... 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).

[LaGuardia]

OP, it sounds like you need to sort out the causes of your depression rather than the symptoms.

[PlentyOfPubeGardens]

Thank you Aphra, that's really helpful!

[ScarletStar]

I've used St John's Wort in the past and it definitely helped me. The only thing I was careful about was sunburn because it makes you photo-sensitive apparently.

I think some GP's might not recommend it because pharmaceutical companies can't make money from it. I am horribly cynical.

[ummingandahhing]

PlentyOfPubeGardens at the time of conception, my friend was not aware of it being a contraindication and I don't think it was common knowledge then.

[schlurplethepurple]

Scarletscar that is categorically NOT TRUE. GPs don't recommend it as it there doubts over dosage in different preparations and the unknown length of side effects.

FOR THE LAST TIME - GPs are not in cahoots with pharmaceutical companies.

[MellieFitz]

So what is the recommended dose of sjw then? Or isn't there one?

[Ghostsdonttalk]

I haven't read whole thread so apologies if this has been said already. There is no St Johns wart licensed by the MHRA that means if the GP prescribes it as an unlicensed medicine and there is a problem (not very likely but possible) then the GP is personally responsible not the pharmaceutical company because it's not marketed to treat depression.

[ScarletStar]

SORRY MUM.

[hollyisalovelyname]

In Ireland you can only get SJW with a doctor's prescription.

[Caitlin17]

I haven't read all the way through this but I'm a bit shocked it is possible to buy over the counter anything which is so powerful it can interfere with the proper working of a contraceptive pill.

[innisglas]

Caitlin, you can buy aspirin over the counter and it is capable of causing a stomach ulcer to bleed.

[candycoatedwaterdrops]

YABU. I once asked my GP who has a specialist interest in psychiatry and he said one of the reasons is because it interacts with a shocking number of other prescribed drugs.

[Divinity]

The Cochrane Review (2009) the OP mentioned found that studies showed St John's Wort had superior results in those with mild/moderate depression BUT with a caveat to say these results should be treated with caution as the German studies had much better results than studies from other countries. They said that they could not rule out "flawed and reported overoptimistic results" in smaller German studies.

On the side effects they say they are "usually minor and uncommon" but St Johns Wort can significantly compromise other drugs .

They also say that an important part of using St John's Wort is to be sure of the product as quality varies.

So that's why some GPs may be cautious about St John's Wort. If you decide to take it yourself that's your choice but it is not appropriate for everyone to use.

[LookingThroughTheFog]

I'm pretty sure (but admit that I'm using rusty memory) that you can't take SSRIs immediately after SJW.

This would mean that if the SJW works, then that's fine. However, if the mild/moderate depression becomes moderate/severe depression, you have to let the SJW leave your system before you can try SSRIs. So that might be a particularly difficult week or so.

Way back when I was first diagnosed, I was advised against because they needed flexibility to get the medication I needed right. SJW can play havoc with that flexibility.

As it happens, it would never have been suitable for me anyway, but I remain pleased that I didn't self diagnose and medicate for this.

[LookingThroughTheFog]

I do agree that it's not homeopathic though - if it was, it would probably be less of a problem to mix and match!

It's on the same level as aspirin in my head - plant derivative, over the counter medication.

[Caitlin17]

OP your comment about aspirin is irrelevant to this discussion. Thinking of it it's extremely disingenuous to sing the praises of this herb but fail to mention something so significant.

Saying most people aren't on the pill is no defence given this forum is overwhelmingly female and I suspect the majority will be of child bearing age. In the context here that fact should have been mentioned from the outset. Not everyone reads the whole thread.

The aspirin side effect is well known and does not affect all users whereas this side affect seems to apply to all users of hormonal contraception.

[schlurplethepurple]

Thankyou for the apology scarlet :)

[zeebaneighba]

Haven't read the whole thread so apologies if this has been mentioned already. Have been doing a lot of reading about this lately as DH suffer s from severe depression.

SJW not only affects other medication but has extremely bad reactions with anyone at risk of being bipolar. This is why it's not generally prescribed for severe depression as that has much more likelihood of triggering bipolar.

So steer clear if your case is severe, if you have any history whatsoever of manic episodes, or you have a family history of any such tendencies. Even with moderate depression I would recommend a session with a psychiatrist to evaluate your risk before taking SJW.

[NurseyWursey]

I hope anyone with depression goes and seeks appropriate advice before starting SJW.

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
I don't understand how anyone with depression could turn down help because it could potentially make them fat or have a low sex drive. I'd chop my own arms off to get help.

[WidowWadman]

nursey - I don't think it's wrong to consider side effects, and look for options which don't have them on you. An AD which kills the sex drive completely or makes you fat quite possibly is not the right one for you, especially if you then start feeling low about the lack of sex or your weight.

Not every AD will kill every user's sex drive, and different ones work for different people, so the answer is to discuss these issues with the GP, I agree, buying SJW over the counter is probably not the answer in depression severe enough to need medical treatment.

I don't think trivialising these side effects is helpful.

[NurseyWursey]

I'm just of the opinion when you're that depressed you don't give a shining shit what side effects it has. It could turn you day glow yellow and you wouldn't care.

I'm not saying people shouldn't be aware of side effects of medications, of course they should so they can make an informed choice regarding their health, but turning down something to get you out of that dark place just because it might make you fat doesn't ring true of depression to me.

[WidowWadman]

nursey - do you have much experience of your own with anti-depressants, how they work, and how unbelievably more shit they can make you feel if they're not the right one?

To claim that someone who worries about getting fat thanks to their medication can't be properly depressed is ignorant bordering on the offensive.

[NurseyWursey]

I do indeed, most of my life.

I'm not talking about feeling shit, any user of anti-depressants knows how terrible they can make you feel, sickness, dizziness, joint pain etc etc even suicidal.

I'm talking about a depressed person turning down the thing that will make them better just because they don't want to put a bit of weight on?

Sorry but no.

No wonder depression has such a stigma. No wonder some people don't take it seriously.

[candycoatedwaterdrops]

Sorry Nursey but I think you are being ridiculous. I work with people with serious mental illnesses. The drugs come with serious side effects and are a consideration for my clients.

[NurseyWursey]

Weight gain isn't a 'serious side effect'.