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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by survivin bpd on December 23, 2006, at 13:24:45
HI
Has anyone with bipolar 1 succesfully used St John's wort when depressed? I am worried about it precipitating a switch to mania. This is my first depression or mood change at all for 5 or 6 yrs. the depression has appeared due to using olanzapine for chronic insomnia - a try out that went wrong. I don't want to get back on the rollercoaster and dont like the side effects of the antidepressants that i know are ok for me. venlafaxine works ok but wrecks my sleep and i have to watch out for hypermania. mirtazapine also works but makes me angry initially and i pile on the weight.
what do you think about the risks of trying st johns wort?
Maria
Posted by blueberry1 on December 23, 2006, at 13:24:45
In reply to St John's wort and bioplar -recipe for disaster?, posted by survivin bpd on December 22, 2006, at 17:54:34
Any antidepressant, whether it be st johns wort or anything else, can induce a manic reaction in someone bipolar. When I tried sjw along with prozac and zyprexa, I swear I felt awesome for about a month. Then all of a sudden one day I crashed into the depths for no reason at all. And it was pooped out after that, with some half decent days and some real bad days alternating, but the goodness was gone. As I think back on it, I can't decide if it was sjw that actually worked and then pooped out, if it was serotonin sydrome, if it somehow messed with zyprexa, or whether it sparked some cycling. I also felt especially good when I was weaning off it. That was weird.
I can't find it now, but there was a report that sjw increased blood levels of zyprexa by 300% in a patient. Though sjw usually decreases blood levels of many meds, it increased blood levels of zyprexa dramatically. Was that what went wrong with me?
Popular theory says that if you are bipolar the important thing is to have mood stabilizers in place before adding an antidepressant. Sigh. But hey, if you start sjw just keep a daily log of your emotions each day so you can see how and if things are changing.
Posted by ronaldo on December 24, 2006, at 5:18:24
In reply to St John's wort and bioplar -recipe for disaster?, posted by survivin bpd on December 22, 2006, at 17:54:34
Hi Maria
Here is some info about SJW interactions
http://services.ascribe.com/bnf/publications.aspx/bnf/current/index.htm
Hope this helps
Alan
> HI
>
> Has anyone with bipolar 1 succesfully used St John's wort when depressed? I am worried about it precipitating a switch to mania. This is my first depression or mood change at all for 5 or 6 yrs. the depression has appeared due to using olanzapine for chronic insomnia - a try out that went wrong. I don't want to get back on the rollercoaster and dont like the side effects of the antidepressants that i know are ok for me. venlafaxine works ok but wrecks my sleep and i have to watch out for hypermania. mirtazapine also works but makes me angry initially and i pile on the weight.
>
> what do you think about the risks of trying st johns wort?
>
> Maria
Posted by ronaldo on December 24, 2006, at 5:30:38
In reply to St John's wort and bioplar -recipe for disaster?, posted by survivin bpd on December 22, 2006, at 17:54:34
More from the BNF (British National Formulary):
St John’s wort (Hypericum perforatum) is a popular unlicensed herbal remedy for treating mild depression. However, preparations of St John’s wort can induce drug metabolising enzymes and a number of important interactions with conventional drugs have been identified, see Appendix 1 (St John’s wort). The amount of active ingredient can vary between different preparations of St John’s wort and switching from one to another can change the degree of enzyme induction. Furthermore, when a patient stops taking St John’s wort, concentrations of interacting drugs may increase, leading to toxicity. Antidepressants should not be used with St John's wort because of the potential for interaction.
http://services.ascribe.com/bnf/publications.aspx/bnf/current/index.htm
Alan
Seems to me you might just as well see a pdoc on the NHS.
Posted by ronaldo on December 24, 2006, at 12:01:31
In reply to St John's wort and bioplar -recipe for disaster?, posted by survivin bpd on December 22, 2006, at 17:54:34
Reposting this here as it was the other side (psychobabble):
Hello Maria
Its me again, the one who recommended Zyprexa for sleep. I'm sorry. :-(
How does your present depression feel? Is it a heavy, constant, overwhelming, depression? Or is it a lighter, transitory, avoidable, depression? If it is the latter maybe you could tough it out for a few weeks and see if it goes away. A few weeks will give the Zyprexa more time to clear. If it is the former then you have to do something about it. Is St Johns Wort the right something?
Maybe you can research it on the internet to assess your chances of success.
Maybe you can try it gently, cautiously, stopping at the lowest dose that makes you feel well again.
I have never used SJW so I don't know what I am talking about. My advice is born of concern and whatever common sense I may have. Seems to me if you go gently and you're careful you can't do much harm. But I could be wrong. Don't keep on taking it if you don't get any response...you might suddenly get more response than you bargained for.
Wikipedia judging by the look of it has a good article on SJW. See:
http://en.wikipedia.org/wiki/St_Johns_Wort
SJW in your search engine will give you loads of leads.
If all else fails you could go and see a doctor. :-) Or a psychiatrist :-))
Actually why don't you try the above. They may be able to help you. Psychobabble can be a dangerous place to go shopping for a cure - especially with me on the loose.
Just insomnia on its own can induce hypermania in me. I think it will in most manic depressives. A final word, found this by putting SJW and Mania in my search engine:
"People with a history of manic-depressive illness (bipolar disorder) or a less severe condition known as hypomania, should avoid use of St. John’s wort as it may trigger a manic episode.15 16 17 18" http://www.hollandandbarrett.com/vf/healthnotes/HN_live_uk/Herb/St_Johns_Wort.htm
Alan
> HI
>
> Has anyone with bipolar 1 succesfully used St John's wort when depressed? I am worried about it precipitating a switch to mania. This is my first depression or mood change at all for 5 or 6 yrs. the depression has appeared due to using olanzapine for chronic insomnia - a try out that went wrong. I don't want to get back on the rollercoaster and dont like the side effects of the antidepressants that i know are ok for me. venlafaxine works ok but wrecks my sleep and i have to watch out for hypermania. mirtazapine also works but makes me angry initially and i pile on the weight.
>
> what do you think about the risks of trying st johns wort?
>
> Maria
Posted by dessbee on December 24, 2006, at 12:05:57
In reply to St John's wort and bioplar -recipe for disaster?, posted by survivin bpd on December 22, 2006, at 17:54:34
I think you need to consult a psychiatrist immediately. Bipolar disorders are more complex medically since AD can cause hypermania.
Posted by ronaldo on January 3, 2007, at 2:33:15
In reply to St John's wort and bioplar -recipe for disaster?, posted by survivin bpd on December 22, 2006, at 17:54:34
Hello Maria
Its me again, the one who recommended Zyprexa for sleep. I'm sorry. :-(
How does your present depression feel? Is it a heavy, constant, overwhelming, depression? Or is it a lighter, transitory, avoidable, depression? If it is the latter maybe you could tough it out for a few weeks and see if it goes away. A few weeks will give the Zyprexa more time to clear. If it is the former then you have to do something about it. Is St Johns Wort the right something?
Maybe you can research it on the internet to assess your chances of success.
Maybe you can try it gently, cautiously, stopping at the lowest dose that makes you feel well again.
I have never used SJW so I don't know what I am talking about. My advice is born of concern and whatever common sense I may have. Seems to me if you go gently and you're careful you can't do much harm. But I could be wrong. Don't keep on taking it if you don't get any response...you might suddenly get more response than you bargained for.
Wikipedia judging by the look of it has a good article on SJW. See:
http://en.wikipedia.org/wiki/St_Johns_WortSJW in your search engine will give you loads of leads.
If all else fails you could go and see a doctor. :-) Or a psychiatrist :-))
Actually why don't you try the above. They may be able to help you. Psychobabble can be a dangerous place to go shopping for a cure - especially with me on the loose.
Just insomnia on its own can induce hypermania in me. I think it will in most manic depressives. A final word, found this by putting SJW and Mania in my search engine:
"People with a history of manic-depressive illness (bipolar disorder) or a less severe condition known as hypomania, should avoid use of St. John’s wort as it may trigger a manic episode.15 16 17 18" http://www.hollandandbarrett.com/vf/healthnotes/HN_live_uk/Herb/St_Johns_Wort.htm
Alan
> HI
>
> Has anyone with bipolar 1 succesfully used St John's wort when depressed? I am worried about it precipitating a switch to mania. This is my first depression or mood change at all for 5 or 6 yrs. the depression has appeared due to using olanzapine for chronic insomnia - a try out that went wrong. I don't want to get back on the rollercoaster and dont like the side effects of the antidepressants that i know are ok for me. venlafaxine works ok but wrecks my sleep and i have to watch out for hypermania. mirtazapine also works but makes me angry initially and i pile on the weight.
>
> what do you think about the risks of trying st johns wort?
>
> Maria
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