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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 SueG on July 19, 2000, at 23:09:27
I know they are contra-indicated but has anybody ever tried them together?
I was taking SJW for about 2 months prior to starting Prozac 20mg. It definitely made me calmer, but did not lift the depression. I stopped taking SJW two days before starting Prozac. Wouldn't there have still been some SJW in my system?
I am in the 5th week of Prozac now, and it seems that anxiety is now coming into play. I have an eye twitch, I bite my mouth/lips a lot, and last night I hyperventilated (panic attack?) during an argument with my husband. I just wonder that now the SJW has worn off and the Prozac alone has kicked in, that it may be causing these anxiety symptoms.
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?
Sue
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).
Posted by JohnL on July 25, 2000, at 3:55:02
In reply to SSRI's St Johns Wort combination, posted by SueG on July 19, 2000, at 23:09:27
Sue,
I've tried SJW with just about anything and everything. For me, SJW+Prozac was actually a pretty decent mixture. Whether it helps relieve some of the Prozac side effects or not remains to be seen...we're all so different. But I have done the combination and it seemed fine.
The only SSRI combination with SJW I would recommend NOT trying is Paxil+SJW. That's a bad one. But Prozac, Zoloft, Celexa, Effexor, Luvox are all fine.
JohnL
Posted by SueG on July 25, 2000, at 18:32:11
In reply to Re: SSRI's St Johns Wort combination, posted by JohnL on July 25, 2000, at 3:55:02
Hi John
I thought I recalled someone having tried this combination. Why did you try it, and can you tell me what dosages of each you were taking?
Why is Paxil different?
Thanks.
Sue.> Sue,
>
> I've tried SJW with just about anything and everything. For me, SJW+Prozac was actually a pretty decent mixture. Whether it helps relieve some of the Prozac side effects or not remains to be seen...we're all so different. But I have done the combination and it seemed fine.
>
> The only SSRI combination with SJW I would recommend NOT trying is Paxil+SJW. That's a bad one. But Prozac, Zoloft, Celexa, Effexor, Luvox are all fine.
>
> JohnL
Posted by JohnL on July 26, 2000, at 3:32:54
In reply to Re: SSRI's St Johns Wort combination » JohnL, posted by SueG on July 25, 2000, at 18:32:11
> Hi John
> I thought I recalled someone having tried this combination. Why did you try it, and can you tell me what dosages of each you were taking?
> Why is Paxil different?
> Thanks.
> Sue.
>Sue,
Doses were 20mgProzac and 1200mg (300 X 4) SJW. I tried it because Prozac alone was only partially effective. The two together was an improvement, but still not was I was looking for.There have been published reports of an extreme sedation phenomenon that can occur when SJW+Paxil are combined. Not sure why that is. But I can verify it from personal experience. Paxil+SJW, for me, was a two day excursion into the ozone. Talk about a druggy sedated feeling!
John
Posted by alison on September 2, 2000, at 14:22:58
In reply to Re: SSRI's St Johns Wort combination-SueG, posted by JohnL on July 26, 2000, at 3:32:54
Hi All,
I stopped taking Effexor four days ago and started on SJW today
I feel so bad now without the SSRI's that Iv've just taken one Effexor. don't know if I can get by without them.
Any thoughts?
> > I thought I recalled someone having tried this combination. Why did you try it, and can you tell me what dosages of each you were taking?
> > Why is Paxil different?
> > Thanks.
> > Sue.
> >
>
> Sue,
> Doses were 20mgProzac and 1200mg (300 X 4) SJW. I tried it because Prozac alone was only partially effective. The two together was an improvement, but still not was I was looking for.
>
> There have been published reports of an extreme sedation phenomenon that can occur when SJW+Paxil are combined. Not sure why that is. But I can verify it from personal experience. Paxil+SJW, for me, was a two day excursion into the ozone. Talk about a druggy sedated feeling!
> John
Posted by afatchic on September 2, 2000, at 21:46:53
In reply to Re: SSRI's St Johns Wort combination-SueG, posted by alison on September 2, 2000, at 14:22:58
I started taking prescription ADs in 1989 and for me they were a turning point in my life. It was as if I had lived in the dark and someone showed me where the light switch was. A few months ago, I lost my job and all my medical benefits disappeared. I was so depressed, I couldn't get out of bed. My supply of AD was gone and without a job, I had no money for a doctor. This is when I started taking St John's Wort. After 4 weeks, I didn't feel any effects or improvement so I went to the about.com site for depression and read that I needed to take atleast 900 mg a day. (I had only been taking 600 mg). After increasing the dosage, my depression lifted and I felt like rejoining the world. When I initally started taking SJW, I thought of it as a temporary fix until I could get a prescription drug; now SJW is my drug of choice. NO SIDE EFFECTS! I know everyone is different and of course ymmv but I'm so glad I gave SJW a fair trial. FYI, I take 2 Centrum brand SJW 300 mg and 1 One-A-Day brand, Tension and mood (contains SJW, Kava Kava, and B vitamins) every day.
Sandi
> Hi All,
>
> I stopped taking Effexor four days ago and started on SJW today
>
> I feel so bad now without the SSRI's that Iv've just taken one Effexor. don't know if I can get by without them.
>
> Any thoughts?
> > > I thought I recalled someone having tried this combination. Why did you try it, and can you tell me what dosages of each you were taking?
> > > Why is Paxil different?
> > > Thanks.
> > > Sue.
> > >
> >
> > Sue,
> > Doses were 20mgProzac and 1200mg (300 X 4) SJW. I tried it because Prozac alone was only partially effective. The two together was an improvement, but still not was I was looking for.
> >
> > There have been published reports of an extreme sedation phenomenon that can occur when SJW+Paxil are combined. Not sure why that is. But I can verify it from personal experience. Paxil+SJW, for me, was a two day excursion into the ozone. Talk about a druggy sedated feeling!
> > John
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