... 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).

[MooncupGoddess]

Why can't a pharmaceutical company set up a big SJW research project, standardise the dose, call it a silly name and make megabucks? Given that it seems to work as well as some of the existing anti-depressants it would be an obvious course of action for them.

[PlentyOfPubeGardens]

I think because they couldn't patent it so it wouldn't be worth their while financially, especially as it would be 'in competition' with SSRIs, which are very lucrative indeed.

[Latara]

I found that SSRIs weren't effective enough for my depression in the end, I'm now on high dose SNRI which works on both Seratonin and Noradrenaline receptors in the brain.

I would be interested to know what receptors SJW work on and how they work but I don't have time to read the research. (I couldn't try it anyway cos I have epilepsy).

[ummingandahhing]

I've read the whole thread and in reply to the OP, YABU.

My friend has a 13 year DD because of SJW!

[PlentyOfPubeGardens]

That's a daft argument. It is well known that SJW is not compatible with hormonal contraceptives. If a GP was discussing the option with a patient they would -

a) be aware of contraindications and drug interactions
b) know whether the patient was using hormonal contraception

[DrSnowman]

I have noticed that the OP has chosen to give a long (maybe verbose) list of possible side effects of a drug. These include some which are perfectly horrible and maybe terminal and many which are close to playful. The problem is that she gives no discussion of how common these effects are in a typcial group of people taking the typical dose which is commonly given for depression.

She should give a risk vs reward discussion rather than just a wall of words.

What I think she has done is to try to scare the wits out of you by making the list very long. While some of the effects are quite common many of the effects towards the end of the list are very uncommon.

It is important to bear in mind that all drugs (and plants) have side effects but the degree of side effects which can be tolerated will vary according to the purpose of the drug. For example a cancer cure which only works 90 % of the time and kills off 1 % of the people who take it will sell like hot cakes.

But "Dr Snowman's contraceptive pill" which only fails for 5 out of every 100 women per year will not sell, even if it only kills off 0.001 % of the population.

For those of you who can not recall the list of side effects here it is, I added a few gaps between the groups of side effects to make it more clear.

"Lots of side effects including making pill ineffective."

The majority of adults are not using hormonal birth control.

And have you seen the side effects linked to setraline?

Side-effects

Very common: More than 1 in 10 people who take Sertraline hydrochloride
difficulty sleeping
dry mouth
feeling dizzy
nausea
sexual dysfunction including ejaculation problems or erectile dysfunction. Sexual dysfunction may affect men and women
sleepiness
tiredness
withdrawal symptoms can occur when this medicine is stopped. These include feeling dizzy, paraesthesiae, difficulty sleeping, strange dreams, feeling agitated or anxious, nausea, vomiting, tremors or headaches

Common: More than 1 in 100 people who take Sertraline hydrochloride
appetite gain
chest pain
constipation
decreased libido
depersonalisation
depression
eye or eyesight problems
feeling anxious
feeling nervous
flatulence
hot flushes
increased muscle tone
indigestion
loss of appetite
musclepain or tenderness
nightmares
palpitations
paraesthesiae
pharyngitis
skin rash or rashes
stomachpain
taste changes
teeth grinding
tinnitus
vomiting
yawning

Uncommon: More than 1 in 1000 people who take Sertraline hydrochloride
abnormal thoughts or feelings
apathy
back pain
belching
bleeding problems such as unexplained or easy bruising of the skin or mucous membranes, nose bleed, gastrointestinal bleeding or blood in the urine - some of these bleeding problems may be fatal
breathing difficulties
bronchospasm
changes to weight
chills
cold sweats
convulsions
coordination problems
dry skin
ear pain
euphoria
faster heart rate
fever
flushing
general feeling of being unwell
haemorrhoids
hair loss
hyperactivity
hypoaesthesia
increased salivation
migraine
muscle contractions
muscle twitching
muscle weakness
oesophagitis
osteoarthritis
passing much more urine than usual
raised blood pressure
respiratory tractinfection
rhinitis
speech problems
swallowing difficulties
swelling around the eyes
thirst
tongue problems
unexplained or unexpected increase in muscle movement
urinary problems
urinary retention
urinating more often at night
urticaria
vaginal bleeding - this may be fatal
weakness

Rare: More than 1 in 10,000 people who take Sertraline hydrochloride
abnormal gait
abnormal laboratory test results
abnormal muscle movements or problems controlling muscle movement
abnormal smell of the skin
behavioural problems such as feelings of hostility, anger, aggression, thoughts of committing suicide or suicidal tendencies - you or your carer must seek immediate medical advice if you have behavioural changes, thoughts of committing suicide or have attempted to commit suicide. Thoughts of committing suicide or suicidal behaviour may also occur soon after stopping treatment with Sertraline hydrochloride
blood in the stool
bone problems
certain types of dermatitis
coma
conversion disorder
decreased blood sugar levels
difficulty speaking
dose tolerance decreased
double vision
ear infection
enlargement of the pupil
faster breathing rate
feeling paranoid
galactorrhoea
gastroenteritis
gastrointestinal problems
genital discharge
glaucoma
hair problems
heart attack
heart or circulation problems
heavy or long menstrual periods
hernia
hiccups
high levels of cholesterol in the blood
hypersensitivity to external stimuli such as light, noise and physical contact
hypoventilation
inflammation or infection of the mouth or tongue
injury
irritation or inflammation of the penis and foreskin
irritation or inflammation of the vagina and vulva
lymphadenopathy
melaena
mouth or tongue ulcers
neoplasms
over-sensitivity or fear of light
priapism
psychosis or psychotic-like behaviour or worsening of psychosis or psychotic-like behaviour
semen abnormal
sensory problems
Sertraline hydrochloridedependence
sleep walking
slower heart rate
spasms of the throat
stridor
tooth problems
urinary hesitation
urinary incontinence
urinating less or less often
vasodilation procedure

The frequency of these side-effects is unknown
allergic or anaphylactic reactions
angioedema
blood problems
blood sugar control changes in diabetics - people with diabetes may be advised to adjust their anti-diabetic therapy
breast enlargement in men
cerebrovascular problems
diabetes
extrapyramidal side effects such as hyperactivity, increased muscle tone, abnormal muscle movement, teeth grinding or abnormal gait
face oedema
feeling restless and inability to sit still
increased blood sugar levels
increased pressure in the eye
irregular menstrual periods
itching
jaundice
jointpain
liver problems
lung problems
mania or mania-like behaviour - seek medical advice if you get mania or mania-like behaviour
may affect the results for certain tests
metabolic problems - some metabolic problems may be fatal. Seek medical advice if you develop headaches; concentration or memory problems; weakness; unsteady movement which may lead to falls; hallucinations; fainting or brief loss of consciousness or respiratory arrest
muscle cramps
neuroleptic malignant syndrome or serotonin syndrome - symptoms may include a fever, rigidity, confusion, feeling agitated, sweating excessively or diarrhoea
oedema of the extremities
pancreatitis
photosensitivity skin reaction
seizures - you or your carer must seek medical advice if you have seizures or there is a change in seizure frequencies
Stevens-Johnson syndrome
strange dreams
thyroid problems
toxic epidermal necrolysis"

[Jollyphonics]

Google "dispensing fee". Pharmacists get paid.

[DrSnowman]

I have consulted a book of plant based drugs (Natural Remedies their origins and uses, by Finn Sandberg and Desmond Corrigan) and it does mention St-John's wort.

One of the main compounds in St-John's wart (hyperican) has an anti-HIV effect and causes photosensitivity. It also does alter quite a few parts of human biochemistry.

The book suggests that this herbal drug should not be taken by people taking quite a broad range of drugs and that it does have antidepresent effect.

[schlurplethepurple]

I'm not refusing to acknowledge the Cochrane Review. However until NICE recommend SJW, I will not recommend it. I have a duty of care for my patients to treat them as per recommended evidence based guidelines.

[WidowWadman]

Mooncupgoddess -"Why can't a pharmaceutical company set up a big SJW research project, standardise the dose, call it a silly name and make megabucks?"

But SJW is already marketed - just because the NHS (rightly) doesn't pay for it, it doesn't mean that people don't sell it for a profit. Do you think the blister packs/boxes/bottles you can buy in health shops grow on trees?

[PlentyOfPubeGardens]

You've missed the point of Mooncup's post, Widow.

Nothing you can buy at the moment contains a standardised dose because of an EU directive a few years ago.

[yegodsandlittlefishes]

If there is an ongoing research project currently being funded by a pharma company, it is not necessarily going to be publicised. It is the kind of thing they like to keep under wraps until they are ready to go on sale.

[Oblomov]

Depends how bad the patient's depression is.
If it is very serious then it is possible that AD's and counselling should be given.

If it is more 'struggling', rather than 'classic depression', then sensitive GP, who phrased it properly, could suggest that there are a number of options, "what do you think might be best of":
AD, CBT, counselling, John Wort, Bach Rescue Remedy etc etc.

[IfNotNowThenWhen]

SJW works really quickly on me-I would say within a week, and I am not suggestible at all.
Citalopram takes about 3 weeks to kick in , but has similar positive effect, albeit with a lot of naseau and headaches initially. I don't get any side effects from SJW.
Unfortunately, SJW only lasts about 3 months, before it stops working for me (but then that happens with conventional SSRI's too).

[Minifingers]

Dr Snowman - my GP didn't talk to me about the side effects of sertraline. That list comes from netdoctor.

[AphraBane]

"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."

Yes, it's still prescribed here in Germany from any GP. The standardised dose is 900 mg daily taken as a single tablet. Lower dosages are available without prescription as a food supplement, but only this one 900mg dose can be prescribed and is regarded as the medically effective level. It's made by Steigerwald and the brand name is Laif 900. Because it's an approved drug I only pay the standard 5 euro prescription fee for a pack of 100 which lasts about 3 months, and I would generally use 2 boxes a year in the winter months only. I don't get real depression as such, but do feel rather bleugghh from the lack of daylight between October and March - for that kind of thing it works really well.

No idea about whether it can be imported, but you might try contacting the company directly.

It usually takes 2 to 3 weeks to get up to the full effectiveness in October, but I don't find I need to wean myself off them because I automatically start feeling better anyway once the days get longer in spring. I've never noticed any side effects (but then I don't take the pill and am not sensitive to sunlight) - but I know my mum was explicitly banned from taking it after her heart valve transplant because it could have interfered with her meds. However, she was equally banned from drinking cranberry juice, so trying to say that SJW is dangerous for that reason only is silly.

I think it's always worth trying out SJW for mild depression if:

• you are being totally honest to yourself that your symptoms are indeed mild and not becoming more serious,
  

-if you do start deteriorating you should go to your GP and make a realistic decision about whether you should go onto ADs instead,

• and always check with your doctor first that SJW is not contra-indicated by any other medication.

[Piscivorus]

quirrel Pharmacies get paid, for each item on prescription, the cost of the drug plus a dispensing fee, a container cost if appropriate and various other charges in certain circumstances. Why would pharmacies dispense them if they didn't make money from doing it? The NHS also pays for various other services such as medicines use reviews, etc

[JGK0]

Of all the "natural remedies" on the market, St. Johns Wort interacts (adversely) with the vast majority of modern pharmaceuticals

www.rxlist.com/st_johns_wort-page3/supplements.htm

[LEMmingaround]

I wouldn't touch it with a barge pole, yes it does a similar thing to SSRI anti-depressants but its going to have all sorts of other unpurified "stuff" in it. That stuff will have its own side effects and it wont have undergone the vigorous research that the medical drugs will have which is probably why there isn't such an extensive list of side effects. You listed the side effects of sertraline, but you did not state that some of those will be described as rare and have to be listed even if they have only been recorded once.

[Viviennemary]

Every drug has side effects. Or so I was told. I think the main reason is that it hasn't been put through the right number of clinical trials.

[JennyCalendar]

About 10 years ago, my GP suggested it. She said that most people don't take a high enough dose of it to be effective, so she wrote down the amount you should take. Can't remember how much she said now, but it was rather a lot.

[LEMmingaround]

Also i think, if you want medication go to your GP, if you want herbal remedies, go to the health food shop or a homeopath. i am not sure why you would expect a herbal remedy from your GP, i'd be a bit pissed off if i went with the flu and they suggested some honey and lemon and echinacia (sp!). If i want that, i'll visit the health food shop.

I am on citalopram which is in the same group of drugs as sertraline. I am overweight but i actually blame the mirena for that. I can tell you that there is bugger all wrong with my sex life :) oh, and it works! I have had side effects and i felt worse when i first started taking them.

What i expect from a GP if i go to them with depression is options and a frank discussion of pros and cons. Most GPs ime will try and push you to help yourself before you have ADs. So they will recommend exercise and talk therapy before ADs, but sometimes you need the ADs before you can get to a place where you can consider the other two.

I am not poo pooing herbal remedies, i think they have their place but it worries me that this stuff can be brought over the counter by people without any training just because their cousins friend tried it and found tht it worked. At least a doctor has been to medical school for 5 years and has years of experience. I think its called supplementary medicine for a reason.

[LEMmingaround]

Vivienne, you are right - paracetemol has a huge list of side effects

[TapirsCaperWithReindeers]

Just as an aside - a well known national pharmacy chain makes just over £1.30 profit on each item on a prescription, and that is after medicine and staff costs have been taken into account.

[WidowWadman]

German GPs might still be prescribing it, but one should bear in mind that German GPs will prescribe any old bunkum a lot of things a British GP wouldn't. Not so much because German medicine is so advanced, but because it has an insurance based healthcare system, and Germans are generally pretty obsessed with taking stuff, especially if it's "natural".

Stuff which you wouldn't even bother to see your GP for over here, but just pull yourself together with a hot toddy is treated with a plethora of stuff, some of which will be paid for by some insurances, others will be happily be bought by the patient because it's what Herr or Frau Dokter has said is needed.