... 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).

[candycoatedwaterdrops]

Other side effects are serious, SSRIs have them, as do tricyclics.

[NurseyWursey]

I'm not talking about other side effects as I've already said, I'm talking about weight gain.

I know about anti-depressants on both a professional and personal level, I know they have serious side effects. I don't class weight gain as one of them, and I don't think someone who is depressed would turn down treatment on this basis.

[LEMmingaround]

Im sorry nursey but i disagree with you. I think weight gain is a serious side effect. Since being on citalopram i have put on four stone in weight (this is partly due to a mirena coil and the fact that at that time i had been quite ill with gall stones so had lost 2 stone in weight very quickly). That puts my BMI in the obese category - I do worry how it is affecting my health, i used to feel relatively fit but i am definately struggling now. I have just started a diet.

I wouldnt' be without citalopram, it helps me so much but i don;t consider weight gain as a trivial side effect. Saying that, i'd not touch SjW with a barge pole

[NurseyWursey]

You're bound to worry after, but if you're in a depressive state and completely at the end of your tether which do you chose - getting better and gaining weight or staying in that dark shitty place and keeping your figure?

It's absolutely no competition for me.

This might be down to the fact I've had depressive breakdowns, been on suicide watch etc. It just makes me question if someone is actually depressed and not simply 'low mood' if they're willing to forgo treatment for their figure.

[candycoatedwaterdrops]

People with eating disorders - particularly anorexia - will have a helluva decision deciding on ADs because of weight gain? To be honest, it sounds like you're just trying to tell everyone that your depression was so much worse.

[NurseyWursey]

Obviously people with eating disorders are going to have to have a real think into it, but since I'm not talking about people with eating disorders (and they wouldn't be prescribed certain anti ds ANYWAY..) I'm talking in general.

Yes of course I want to let everyone know how my depression is so much worse I'm saying people may need to rethink if they're actually depressed if the first thing out of their mouths is 'will I gain weight'.

[NurseyWursey]

And I did gain weight, about a stone. But it's a small price to pay for being able to function properly.

[LEMmingaround]

At the weight i am now (15 stone and 5'2") there are certain ADs that my doctor wont even allow me to try (mirtazipine) and i think there would have been questions asked if they felt it would make me put on MORE weight. Its not just about keeping your figure - surely as a nurse, you know that obesity IS serious.

The thing is, there ARE varying levels of depression, it is definately better to choose a natural approach to dealing with it if you possibly can - so, exercise (very good for releasing endorphins) talk therapy, relaxation techniques etc. For some people that isn't enough, for many reasons.

by natural approach i don't mean SJW - i think its pretty niave to think that it isn't a drug - yes its not a REFINED drug, but it has neurological effects and it has side effects, its just not so precise, so i'll give that a miss - if i am going to take something that affects my body i want to be damned sure that someone alot cleverer than me knows exactly what is in it and exactly what side effects i am likely to have. Also the interaction with other drugs is a huge worry, there is quite a list of drugs that interact, it would be quite easy for someone to take this without realising - i mean, how many people actually read those data sheets?

[PlentyOfPubeGardens]

Nursey I find your attitude very dismissive.

everybody is different

[candycoatedwaterdrops]

"I'm saying people may need to rethink if they're actually depressed if the first thing out of their mouths is 'will I gain weight'."

How judgemental! Different things mean a LOT to different people.

[Latara]

Not all SSRIs and SNRIs make you put on weight and ruin your sex drive; it's just a case of finding the right one for you.

I find Venlafaxine works well for me and it doesn't do either of those things luckily; I would hate to put on more weight because for me, being fat is a depressing thing and I already have 2 stone to lose.

[Latara]

I can see Nursey's point too though - if you are severely depressed to the point where you can't even get a glass of water like I was when I was really ill and you are numb to everything, then you don't give a shit about weight, sex or anything else at that point.

If you have milder depression then you may be more concerned about things like weight gain and sex drive because you aren't so numb to things.

[PlentyOfPubeGardens]

Yes SJW is drug - that's why it works (for some people). It's not the only OTC drug that has interactions with other things you may be taking or serious contraindications. People should read the leaflet that comes with their drugs, especially if they are taking other things as well or have any sort of health condition.

Ideally, a GP would be able to prescribe it, having discussed the potential problems and made sure there are no drug clashes. Meanwhile, read the leaflet and the same goes for any other OTC medication you use.

[iamsoannoyed]

YABU

Glad you've found something that works for you.

However, SJW is not licensed for use in the UK, nor is it in any of the guidelines. Therefore if any GP prescribe or recommend it, they would have to take responsibility if anything adverse happened to the patient. Some GPs may chose to take that risk, most won't.

I'm not even sure if the NHS will pay for SJW.

GPs don't get paid for prescribing medications, BTW.

Also, OP you keep mentioning the Cochrane Review and it's positive conclusion re SJW. Firstly- I would seldom recommend relying on one source of information (even if a good one, such as Cochrane review).

Secondly, although the conclusion you quote is true, the Cochrane review does cast some doubts on the validity of the conclusion re the efficacy of SJW- mainly because there are concerns that the German data may be somewhat inaccurate (and is quite different to data from studies from non-German speaking countries, where there is a long tradition of using SJW).

That is something that needs to highlighted and something the OP conveniently failed to mention, while suggesting SJW should be used on the basis of the Cochrane Review's conclusions.

I'm not saying SJW should not be used or does not work- although you do have to be very careful when taking other medications and when you have some medical conditions (same for all meds).

What I am pointing out that the Cochrane review being espoused as evidence GPs should recommends it is slightly more nuanced than OP seems to be aware of/ willing to admit. Advocating SJW using the Cochrane Review, while failing to acknowledge the confounding factor, is not helpful IMO.

[quirrelquarrel]

It just makes me question if someone is actually depressed and not simply 'low mood' if they're willing to forgo treatment for their figure.

People are not always rational. You can fixate on things to the exclusion of thinking logically. If someone's world is crashing down around them but they are thin, and that's important to them normally anyway, then the modicum of control that denying themselves a drug that would change the way they looked that can seem very valuable. Read the Beauty Myth if you really need convincing that people particularly women will very often sacrifice their health to remain acceptable (in this case read: thin) to the world around them.
Things aren't always as they seem, people rarely think with perfect clarity. Gaining weight is very loaded in terms of effect, response from other people etc etc. Whereas the thought that you may perhaps begin to feel better after some time after taking this little pill is nebulous and not automatically reassuring.
When I first went on ADs people kept telling me, oh, isn't it great, in two weeks you could be feeling normal again! But I just couldn't take that seriously. I knew everyone reacted differently. There wasn't a huge chance I'd react well to this. Wouldn't you rather go for the solid option (not gaining weight) rather than the vague ambiguous one (taking ADs) if you were already very scared about what was happening to you and unsure of your thoughts and not trusting yourself?

Just offering a different perspective. It's so much more complicated than that. I personally would be quite scared if I put on a significant amount weight and became obese because I've always been in the underweight BMI category and it's one thing I can rely on!

Persistent low mood can be extremely destructive anyway and I don't appreciate anyone trying to minimise the impact of it, btw.

[LEMmingaround]

"It just makes me question if someone is actually depressed and not simply 'low mood' if they're willing to forgo treatment for their figure."

Comments like this make me despair that anyone actually has any idea about depression and mental health issues.

Many people with depression have severe self esteem issues, this is often tied in with their body image which may well already be low. We live in a society that pushes the ethos down our throat that Slim = good, successful, motivated and Fat = bad, ugly, lazy etc. I think it is unfair and niave to write someone's mental health off because they are concerned about weight gain, remembering that being overweight is not a healthy thing. If a patient is already overweight then a drug that could potentially lead to further weight gain may not be the first option.

The OP has stated herself that she feels that she is only struggling with a mild depression. I don't like SJW myself and if i were going to self treat, id be looking at exercise and relaxation techniques. SSRI ADs are indicated for mild/moderate depression.