Herbal weirdness

January 18, 2010 9:38 AM

Am I high on St. John's wort?

Six months ago I was diagnosed with mild depression and high anxiety. It was mostly situational after a lot of big life events that didn't really quit until christmas. At the time I was offered antidepressants but I didn't want to go that route just yet so I opted for therapy instead. It helped a lot, but over christmas I started to feel low again, especially in the dark nights. The doctor had given me a leaflet about depression and that said some people have found St. John's wort effective so I thought I'd give it a try. I got some over the counter at chainstore chemist - one dose of 425mg a day - and tried it. I didn't really expect much - it can't be that strong if it's 0TC right? But a day after the first dose I actually felt calmer. A week later I was feeling great and so laid back that work was a breeze and even the neighbours clattering around upstairs didn't bother me a jot (normally I'd be banging on the walls!). I was astonished - I hadn't realised how anxious I had been.

I did think it might be placebo, but hey, if it works fair enough. However, over the last couple of days I've been feeling a bit weird. Yesterday I was slightly manic but I put it down to being out in the first sunshine of many weeks. Today I feel like I'm crawling out of my skin a bit - still really calm but, I don't really know how to describe it - just..'intense' - sort of like everything's been dialled up to 12 on the physical sensation scale. I feel slightly buzzed, a bit dizzy and my fingers are tingly. It's not pleasant.

I've made an appointment to see my doctor in a couple of days but I'm feeling freaked out - can I just stop taking this stuff? Should I try a lower dose? Am I imaging things? I was feeling really great for the first time in ages,and I really don't want to go the full pharmaceutical route if I can manage this in other ways, but I don't want to do myself a mischief in the process! Has anyone had a similar reaction? What did you do? (anon for work reasons etc).

posted by anonymous to Health & Fitness (17 answers total)

At the time I was offered antidepressants but I didn't want to go that route just yet

You didn't want to take medication for your depression, and yet here you are taking medication for your depression. The only difference is that the potency and dosage of St. John's wort are totally unregulated.

Anti-depressant medication works best when administered by a psychiatrist who monitors the effect and impact of each change in dosage, and when accompanied by talk therapy. Taking St. John's wort is taking a chemically active medication whose compounding isn't regulated; you're also not talking about your dosage and side effects with the doctor.

You can just stop taking it--there's no discontinuation effect with St. John's wort--and talk with your doctor. If you would rather take St. John's wort than another medication, your doctor should be aware of which are the more reliable compounds (in terms of potency) and what dosage would be a good starting point.
posted by Sidhedevil at 9:52 AM on January 18, 2010 [4 favorites]

I don't think it's placebo. St. John's wort is a known natural feel-good herb. But just as Western meds should be taken under the guidance of a doctor, so too should holistic remedies. I would urge you to 1) consult a psychiatrist/therapist, 2) see a naturopath.

St. John's wort can be a really great solution for many folks, but just because it's natural doesn't mean it's something you just want to fuck around with.
posted by Lutoslawski at 10:08 AM on January 18, 2010 [1 favorite]

Is there any history of bipolar disease in your family? (Could also be termed manic-depression.) Any anti-depression medication, including SJW, can trigger mania in a person that is pre-disposed to bipolar disease. (So can sleep disturbance, FWIW. If you have had a night of little sleep recently, this could have also triggered these feelings.)

On the other hand, it could be Serotonin Syndrome--the symptoms you are describing don't really strike me as mania per se. You are telling us about more physical symptoms, and not the racing thoughts, grandiose ideas, and less need for sleep as I usually associate with mania. I know nothing about serotonin syndrome, but you should attend to it immediately, according to the internets.

Either way, can you put a call in to your doc before the appointment?
posted by thebrokedown at 10:09 AM on January 18, 2010

St John's wort has a list of interactions as long as your arm. If you're on any other medication you need to check out with your doctor whether it interacts ASAP.

As Sidhedevil says - you are going down the "the full pharmaceutical route" by using St John's Wort. Yes, it is effective - but it's effective because it has effects on your brain like any other psychiatric drug.
posted by Coobeastie at 10:14 AM on January 18, 2010 [1 favorite]

St John's wort has a list of interactions as long as your arm. If you're on any other medication you need to check out with your doctor whether it interacts ASAP.

Yes, and this. I take a good dose of SSRI's and I was told explicitly not to take any St. John's wort because of how it interacts with the SSRI's. This should be a clue to its potential potency and the degree of necessity with which you need to consult medical professionals.
posted by Lutoslawski at 10:30 AM on January 18, 2010

St John's Wort is a psychoactive drug. The fact that it's sold over the counter in health food stores doesn't make that less true. Please see your doctor to talk about the effects that taking this drug might have on your health. And discuss with her/him whether this or a different drug might help you with fewer side effects. But please, don't kid yourself that you're not taking a psychoative drug just because it's "herbal." You're doing the same thing as if you were taking prescribed Prozac; you're just doing it without the benefit of medical supervision.
posted by decathecting at 10:47 AM on January 18, 2010

Not to discount the more serious possibilities above, but "slightly buzzed, a bit dizzy and my fingers are tingly" is how I feel when I hyperventilate. You might take a look at your breathing and try exhaling for longer than you inhale. Blowing the air out through pursed lips can also slow down your breathing.

I agree that St. John's wort is a drug with poor quality control and that it's probably a good idea for you to stop taking it and see if you calm down. If you do decide to try it again sometime, I'd recommend a standardized extract, where supposedly the potency is verified.
posted by PatoPata at 10:55 AM on January 18, 2010

So, a slightly different take on this... I took St John's Wort for a while, and I have had a similar reaction to what you describe (also to some fish oil/evening primrose oil capsules). In me what it seems to indicate is that I need to cut back on the whatever-it-is. I get sensitised to things and/or some ingredient builds up in my system to an extent that I react to it - or, possibly, whatever I'm lacking has gotten closer to the level it's supposed to be, so I don't need as much Factor X ...? (just guessing.) I found the St John's Wort and the fish oil useful enough that it was worth sticking with them and just paying attention to my reaction so I could change the dosage as required (up as well as down, and this is something you'd be doing with a prescription med as well, I think? Not randomly on your own, of course, but with your doc...?). I think I went down to one every other day as I was coming off it. (I still take the fish oil every winter, but come off it once I start getting symptoms sort of like you describe, cos it means I'm fine til the next autumn.)

And adding to the other comments about mixing SJW with SSRIs - my doctors told me I could just stop taking SJW and start taking Effexor, no need to wind down or wait for SJW to clear my system. Whether that's objectively true or not, I had a horrible reaction to that. Just a data point.

And also - I think not waiting to see your doctor is a good suggestion. They'd want you to call them about this, I suspect.
posted by magdalenstreetladies at 11:12 AM on January 18, 2010

But a day after the first dose I actually felt calmer.

SJW's effectiveness is much like an SSRI. It takes a couple of weeks to do anything, if it works. Most likely this is confirmation bias. You were calm or manic or weird for an unrelated reason (chemical imbalance?) and you are blaming the herb. Perhaps its best to go on a real medication if you have such strong symptoms. As others have stated, you pretty much are taking an SSRI right now, albeit a terrible one.
posted by damn dirty ape at 11:29 AM on January 18, 2010

follow-up from the OP

"Erm...thanks? For everyone's information, in the UK people don't get to see psychiatrists unless they are severely mentally ill. The first point of call is the GP - we're on the national health after all. GP's provide advice and prescription drugs. If you are referred to a therapist for moderate depression/anxiety it will be a psychotherapist, not a clinician (i.e. they cannot prescribe drugs).

The information given to me by my GP said that St. John's wort might help and is worth trying for people who feel prescription drugs are a last resort - it only said to check with the doctor 'if your symptoms change' - which I am doing. I did not head to the nearest head shop and buy a vat of the triple xxx variety, I went to Boots (our trusted national high street pharmacist) and bought their own brand version, 30 tablets, at one a day. They are sold alongside Kalms and other 'Herbal remedies' for 'slightly low mood and anxiety'.

I've rechecked the leaflet and found the amount in this product is equivalent to up to 2 and 1/2 times the recommended maximum of the standardized preparation per pill. That's enough to put me off right there. I genuinely wasn't aware that SJW wasn't just a mild sedative.

Anyway, thanks magdalenstreetladies - your experience chimes with mine. I still feel weird, but less so. Maybe it'll wear off quickly? I'll wait and talk with the doctor. "

posted by jessamyn at 1:32 PM on January 18, 2010

Thanks for the follow-up! I was guessing you'd got it from Boots - I always used the Kira (?) kind - not Boots' own, and I think it was prepared in such a way that the max dose was meant to be three tablets a day (and I started with one, and went up a bit and then back down). For interested readers - depending on the manufacturer, the SJW you get here is standardised.

OP - I've had good experiences with milk thistle with getting rid of the 'too much!!' symptoms. Feel free to memail me.
posted by magdalenstreetladies at 2:28 PM on January 18, 2010

I still feel weird, but less so. Maybe it'll wear off quickly?

St John's Wort has a long half life (at least 24 hours, up to 48) so it will be several days before it's all out of your system. You might feel worse before you get better - see your doctor straight away if that happens. Don't let them give you any other drugs which act on serotonin until all the St John's Wort is out of your system.

What you have right now sounds like mild serotonin syndrome. You overdosed on a drug which acts on seratonin. That's as serious and almost as dangerous as overdosing on prescription anti-depressants. No wonder you're wigging out. It might be a good idea to ask a friend to look after you for the next few days to make sure you don't do anything stupid.

Incidentally, the reason St John's Wort tends to have wishy-washy labels like "May be helpful for mild feelings of sadness and anxiety" is that the regulators won't let the producers make therapeutic claims about it. In most countries it's categorised as a herb, not a medicine, so the labels aren't allowed to claim that it will actually make you better.

Ironically, this leads many people, including some doctors, to that this psychoactive drug can be consumed as nonchalantly as a cup of camomile tea. Because it's not a drug, there's not much incentive for pharmaceutical companies to test for interactions with it - so although St John's Wort has a long list of drug interactions, particularly with SSRIs, they're mostly discovered through after-market reports, not pre-emptive research.

Hope you feel better soon.
posted by embrangled at 3:23 PM on January 18, 2010 [1 favorite]

...to *assume* that this psychoactive drug...
posted by embrangled at 3:24 PM on January 18, 2010

The information given to me by my GP said that St. John's wort might help and is worth trying for people who feel prescription drugs are a last resort - it only said to check with the doctor 'if your symptoms change' - which I am doing. I did not head to the nearest head shop and buy a vat of the triple xxx variety, I went to Boots (our trusted national high street pharmacist) and bought their own brand version, 30 tablets, at one a day. They are sold alongside Kalms and other 'Herbal remedies' for 'slightly low mood and anxiety'.

I am sorry that such absolute crap information was given to you in your doctor's office and that such an off dosage of a chemically active herbal medication is dispensed, under its own brand name, by the UK's largest chain pharmacy.

You did everything right, but you were sandbagged by people who should know better. That sucks.

And I'm appalled that the NHS doesn't bring psychiatrists into the picture of dispensing antidepressants; psychopharmacology is a specialty for a reason, and GPs may not have enough information to be truly helpful (as was sadly the case for you).
posted by Sidhedevil at 7:30 PM on January 18, 2010

You didn't want to take medication for your depression, and yet here you are taking medication for your depression.

well, there must be a scale at least, right? Otherwise anyone who drinks coffee or eats carbs is taking antidepressants. The engineering involved in created prescription pharmaceuticals usually results in more drastic side effects, for one thing, and it seems valid to recognize a distinction between taking st. john's wort and prozac...

Anyway - to the poster, I'd reduce the dose and try to relax since you already have an appointment set up. It could easily have had a slight unwanted effect, but it won't be long lasting, and it's possible there's a psychosomatic element, too.
posted by mdn at 10:03 PM on January 18, 2010 [1 favorite]

Just checked up on this again. Anon, you might want a different GP. He seems unaware of what St John's Wort is, what it does, and the national guidelines on the subject. This is not someone you want in charge of your mental health care.

The NICE Guidelines on Depression in Adults look at the research that shows that St John's Wort is more effective than placebo in depression, but go on to say:
Practitioners should:
• not prescribe or advise its use by people with depression because of uncertainty about appropriate doses, persistence of effect, variation in the nature of preparations and potential serious interactions with other drugs (including oral contraceptives, anticoagulants and anticonvulsants)
• advise people with depression of the different potencies of the preparations available and of the potential serious interactions of St John’s wort with other drugs.

If a doctor wants to recommend it because they think that the effectiveness and relatively low side effect rate is worth it, then that's their clinical decision. But to blithely recommend it as if it wasn't a serious drug, to not mention the serious interactions and so on is downright irresponsible.
posted by Coobeastie at 4:22 AM on January 19, 2010

And I'm appalled that the NHS doesn't bring psychiatrists into the picture of dispensing antidepressants; psychopharmacology is a specialty for a reason, and GPs may not have enough information to be truly helpful (as was sadly the case for you).

Sidhedevil, that's the way that healthcare is structured in the UK, not just with mental heath. Assuming you're in the USA, we do an awful lot in primary care that your system does in secondary care. Because of this, a lot of GPs are actually very experienced in dealing with depression, and do know what they're talking about. I think anon met a bad egg, not a rotten system.
posted by Coobeastie at 4:25 AM on January 19, 2010