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Re: Larry Hoover, SJW Question McPac

Posted by Larry Hoover on August 19, 2003, at 8:07:39

In reply to Larry Hoover, SJW Question, posted by McPac on August 19, 2003, at 5:55:51

> Lar,
> I know I asked you this question one time before (I don't believe I understood your answer at that time).

I don't think you ever asked me just what you're asking here.

>Regarding SJWort, why is it okay to take, for example, 1800 mg a day of SJW along with, say, 60 (or more) mg's of Remeron (high doses of both the SJW & the Remeron)....

Where'd you get those numbers from?

> Yet, someone is NOT supposed to take ANY SJW (even a low dose) with 25 mg of Zoloft (a low dose of that med)?.......Just because Zoloft is called an ssri and Remeron is not?<(they still BOTH effect serotonin, Remeron simply affects norepinephrine also).

The issue is the mechanism. SJW is a serotonin reuptake inhibitor (among other things it does). SSRIs are defined as serotonin reuptake inhibitors. Combining two drugs that do the same thing gives an additive effect. Remeron (mirtazapine) does not block serotonin reuptake. It binds to different components of the serotonin regulatory system altogether.

> Why is the serotonin syndrome risk of the SJW/Zoloft-low dose combo much greater than the high dose SJW/Remeron combo?

That issue is also something that comes out of real-life experience. Some (perhaps foolish) people have taken SSRI/SJW combinations and have gone on to develop serotonin syndrome. Therefore, it's not recommended that others follow in the foolish peoples' footsteps.

>(To take it even further, 2400 mg SJW + 100 mg Remeron (HIGH doses of both) would still be fine but 300 mg SJW + 10 mg Zoloft (PUNY doses of both) would not be allowed?

I don't know where you're getting these dose numbers from. I've used 2400 mg SJW, but I've never seen that dose in medical journals (books yes, journals no). And I didn't combine it with anything.

> That makes no sense yet that seems to be what the going logic is, i.e. SJW + ANY ssri is NOT allowed, YET if a drug is not called an ssri (but still effects serotonin, it just affects something else too) then you can take HIGH doses of both it and SJW?

You have to look at exactly what the different drugs do, not just that they affect serotonergic processes. The specific processes that are affected matter. Some combinations have proven to be safe (you can take Remeron with an SSRI, for example), whereas others have proven to be risky. With all the people in the world struggling with depression, and all the available drugs and herbs and such, someone has probably tried any possible combination you can think of. We only hear about the ones that are dangerous. Then, doctors and scientists try to suggest reasons certain combinations have proven to be dangerous, and warn against any similar combination.

At some point in time, some doctor "did the experiment", and combined Remeron with an SSRI. It may have been dangerous (and I'm sure the subject was closely monitored), but it wasn't. It could have been dangerous. It wasn't.

Manerix (moclobemide) is supposed to work in a way that avoids the tyramine reaction (huge increase in blood pressure), but some people still get it. We only know that because of people showing up in the emergency room. Theory is one thing, but reality is the proof.

>Makes no sense....thanks for any explanation Lar (please, please try to make it clear...my brain is rebelling against complexity right now, lol) As always, much appreciated Lar!!

I hope I helped. Try again, if not.

Lar

 

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poster:Larry Hoover thread:252068
URL: http://www.dr-bob.org/babble/20030818/msgs/252090.html