Why divide doses of St John's Wort?
December 22, 2015 2:50 PM Subscribe
The St John's Wort that I take indicates that I should divide the dose into 300mg doses, 3x a day. I also see that studies done with St John's Wort divided the doses into 2-3 per day. Is this necessary for best results or can I just take it once a day?
I'm taking it for mild depression and really suck at remembering to take pills, so I'd prefer to just take it once at night with my vitamin D.
I found one mention online that the doses are divided to avoid upset stomach, but the site was something called ShareCare, which doesn't seem reputable (it seems to be affiliated with Dr Oz, so, yuck.)
I'm taking it for mild depression and really suck at remembering to take pills, so I'd prefer to just take it once at night with my vitamin D.
I found one mention online that the doses are divided to avoid upset stomach, but the site was something called ShareCare, which doesn't seem reputable (it seems to be affiliated with Dr Oz, so, yuck.)
I took it for a while and found that my mood would drop off as I got closer to 8 hours since the last dose and felt better again a while after taking another dose, so I assume it's related to how long it takes for the body to eliminate whichever chemicals are providing the benefit.
On the other hand, Wikipedia says some of the known chemicals in SJW have a half life of 15-60 hours which contradicts my idea.
Anyway, I took 300mg 3 times a day as close as possible to 8 hours apart and it worked well for me.
posted by duoshao at 3:04 PM on December 22, 2015 [2 favorites]
On the other hand, Wikipedia says some of the known chemicals in SJW have a half life of 15-60 hours which contradicts my idea.
Anyway, I took 300mg 3 times a day as close as possible to 8 hours apart and it worked well for me.
posted by duoshao at 3:04 PM on December 22, 2015 [2 favorites]
This is the guidance your pharmacist will look up (this version from WebMD but it's standardized in most evidence-based sources and the baseline for clinical trials):
"For depression, the standard dose for adults is 300 milligrams of St. John's wort (of 0.3% hypericin extract) taken three times a day. After the initial treatment, some people choose to go onto a lower maintenance dose of 300 milligrams to 600 milligrams of St. John's wort per day."
Here is a good summary of the known pharmokinetics (a lot is unknown) of SJW.
Here is the (2008) Cochrane (standardized evidence-based metareviews of literature) review of SJW for depression, which presents a complex picture.
You can also hear the Cochrane review summary as a podcast here.
SJW has many known drug interactions that should be considered (and you are advised to discuss using it with your doctor). There is also a big problem with non-standardized dosing in all herbal supplements, which are broadly unregulated. If you already take a brand and find it helps you, has no side effects of concern, has the approval of your doctor, and you are confident in its chemistry, you could probably experiment empirically with reducing the dose incrementally and just seeing what the effect was. This is in fact suggested in the WebMD dosage guidelines (emphasis on "choose").
In clinical practice this is the method by which antidepressants of all sorts are effectively dosed anyway, with the exception of those where blood levels are monitored out of concern for side effects. You want the minimum effective dose. Effectivity of antidepressants is largely a subjectively registered standard, although there may be objective behavioral correlates (your insomnia returns, you gain weight, etc.).
posted by spitbull at 3:43 PM on December 22, 2015 [4 favorites]
"For depression, the standard dose for adults is 300 milligrams of St. John's wort (of 0.3% hypericin extract) taken three times a day. After the initial treatment, some people choose to go onto a lower maintenance dose of 300 milligrams to 600 milligrams of St. John's wort per day."
Here is a good summary of the known pharmokinetics (a lot is unknown) of SJW.
Here is the (2008) Cochrane (standardized evidence-based metareviews of literature) review of SJW for depression, which presents a complex picture.
You can also hear the Cochrane review summary as a podcast here.
SJW has many known drug interactions that should be considered (and you are advised to discuss using it with your doctor). There is also a big problem with non-standardized dosing in all herbal supplements, which are broadly unregulated. If you already take a brand and find it helps you, has no side effects of concern, has the approval of your doctor, and you are confident in its chemistry, you could probably experiment empirically with reducing the dose incrementally and just seeing what the effect was. This is in fact suggested in the WebMD dosage guidelines (emphasis on "choose").
In clinical practice this is the method by which antidepressants of all sorts are effectively dosed anyway, with the exception of those where blood levels are monitored out of concern for side effects. You want the minimum effective dose. Effectivity of antidepressants is largely a subjectively registered standard, although there may be objective behavioral correlates (your insomnia returns, you gain weight, etc.).
posted by spitbull at 3:43 PM on December 22, 2015 [4 favorites]
Response by poster: Hmm, if a pharmacist would be able to answer this, I would be glad to ask. I don't have one that I consider my own, as I don't take any medications apart from St John's Wort and vitamin D, both under supervision of my primary care physician, and I am in the US so both are sold without a prescription. So you can walk into, say, a Walgreens and ask questions if you didn't purchase anything from that pharmacy?
posted by the thorn bushes have roses at 4:12 PM on December 22, 2015
posted by the thorn bushes have roses at 4:12 PM on December 22, 2015
The quality of the answer you get from a pharmacist at a retail chain store like Walgreens or CVS can vary dramatically. But yes, they will answer questions about products that are sold OTC. You may consider asking your primary care provider's office if they either have a pharmacist on staff (increasingly common with the advent of the 'medical home' model) or if they can recommend a pharmacist.
posted by mattbcoset at 4:21 PM on December 22, 2015 [2 favorites]
posted by mattbcoset at 4:21 PM on December 22, 2015 [2 favorites]
Your health insurance provider may also provide a helpline that could give you access to a pharmacist over the phone.
posted by kindall at 4:22 PM on December 22, 2015
posted by kindall at 4:22 PM on December 22, 2015
Response by poster: Sorry to threadsit, but I'm unclear about this: would a pharmacist or the helpline (I believe I have access to the "ask a nurse" type hotline through my insurance) know anything about St John's Wort, since that's considered a supplement here in the US?
posted by the thorn bushes have roses at 4:26 PM on December 22, 2015
posted by the thorn bushes have roses at 4:26 PM on December 22, 2015
Best answer: FWIW, SJW is available in a time release form.
posted by SemiSalt at 4:57 PM on December 22, 2015
posted by SemiSalt at 4:57 PM on December 22, 2015
Try it on different schedules. I'd start with 3 times a day; then, once it's working, I'd mess around with the timing. If it wears off after only a few hours, you'll feel it.
posted by wryly at 7:11 PM on December 22, 2015
posted by wryly at 7:11 PM on December 22, 2015
Best answer: . So you can walk into, say, a Walgreens and ask questions if you didn't purchase anything from that pharmacy?
Yes. Pharmacists love answering questions and are happy to help. I ask questions about stuff they don't sell and I'm not buying from them all the time. I don't even identify myself as a pharmacy student. They are happy to help and appreciate the questions, and getting away from the monotony. Patient counseling in many forms is a real feel good endeavor. They are not going to demand you buy something or pay for advice. They really do care about helping people and we take an oath and everything.
posted by discopolo at 8:17 PM on December 22, 2015 [5 favorites]
Yes. Pharmacists love answering questions and are happy to help. I ask questions about stuff they don't sell and I'm not buying from them all the time. I don't even identify myself as a pharmacy student. They are happy to help and appreciate the questions, and getting away from the monotony. Patient counseling in many forms is a real feel good endeavor. They are not going to demand you buy something or pay for advice. They really do care about helping people and we take an oath and everything.
posted by discopolo at 8:17 PM on December 22, 2015 [5 favorites]
+1 to yes, pharmacists will help even if it's not a prescription/didn't come from their store. My aunt, uncle, and cousin are pharmacists and they've commented on several occasions that they wish more people would ask questions, and how happy they are when someone does, regardless of why.
posted by dust.wind.dude at 6:58 AM on December 23, 2015
posted by dust.wind.dude at 6:58 AM on December 23, 2015
You say you take SJW under the supervision of a physician; she is the logical person to ask a question like this and is likely to know more about the subject than the average pharmacist if she is using it in her formal treatment regimens with patients. Is there a reason you wouldn't call your doc?
posted by spitbull at 9:59 AM on December 23, 2015
posted by spitbull at 9:59 AM on December 23, 2015
This thread is closed to new comments.
posted by discopolo at 2:57 PM on December 22, 2015