Posted by Sunnely on July 20, 2000, at 1:40:26
In reply to SSRI's St Johns Wort combination, posted by SueG on July 19, 2000, at 23:09:27
> I'd like to try adding SJW to the Prozac, to see if it helps the anxiety. If i do, what can i expect? I don't want to take benzos for anxiety. I take them for insomnia sometimes now.
> Any comments?
> SuePlease allow me.
I strongly suggest that you do not combine SJW with Prozac or other antidepressants. The occurence of a potentially serious drug interaction called "serotonin syndrome" is not a remote possibility.
Serotonin syndrome is a condition that occurs following an episode of overabundance of serotonin in the brain. The condition is potentially serious and deaths have been reported. It is oftentimes caused by the combination of drugs that stimulate release of serotonin or inhibit its degradation leading to excessive supply of this neurotransmitter (brain chemical).
The symptoms of serotonin syndrome may include: 1) uncontrollable shivering or teeth chattering, 2) incoordination, 3) restlessness, 4) muscle twitchings and or jerking, 5) tremor (rigidity may be present), 6) hyperreflexia (exaggerated nerve reflex), 7) freightened, manic, agitated, confused, 8) fever, 9) rapid heart rate, 10) elevated blood pressure, 11) sweating, 12) diarrhea, and 13) seizures.
The exact mode of action as to how SJW acts as an antidepressant remains unclear. One of the hypotheses is that, it is due to its ability to increase certain brain chemicals such as serotonin and norepinephrine by inhibiting the enzyme that metabolizes them (i.e., like a MAO inhibitor). It was suggested that SJW's antidepressant effect may be related to its hypericin content. However, recent pharmacologic research has focused on hyperforin as the active chemical constituent.
Despite lack of evidence that enzyme (monoamine oxidase) inhibition is truly involved in SJW mode of action, there have been anecdotal reports of serotonin syndrome caused by concurrent intake of SJW and SSRIs. In another related case, acute confusional state was implicated to the concomitant use of loperamide (Immodium), an opioid-based antidiarrheal and SWJ.
It is generally recommended that, until the monoamine oxidase inhibition (MAOI) status of SJW has been clearly defined, to avoid its concurrent use with known MAOIs, SSRIs, tricyclic antidepressants, and other drugs that affect serotonin levels (e.g., tryptophan, psychostimulants, lithium, sumatriptan [Imitrex], tramadol [Ultram], cocaine, and MDMA or Ecstacy). Until further information is available, it would be prudent to avoid the use of SJW and antidepressants in combination. A conservative recommendation would be to wait 2 weeks after stopping SJW before starting antidepressant, and vice-versa (except Prozac).
poster:Sunnely
thread:40989
URL: http://www.dr-bob.org/babble/20000717/msgs/41003.html