![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by fattoush on September 11, 2009, at 17:54:52
I am now on a low dose (450 mgs) of Lithium for my bipolar II depression. I could not tolerate any form of anti-depressant. I also could not tolerate AAPs or other anti-convulsants. I am doing better, not suicidal anymore, but am still depressed. I have a friend who swears by St John's Wort. She says that she was jittery at the beginning but that went away. Her depression lifted, her concentration is better. Any bipolars out there with experience with St John's Wort?
Posted by bleauberry on September 13, 2009, at 17:38:41
In reply to St John's Wort on Bipolar II, posted by fattoush on September 11, 2009, at 17:54:52
> I am now on a low dose (450 mgs) of Lithium for my bipolar II depression. I could not tolerate any form of anti-depressant. I also could not tolerate AAPs or other anti-convulsants. I am doing better, not suicidal anymore, but am still depressed. I have a friend who swears by St John's Wort. She says that she was jittery at the beginning but that went away. Her depression lifted, her concentration is better. Any bipolars out there with experience with St John's Wort?
St Johns Wort can be used in bipolar and anecdotally has shown mood stabilization properties, though I am not aware of any scientific studies done on that. One of the most frequent comments by SJW users whether it works on their depression or not is that it levels out their mood swings.
SJW can cause overstimulation at first and can unbalance things, as can anything that impacts the nervous system.
SJW can be more potent than people realize. Just because it is sold like a vitamin doesn't mean it isn't a drug.
The most responsible approach I know of to approach this would be:
1. Start with 75mg for the first 3 days.
2. Increase to 75mg BID the next 4 days.
3. Add 75mg every 3-4 days.
4. Be prepared to wait or adjust depending on what you feel.At a SJW forum, these are some common trends that are seen in their years of archives:
1. The brand matters. For some people, the cheap brands (Spring Valley WalMart, Rite-Aid) work best while the clinical brands (Kira, Perika) don't. With others, the exact opposite scenario happens. When one brand doesn't work or is problematic, one of the next 4 brands tried usually works well. So just as with individual antidepressants, individual brands of SJW are uniquely different. It is important to try multiple brands to find the right one for you.
2. Dose size makes a difference. For some, it is 300mg per day. Others, 600mg or 900mg. Rare, but a few others, up to 1800mg. More is not always better. Less can be better unless proven otherwises in each individual case.
3. Dosing time makes a difference. Some people noticed an ineffective one time morning dose of 900mg became very effective when they switched to taking it at night instead. And the opposite. Some people do best with the entire day's dose all at once, while others find specific times of the day to spread out their doses.
When SJW works, it really works amazingly well. I think what causes a lot of perceived failure with it is the lack of awareness of the above observations of longtime successful users.
Posted by fattoush on September 13, 2009, at 17:45:22
In reply to Re: St John's Wort on Bipolar II, posted by bleauberry on September 13, 2009, at 17:38:41
Thanks a lot, Bleauberry. I guess there's no harm in trying, especially a gradual approach. I would start with inexpensive store brands. That's what my friend uses. She also claimed that it worked within two days for her? Is that commonly reported to your knowledge?
Posted by Ron Hill on September 13, 2009, at 19:30:08
In reply to St John's Wort on Bipolar II, posted by fattoush on September 11, 2009, at 17:54:52
> I am now on a low dose (450 mgs) of Lithium for my bipolar II depression. I could not tolerate any form of anti-depressant.
Have you tried an MAOI like Nardil or Parnate? They have side effects, but they bring great relief to many.
> Any bipolars out there with experience with St John's Wort?
Yes, I tried it many moons ago. But, at 900 mg/day it was only powerful enough to barely scratch the surface of my BPII depression. Plus, SJW completely pooped out in a short period of time.
Lithium is typically useful for BPI patients as a moodstabilizer but, most often, with little or no antidepressant effect. BPII patients typically do best on antiepiletic medications (AEDs).
Please list the AEDs that you have tried and your response to each.
-- Ron
dx: Bipolar II with ultra rapid cycling and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
Posted by fattoush on September 13, 2009, at 19:47:17
In reply to Re: St John's Wort on Bipolar II » fattoush, posted by Ron Hill on September 13, 2009, at 19:30:08
I don't know the comprehensive list of anti-epileptics but here is what I tried. I tried Depakote, which I gave up on because of fatigue, excessive sleepiness, weight gain, and hair loss. I took it a long time ago, more so for my migraines than my depression. I wasn't that depressed back then so I can't comment on its effectiveness on depression. I've also tried Topamax, again for migraine, three separate times. Every time I took Topamax, I went - long story short - crazy. I was jittery, belligerent, teary, suicidal, etc.... The reason I gave it so many tries was its effectiveness as a migraine prophylactic. The latter times I tried it, it was with other meds on board and at lower doses, so I thought I'd have a different reaction. I've tried Lamictal and though I could tell from as soon as 50 mgs that there was some improvement (I felt serene) it was also aggravating my headaches. At just 75 mgs, I felt that my head was stuck in a vice around the clock, seven days a week.
I am quite sure that Lithium has been effective on my depression and I am definitely not BPI. I know that a lot of literature states Lithium as better on mania but many psychiatrists, three I've consulted, believe it is quite effective on depression. I know that there's been support for it doing away with suicidal ideation and that is what happened in my case. I also know that I am better at higher doses, less depressed, but I can't tolerate the higher dose because I get very tired and short of breath.
Posted by Ron Hill on September 13, 2009, at 23:08:07
In reply to Re: St John's Wort on Bipolar II » Ron Hill, posted by fattoush on September 13, 2009, at 19:47:17
Fattoush,
First and foremost, I want to apologize for using over generalizations in my previous post.
> I don't know the comprehensive list of anti-epileptics but here is what I tried.
There are a bunch of them available now. One or more might help you.
> I tried Depakote, which I gave up on because of fatigue, excessive sleepiness, weight gain, and hair loss. I took it a long time ago, more so for my migraines than my depression. I wasn't that depressed back then so I can't comment on its effectiveness on depression.
I hated Depakote for the same reasons you list, plus it made me even more depressed.
> I've also tried Topamax, again for migraine, three separate times. Every time I took Topamax, I went - long story short - crazy. I was jittery, belligerent, teary, suicidal, etc.... The reason I gave it so many tries was its effectiveness as a migraine prophylactic. The latter times I tried it, it was with other meds on board and at lower doses, so I thought I'd have a different reaction.
Your migraine and depression comorbid disorders make your case much more difficult to treat.
From what I've read, and as you know, Topamax is the best med available as a migraine prophylactic. I wish you and your doc could find an add-on medication that would allow you to take topiramate. I'm not a p-doc, but the symptoms you list sounds to me like a lack of serotonin. Did you try any serotoninergic medications as an add-on to Topamax?
The risk of taking an SSRI is that it could switch you into mania or hypomania. The over-the-counter products 5-HTP and SAM-e might help take the edge off of topiramate. But again, there is a risk of inducing mania or hypomania.
What about another approach; have you ever tried a benzodiapine with topiramate?
Have you ever had a hypomanic episode?
> I've tried Lamictal and though I could tell from as soon as 50 mgs that there was some improvement (I felt serene) it was also aggravating my headaches. At just 75 mgs, I felt that my head was stuck in a vice around the clock, seven days a week.
Because of rashes, I have to ramp-up Lamictal at a rate of 5 mg/wk or less. Have you ever tried to very very very slowly ramp-up topiramate and lamotrigine together while keeping the low dose lithium in place? When I say ramp slowly, I mean at a snails pace.
> I am quite sure that Lithium has been effective on my depression and I am definitely not BPI. I know that a lot of literature states Lithium as better on mania but many psychiatrists, three I've consulted, believe it is quite effective on depression. I know that there's been support for it doing away with suicidal ideation and that is what happened in my case.
You are right. I apologize for over generalizing.
> I also know that I am better at higher doses, less depressed, but I can't tolerate the higher dose because I get very tired and short of breath.
Me too; I hated theraputic dosage levels (900 mg/day) of lithium. For me, I never received any antidepressant effect from lithium.
You sound very intelligent. Do you have the time needed to do your own research? If so, do you know some of the web sites to get started on?
I'd like to help you to the extent that I can.
As listed below, I take three AEDs and an MAOI antidepressant.
-- Ron
dx: Bipolar II with ultra rapid cycling and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
Posted by morganator on September 14, 2009, at 3:03:56
In reply to St John's Wort on Bipolar II, posted by fattoush on September 11, 2009, at 17:54:52
If lithium is keeping your mood fairly stable I see no reason why you should not try SJW.
Try to keep things simple. Hopefully your condition only requires two medications, a mood stabilizer and an antidepressant.
If you give us some background, we can better give you suggestions on medications.
Are you seeing a good board certified psychiatrist?
Posted by fattoush on September 14, 2009, at 7:29:07
In reply to Re: St John's Wort on Bipolar II » fattoush, posted by Ron Hill on September 13, 2009, at 23:08:07
It would be irresponsible for me to give Topamax another try, however effective a migraine prophylactic I know it is. Each time I went on, whatever add-ons I'd be taking, I'd gradually become severely depressed, until I' thinking of killing myself.
My Gipolarity was very difficult to diagnose. My long time psychiatrist, who teaches at the APA annual meetings and wrote a book on phycotropic drugs, only clearly realized it when she put me on Emsam 12. We went up to 12 because smaller doses did not work. Then, I was not only still depressed, but I was sexually promiscuous. It was clearly hypomania. I don't know that I can boost Serotonin because of that.
In any case, I'm tired of experimenting and researching. As Morganator said, if I can just add St John's Wort, I'd be grateful.
Posted by fattoush on September 14, 2009, at 7:42:05
In reply to Re: St John's Wort on Bipolar II, posted by morganator on September 14, 2009, at 3:03:56
I've never seen but experienced board-certified psychiatrists. I have been in and out of the psych units and I've been in partial programs, which is why I've seen a few. Mind you, the one who was most clever most quickly was a younger one barely out of residency. I am one whose depression and occasional hypomania only became debilitating issues when environmental factors very traumatic took place. Then I became non-functional and suicidal. Shrinks, for the longest time, treated me as depressed. My hypomania was hardly visible. It took Topamax and Emsam to trigger it. After that, I was sensitized to any SSRI and SNRI and, of course, MAOIs. When and if I took, even 10 mgs of Lexapro or 20 of Celexa, and even if I were on Lamictal or Lithium at the same time, I became more impulsive and agitated than my nature.
I can't do AAPs either. I just don't have it in me to try every drug out there. I'd like to keep it simple as you said. So, if SJW can be a mood stabilizier and an AD, I'll definitely go out and get me some and go gradual with the dosage.
Posted by morganator on September 17, 2009, at 2:41:53
In reply to Re: St John's Wort on Bipolar II » morganator, posted by fattoush on September 14, 2009, at 7:42:05
Good luck, hope it works out for you.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.