Bipolar Disorder Community
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574118 tn?1305138884

st John's Wort again and again

Apart from bringing mania and/or interacting with some AC's, does any one know the inapplicability of the plant extract to BP specially.

The reason is that all the AD's I use eventually drive me manic. I know why, because i am not on a strong MS. I wish i stay i.e. remain like this, though except it's the AD which needs a change. The pharmacist says it has no side effects. This is expected because nobody knows what is BP like. Also it's produced locally, so its brochure says the same. One pdoc told me it has side effects, of course it has, aspirin does too.

Pls I need a RIGOROUS proof that it should not be used for BP. It has been used for centuries for mild to moderate depression.
I am relying on your kindness to tell me something concrete rather than rumours about it.
23 Responses
1039200 tn?1314915608
Hi adel thought this link might be useful:


It explains a bit more about it, actually there does appear to be a risk according to the data - see what you think.
574118 tn?1305138884

Thank you very much. In fact it happened that i came across this same site this morning and saw nothing special address to bipolars although it says for BP. When you read it it says not suitable because of mania risk. however all antidepressant have the same risk. pdocs of course admit only what they know. this is why i really am skeptical about their opinion and whether i can use it as a last resort. as to seratonin syndrome and the like all of them cause it
thx anyway for your help

Avatar universal
There are other things that can help with depression and raise serotonin levels.  Eating bread can help.  Also eating a small amount of dark chocolate 60% or 70% cocoa daily will lift your mood.  
Also try Omega 3 Fish Oil that has been proven to help bipolar.  
Usually people in depression are low in B12.  I did some research and I saw it on the show "House"  that people that feel guilty alot are low in B12.  I think though you have to be careful because too much of the vitamin makes me manic.  However you can eat a healthy cereal and get that vitamin daily from the cereal.  
Also there is some new research that staying up late at night can cause serotonin loss and lead to depression.  Going to bed earlier will help alleviate that.  
My psychiatrist's nurse said not to do the St. John's wart.  
Oh, and sunshine daily at least half an hour between 8:00 am and 12:00 noon can cure depression.  
These are all things that have helped me feel better, I hope they help you too.  
1039200 tn?1314915608
I can understand you wanting to make a decision based on the best evidence possible. I also think if you dig deep enough you will find both evidence to support and against taking st Johns wort which can sometimes confuse the issue.
You know yourself there is some risk, as there is with just about any antidepressant, but you may have to go with your gut instincts on this one, because everybody reacts to medication in an individual manner anyway,ultimately the choice is yours.
I took st johns wort for several months from a good quality source many years ago, before my BP diagnosis, and I found that it had absolutely no effect - it diddn't send me into mania, or touch the depression.for what it's worth and I had no side effects. The risk of mania wouldn't put me off trying it again if i felt the need, but it wouldn't be high on my personal list of choices for an AD. I hope you get the information you want!
Good luck whatever you chose to do
574118 tn?1305138884
Thank you. your post is very clear

the thing is my depression is mild so i thought it will help me. the slightest AD sent me into mania. Each time i try a new AD, it's ok at the beginning, then i face its complications. I know the list of AD's is long, but i tried at least a quarter of it, my last one they said very mild and here in egypt people take it like water, it's called stablon/coaxil from a french farm. This time it lasted with me for 8 months the longest period, but eventually i started to cycle and mixed states, you understand the reason now. Of course i can have patience and try to exhaust the list first, but i don't believe i will find one void of any complications. an AD is just unsuitable to BP.

The mistake was mine, i was on an AP together with an AD (tricyclic) for 6 years and life was ok, until i decided to stop the meds. I lifted the AP and after 3 months i got my 1st mania, so the radar finally located my BP because prior to this date i was classified OCD. Since then life became difficult in fact very difficult. I started to have mixed states the ups and lows often,... You hear from pdocs that OCD turn into BP, others say either you have affective disorder or not. All the confusion I heard and none really convinced me till now. All i know starting from 2006 my life has become hell. OK i have to accept the new fact. the classical meds are mood stabilizers. Although you read that lithium is safe with some, you encounter people having serious problems. valporex causes liver problems, all of them with no exception. Usually at the beginning you don't feel the issue but only after 10 years or so that the MS cause problems. in my drawrs I keep the british medical health guide as well as the american one, i read and i read but in vain. Yet all agree that lithium is the 1st line mood stabilizer for many reasons one is historical, usually the new trend is to give antipsychotics 1st until you reach stabilization then you switch to lithium. One new trend says lithium + abilify but no 2 pdocs agree on the same meds neither the doses. Perhaps after a few decades that they can find something. The pharm comp in order to spend money on research it has to be rewarding, 1% of the population is not enough. However 50% women warrants spending on cosmetics.

I have given up really, and i have to admit that i shall have to suffer the rest of my life, most of the time my wish is to die.

thank you anyway  
1039200 tn?1314915608
Bipolar depression is a £$%^&&^% !! and combined with rapid cycling can be difficult to treat. This is because it represents a 'moving target'. From what you say, you are sensitive to the effects of antidepressants  and find that they eventually cause you to cycle. I also find antidepressants difficult to tolerate for the same reason - and have tried at least ten different types throughout the years. It poses a real dilemma of what to do for the best.

It sounds like you really need a good mood stabiliser to anchor you first before trying any more. Have you checked the dosage of your current medication to see if you are on a therapeutic level? Do you need to raise the dose? For example when I took 100mg seroquel if sedated me without touching the depression or psychotic symptoms and it wasn't until it was raised to 400mg that it started to work as a mood stabiliser, and even then the depression persisted.

You tell me your depression is mild, adel but if you are having thoughts where you feel you wish to die then that gives me the feeling that it is more serious than you think, and needs to be addressed as such. Try not to dwell on the long term risks of taking medication, perhaps it is better to weigh it up against the short term risk of harm which may be greater?

I can identify with your frustrations because I am in a similar situation. I am hoping a change of AP or additional AC will do the trick so I won't have to add an antidepressant. I really wish you well with this one adel, and I am so sorry you are suffering. I'm sure that you will eventually find a way to slow the cycling and stabilise your mood -you just need to find some inner strength to keep going right now, I find it helps to break it down to get through each day at a time, hour, or even minute at a time when it gets really bad, and of course posting here helps too!  take care

574118 tn?1305138884
it's very kind of you to spare such a long time to write this letter to me.

The no of persons in this forum with BP are counted on the finger, does this mean the others don't know this forum or that perhaps have found ways to get stable.

as to my dose it is subtherapeutic indeed but i can't tolerate higher doses. pdocs tell me there is no such thing as therapeutic it depends on the person. i take 50mg seroquel and keeps me lethargic and doesn't remove depression. i can't understand why a 400mg will do the trick

as to the AC's i tried tegretol and lamictal, the 1st gave me headaches and te 2nd kind of seizure. I feel not at ease with the drugs in general, feeling drowsy and numb and want to vomit, i.e. in short don't tolerate them.

as to seroquel helping in depression, i don't believe it based on my experience irrespective to what astra zenica says. true all atypical do not worsen mania but don't help in depression either from the very definition of antimanic.

than you. i shall try to see a pdoc tonight
1134609 tn?1269275800
I can't site any specific evidence with respect to St. John's Wort and BP disorder, but I did see a neurologist that said to stay away from it.

I had my own experience with St. John's Wort several years ago. I was taking in vitamin supplement; it had high doses of St. John's Wort in it. It made me euphoric (hypomanic- but wasn't diagnosed), and it also started to throw my moods around. When I quit it, it caused even more issues.

The problems with herbal supplements is that they aren't regularly researched because there is very little funding for it. The pharmaceutical companies have no use or them, for obvious reasons, so they don't fund studies. The major universities don't touch them much either; outside of ephedra.. And they didn't start looking into that herbal supplement until professional athletes started dying. And, even then, studies at major Ivy League institutions came back and said that ephedra was safe for weight loss, in short term usage.. So, it is really hit and miss.

In my case, the only herbal supplements that I have found to be safe (for me) are melatonin and Valerian root. The melatonin might be something to look into, if you haven't already as it helps to regulate your Circadian sleep cycle. Your body ups melatonin as night, decreases serotonin and vice versa. Honestly, I have been on every sleep aid out there; Lunesta, Ambien, Trazadone, etc... None of them regulated my sleep cycle and made things worse for me.. Neurontin and melatonin are absolutely the best for me. I sleep eight hours, wake up refreshed, and ready to go. With the other medications, I would wake up depressed because my sleep was off and it would cause me to cycle again.

I will echo the suggestions of other folks around here; take a closer look into mood stabilizers and past the ADs. I haven't found a single BP person that hasn't had some kind of trouble with one AD or another. But, you know your body and your moods, so keep in touch with your pdoc and go from there.
574118 tn?1305138884
thanks for you.
about MS the word itself is vague. Some consider AD's mood stabilizers. It's crazy but true. AP's like abilify and seroquel are spoken about as mood stabilizer, so it isn't only the AC's and lithium. In short no common decision about what can be classified as MS and what that doesn't, except the tranquilizers, even them are sort of.'

neurontin (gabapentin) is considered one of the safest, true but is weak and some said it works well in the beginning then cause anxiety. Of course it may for some and not for others. So no use in saying this med is good or bad like these questions that pop up in the forum asking whether such and such is good or not. It depends on the individual.

However your post is very useful, because here now a neurologist rather than a pdoc who advised to stay away from S.J.W.

Now melatonin i heard about many times in this forum but i know nothing about it, so i shall look into it. But outside sleep cycle what can it offer for BP, that's the important thing. also valerian root I know nothing abt either. So i shall try to read abt them. But you said you found them the safest but then you added (for you) which means out of experience only or it's common fact. Again suppose you use them to get fresh in the morning, what about depression or you don't get it, because that is the big issue. In my view, if there is no depression, then there is no bipolarity, because you don't need to go into the cycle of AD->mania->AP->depression->....

Finally suppose i past the AD, what MS shall i deploy, lithium, or AC's or what then spend months of frustration, trial and error, and spend the night addressing forums and reading of the side effects. Last week, I did a CBC, liver enzymes tests (AST,ALT) , ESR, and found to my great surprize that all are norma,l meaning my drugs are safe: risperidone 1mg, seroquel 50mg, AD (smallest dose), I know all are subtherapeutic, it's like i am leaning on the wall to walk but this is instead of trying to run while being crippled.

Thank you so much for your post you and starbunny
574118 tn?1305138884
ok i read abt melatonin, it's interesting what is in the wikipedia. at least i shall spend time doing some homework.
574118 tn?1305138884
incidentally, is there a blood test to check the ammount of secretion of melatonin by the pirenial gland. it's said its sold on the shelves without prescription like st john's wort i suppose
1039200 tn?1314915608
Wow I had no idea about the melatonin blood tests, it is interesting what bpchrisb said about the valerian and melatonin. I support what he said about the valerian being safe, (for me anyway) I have used it several times and it has a mild sedating effect and could be used as a sleep aid (no mania).

Melatonin I have not tried but it is interesting that one of the newest and currently only melatonergic antidepressant available called agomelatin (valdoxan) by servier works by being a potent agonist at melatonin receptors.

It is also interesting bpchrisb that you find neurontin helpful, because my doctor recently suggested pregabalin which is it's more potent successor, and I am going to discuss this with the pdoc at my mext appointment.

Subtherapeutic doses are fine if they work for you adel there is no need to change! The reason I increased was because I felt I wasn't getting the full benefits. I understand your need to be cautious with medication changes and if you are forced to go 'trial and error' it is only natural you want the odds to be on your side.

Let me know how you get on!
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