horrendously heavy 12 week long bleed, so of course it was bloody anaemia. I cried with relief, got some. Spatone and in less an a week began to feel better again in every aspect.

So on the very small chance you suffer with heavy periods and might be anaemic which causes almost identical symptoms of depression I figured Id mention it since Im here.

[Minifingers]

Have hideous periods and very low ferritin levels - but although this feeds into the depression it's not the cause this time.

[SackAndCrack]

Are you treating the low ferritin levels?

[Jollyphonics]

Just in case anyone believes the post about pharmaceutical companies having an input in medical training, that is totally untrue.

In fact, drug companies have far less influence than they used to. In the old days doctors were taken out for meals by drug reps and sweet-talked into prescribing that brand instead of others. These days prescribing is far more price-orientated, and is virtually all generic, so the reps don't have the budgets for entertaining any more as it's wasted money for them.

Most localities will have their own recommended formulary, listing the preferred (ie cheaper) options of each drug group. Obviously GPs can prescribe different and more expensive versions, but if they go over their drub budget they'll be in trouble.

I will sometimes mention to patients the various herbal options available to them, but I always add the caveat that they are not licensed conventional medicines and therefore I can't advise as I don't have the training in "alternative" therapies. But generally I would assume that if someone has gone to the trouble of booking an appointment with a doctor, then they've already looked into alternatives and now want something more.

[Jollyphonics]

Drug budget not drub budget!

[PlentyOfPubeGardens]

I use SJW from time to time and find it effective.

The trouble is it's now difficult to find it in a standardised dose. An EU directive a few years ago made it illegal to sell in a standardised dose without a medicinal licence. This proved too expensive for manufacturers (who are generally not the huge pharma companies) so now all you can get hold of is non-standardised 'food supplement' products. Most will have some active ingredients in it but there's no way of telling how much. I stocked up before it disappeared and have a few months' worth squirrelled away should I need it. It goes out of date next summer though so that'll be that. I'd probably still try it in non-standardised form before resorting to SSRIs though.

I would be interested in whether it's still being prescribed in Germany - can they get a standardised dose there? Who's making it and what are the import possibilities? I haven't seen it on the shelves here for about 2 years.

[MyMILisfromHELL]

* Pharmaceutical companies do not make much from selling natural/homeopathic medicines *

That is the ONLY reason

[yegodsandlittlefishes]

The SJW could be working as a placebo and iron tablets are going to have a better long term effect. Anemia can also be a symptom of auto immune diseases which can also cause depression (sometimes intermittent) so worth looking these up and checking to see if you have other symptoms. I don't understand people who will take non regulated herbal remedies but won't find out if their symptoms could be caused by an underlying illness or unhelpful lifestyle choices.

Yes, placebos are a wonderful thing but should be very cheap and not have the kind of fuckquackery homeopathy is mixed up in. My GP prescribes homeopathic remedies and I can get free prescriptions, so it costs me nothing. I will not charge silly amonts of money to the NHS for an industry based on sugar pills and salt powders which have had poisons waved around them!

[barleysugar]

It can cause cataracts, if you spend any time outdoors, make sure you wear good sunglasses.

[yegodsandlittlefishes]

X posted with Pubegarden. Didn't realise there used to be standardised doses available.

I guess that EU law was brought in to bring about proper testing and to bring any effective herbal treatments into the medical domain with tests of active ingredients and controls over what else is in the dose, and for the public to see which ones are not really effective.

[schlurplethepurple]

innisglas what on earth are you on about?

1. aspirin in children can cause Reye's syndrome. Certainly a reason not to prescribe it
   
2. Aspirin (and any other NSAID) should not be prescribed in people with stomach ulcers as it can make those ulcers bleed. It can be very painful and dangerous and is certainly a reason not to prescribe it
   

Pharmaceutical companies do not have any input in medical training.

The list of prescribable medicines in the community is compiled by the medicines management team, pharmacists employed by the CCG (what used to be the PCTs) not by pharmaceutical companies. The list of medicines are to do with cost effectiveness as well as efficacy and safety.

Salaried GP here and I am DEFINITELY not paid per prescription.

OP Im glad the SJW has helped. I do not discuss SJW with patients because NICE does not recommend it as there concerns over appropriate doses, duration of effects, variation in preparations and potential for serious drug interactions.

www.patient.co.uk/doctor/st-johns-wort

[quirrelquarrel]

Because they're not going to get the money for it are they? Pharmaceutical companies won't be too happy if GPs start encouraging people to take a much cheaper and readily available alternative.