Posted by: Needtoknow | 2004/01/11

Will St John's Wort help dysthymia or something stronger needed?

I am a 38 year old, single female with dysthymia, this being a mild, ongoing case of depression caused by lack of seretonin in the body. I am intelligent, well-educated, have my own writing business and am relatively attractive.

I have had this condition since I was 16, and since about 26 years old have been on and off Prozac (in more recent years on the equivalent, which is Lilly-fluoxetine). I try not to stay on Prozac for any length of time, as I believe it is VERY strong, it effects the libido (sorry but let's be straight here!), and its safety is not yet known. The last time I went off it was in July this year.

For about 4 months off Lilly-fluoxetine, I was OK, but then the depression/anxiety/anger started settling in again (this is always the pattern). This was exacerbated by the Christmas/New Year period (awful for a single person), and I then started to become VERY depressed (and also angry). I decided to try St John's Wort and have been on it for about 25 days now. It has made zero difference.

My depression is always triggered by emotional problems, and on Friday after a post-New Year week with my on/off boyfriend who lives outside SA, he left for home and I said good-bye to him until who knows when we will see each other again - not a nice feeling. (I may add here I have had a very emotionally traumaitic family life.) As from Friday, due to 'losing' him, I have been feeling chronically depressed - desperate, drowning feeling, - tearful for very little reason - don't know what to do with myself. (Drinking helps temporarily.)

I know you need background to effectively answer a question, thus all this info here, but MY QUESTION IS: IF SOMEONE HAS DYSTHYMIA, CAN THIS SERATONIN DEFICIENCY CONDITION BE EFFECTIVELY TREATED BY St John's Wort (and should I stay on it longer and give it more of a chance?), or do I need to go back to something stronger, such as Prozac?

AS IMPORTANT A QUESTION, my problem is physical, but triggered off by emotional issues, so my NEXT QUESTION IS: DO I NEED TO SEE A PSYCHIATRIST, or will medication alone do the trick? (I saw a Psychologist many, many years ago, and this did not help at all.)

Many thanks for your advice. I appreciate it!


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Our expert says:
Expert ImageCyberShrink

Dear needtoKnow,
Actually ( also for Zeena!) I'm not against st John's Wort, though I believe we need to get it into perspective -- there is some evidence that it can help mild Depressions, but when it does so, it does so by EXACTLY the same sort of cemical effects as does Prozac and its relatives. It isn't helping in some mysterious alternative way, as some of its hawkers try to imply.
What does rile me is the false assertions that herbal remedies are somehow "natural" and inherently better than chemical remedies. They're not natural ( our ancestors did NOT wander round chewing most of these herbs, actually ), and if one means naturally-occurring, well, then the presence of similar chemicals in the Wort and in Prozac, suggests that Prozac would be considered "natural", too. And natural doesn't automatically mean healthy and good for you --- arsenic and strychnine are totally natural, but really not good for us at all.
My main concern about herbal remedies is this. One is that they're always dirty. When you swallow Prozac, you're consuming one single chemical entity, Fluoxetine ; which is easier to evaluate for safety and effectiveness, ans 20 mg of it in one tablet is the same as 20 mg of it in another tablet. When one takes any herb, such as the Wort, though it is likely to contain some of the substance you want, the exact amount is always unpredictable, and is always accompanied by a host of other chemicals. most of which no-one on earth knows anything about. So it is far harder to get reliability of effect, and far harder to know what benefits and risks will be involved. Also, there are rarely proper studies of the efectiveness and safety of herbal remedies, and especally in a country like SA where the health authorities seem to have totally given up any interest in monitoring the accuracy of benefit claims made for products, and in requiring proof of effectiveness and safety, especially when a drug remedy is allowed to pretend to be a "dietary supplement", high caution is the only sensible approach.
I'm puzzled by the inconsistency of people who on the one hand get very anxious about possible harm caused by such technological creations as genetically modified foods ( merely making more eficient a process farmers have used for centuries ) and without any actually existing evidence of harm ; they on the other hand cheerfully devour any form of herbal remedy or "supplement" though very much less is known about their safety, and many of those marketing companies invest little or nothing in appropriate reseach to check this.
Anyhow, to return to your precise question.
Though I have seen sme evidence that the Wort can be effective in treating MILD depression ( not severe Depression) in single episodes, I have not seen any research on its effectiveness in a chronic condition like Dysthymia, or to safety and effectiveness in really long-term use. Also, studies have suggested that in treating Dysthymia with the Prozacs of this world, the same or a higher dose than needed in treating ordinary Depression seems to be useful, but not lower doses. This would suggest that a very low dose Przac like St Johns Wort may not be enough to be helpful.
( BY the way, do remember, if you need Fluoxetine again, to check out as there are other generic forms than Lilly-Fluoxetine, which may be equivalent and even cheaper ).
Serotonin is one of the major chemicals involved in our brain's regulation of our mood ( not the only one ) ; and it seems likely that while all of us are capable of becoming Depressed under the right, or rather the wrong circumstances in terms of life experiences, some of us are more vulnerable, perhaps with an inherently less stable set of mood regulation mechanisms, and are capable of being pushed into a Depression either by purely chemical events, or by less intense or less long-lasting life experiences than others.
Be wary of the drinking, a you know, because though it may help one feel a little better in the short term, especially to the extent that anxiety is part of the picture, it doesn't help in the long-term, is a potent cause of worsening Depression, and may interere with the actions of remedies for Depression.
Where Depression is signifcantly severe and recurrent, modrn expert consensus leans towards considering long-term use of a drug like Fluoxetine. As you've found, there can be a high risk of recurrence if one stops the medication, and apart from the suffering experienced, it can take longer to re-establish control of the condition if one has to start again periodically.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

Our users say:
Posted by: needtoknow | 2004/01/13

To Cybershrink, Zeena and Jitterbug

Many thanks for your advice. I will definitely go back on fluoxetine, and have made an appointment with my GP. I did want to get input from a Psychologist first though regarding the medication, so thank you very much. I know Prozac works for me, so why battle on with St John's Wort, which is not working, simply because of the dubious claims that it is 'natural'. More than 25 days is a long time to wait for results when one is depressed.

In ten days on Prozac/Lilly-fluoxetine, I know I will feel a lot better, and won't be 'drowning' any more!


Reply to needtoknow
Posted by: Jitterbug | 2004/01/12

Wow, Cybershrink - a really professional reply!! Well Done... I have read that Wort has an effect on your skin - making it more sensitive to the sun.

But like the doctor recommends, probably keep taking fluoxitene.

Reply to Jitterbug
Posted by: Zeena | 2004/01/11

This is not for me to answer, but I know the Shrink is against herbal remedies like St John's Wort. I myself think it has a very tiny effect on depression. I know, I've tried it. There is SOME effect, but it is definitely not for someone with a serious problem. Why not consult a psychiatrist?

Reply to Zeena

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