Anti-depressants

I've used the herbal remedy of St John's Wort to positive effect in the past.

Admittedly; it was for mild depression, but it really worked for me. It's herbal, so uses natural ingredients and is freely available from Chemists.

John.

And Yes indeed Mr Parry - Bang on!

If deeply depressed people (that are not close to you) can't get medication and throw themselves off tall buildings, it will save the National Health Service a fortune.

Have you considered a career in Politics?

John.

Earwicker,

I don't think it's worth seeking advice on what antidepressant to take, since antidepressants affect different people in different ways.

Perhaps the best use of anecdotal evidence is for the horror stories and their frequency. If only I had read up on venlafaxine before trying it, I would have started on a fifth of a tablet rather than the unnecessarily large standard dose...

Of the seven antidepressants I've tried:
Two (venlafaxine and mirtazapine) had only harmful effects. One (sertraline) had virtually no effect. Four (citalopram and S-citalopram, Prozac and reboxetine) had beneficial effects for a while but either stopped working or had increasingly bad side effects. I also tried St. John's Wort - it was a little like cipralex but far less effective.

I haven't taken an antidepressant for two years or seen a therapist for three years but I've managed to halt and start reversing my decline mainly through exercise, diet and nutritional supplements.

The three key things for me are walking half an hour every weekday [ideally it should be an hour but I'm not fit enough yet], taking EPA or EPA/DHA and cutting down on potato and grain - no wheat, very little rice. But I also have a long and evolving list of daily vitamin/nutritional supplements, and I'm using meditation, self-hypnosis CDs and sports psychology in order to keep up the battle against depression. The trouble is, every time I have a slight setback I stop doing most of these things and take a week or longer to get back on track.

quote:

Originally posted by J.N.:
It's herbal, so uses natural ingredients and is freely available from Chemists.

I'm not decrying the treatment, but this "it's natural, it must be safe" thing is pure marketing bull****.

Many "natural" products are extremely dangerous, eg "deadly nightshade".

Botox is also a "natural" product which is possibly the most toxic substance known. As a chemical weapon, 1 gram would be sufficient to kill every person in the UK.

Also, I believe there are/were some issues that St John's Wort and other plant extracts, not officially being "medicines", were not as strictly controlled as to the amount of active ingredients in each pill as you might expect.

Also, St John's Wort acts very similarly to SSRI's (Prozac, etc), and seems to interact if both are taken together.

With all this in mind, though, St John's Wort does seem to be efficacious for some people.

cheers, Martin

St John's Wort does seem to be a reasonbably efficacious anti-depressant for patients with dysthemia (mild depression). It takes about 8 weeks to do its stuff though, and isn't much use against major depression. It can be useful in conjunction with some prescription anti-depressants, but not, I suspect, mirtazapine as high doses of St John's Wort appear to induce the liver enzymes that metabolise this fine drug!

An interesting newish herbal rememdy for depression is 5-HTP - the immediate metabolic precursor molecule of serotonin (5-HT); Holland and Barret have recently taken it on, but it's bloody expensive. Basically, there's a single decarboxylase enzyme between 5-HTP and 5-HT, so depending on the order of reaction with respect to 5-HTP...!

So far as depression as a disease goes, it's far more debilitating than many diseases that attract far more research effort and funding; major depression is fatal in 15 % of cases. It is a testament to modern medicine and molecular biology that the proper biochemical basis for severe depression has to some extent been elucidated and, although some of the creaky old SSRIs, SNRIs, tri-cyclics and MAOs have their drawbacks, there are some quite effective new drugs on the market, like mirtazapine, that can not only make life bearable for severe major depressives with suicidal ideation like myself, but can save lives. And that's sort of the point of medicine.

There's still a long way to go before a true wonder drug is developed, but let's keep our fingers crossed.

Mick - I suppose I see where you're coming from, but you'll change your tune if you ever have the misfortune to suffer from major depression youself. Like a good many illnesses, they don't matter much... until YOU get them!

Best wishes,

EW

Mick

I honestly believe you cannot have ever encountered mental illness to have your attitude. This is surprising since 1 in 10 of us will have such an illness in our lifetime. I'd genuinely love to introduce you to patients who have been through a depresssive illness so that you could get to grips with what we are talking about. Many of them are just like you at first, and emerge astonished that they could possibly have had such a thing, and far more aware of such problems in others around them as a result.

For sure we use drugs too often at times, although the evidence is that we identify depression too infrequently rather than too much.

I'd be happy to see more money spent on these illnesses, not less. Mental illness destroys young lives as well as old, can blight individuals for decades and tears apart families and relationships. No different to cancer then.

quote:

They must surely affect you brain and the long term implications are horrendous

What long term implications incidentally? Considering the vast amount of Ad usage experience I think it is quite astonishing (even suprising) that these drugs have turned out to have very few long term risks. They are not addictive, do not cause tolerance, do not affect long term cognitive function and tend to be safe with other medications and illnesses. Some are quite amazingly safe in overdose. Do not mistake modern AD Rx for old fashioned treatment with tranquilisers that patients are still unable to stop 50 years later. Modern Ad Rx is not perfectly safe, not without problems or side effects but it has a very impressive safety record compared to many classes of drugs.

I'd rather have to take an anti-depressant for a year than ibuprofen for my arthritis.


Bruce

And Sir Mike Thrust spake thus to his many admirers:

"Sod the pills. Let them eat cake!"

EW,

Not sure about which medicines to recommend but I always had the impression that they take a month or to two kick in and that they are also only medium term solutions. ie it stops you from making mountains out of molehills so you can tackle making some changes in your live without getting mired in extreme negative thought.

Excercise, sunshine and a healthy diet also make a huge difference. As a bonus walking around the block is free and cooking your own food is generally much cheaper than buying take aways.

http://beyondblue.org.au/ has a lot of resources for depression.

cheers
Gus

The member/s of the forum with a conservative political slant might like to consider that the economic penalty to a country from sick leave and work impairment due to depression far outweighs the cost of such medications. This can be seen as one reason why they are so widely prescribed. A further reason being that the labour costs of visiting a GP are much less than psychological treatments.

On the herbal remedies, St. John's Wort is illegal here in Ireland!

Nick

quote:

Originally posted by Nick_S:
The member/s of the forum with a conservative political slant might like to consider that the economic penalty to a country from sick leave and work impairment due to depression far outweighs the cost of such medications. This can be seen as one reason why they are so widely prescribed. A further reason being that the labour costs of visiting a GP are much less than psychological treatments.

On the herbal remedies, St. John's Wort is illegal here in Ireland!

Nick

Some very good points! And I didn't know John's Wort was illegal in Ireland. It's far too innocuous to be banned!

EW

It is not innocous, it has risks/side effects comensurate with its action. Herbal remedies like to make us think 'natural'= safe. Not true. Lots of nice spectacularly toxic agents are derived from plants and herbs!

I think SJW should be a POM if anything.

Bruce

quote:

Originally posted by Bruce Woodhouse:
Lots of nice spectacularly toxic agents are derived from plants and herbs!
Bruce

True, but hypericin isn't really one of them is it? SJW seems to me to be a safe herbal remedy that's done a lot of people a lot of good - whether for psychological or biochemical reasons I don't know.

The biggest problem I can see with SJW is it induces enzymes that metabolise other drugs if you take enough of it to remedy depression. It has fewer side effects than standard SSRIs or certainly hateful SNRI compounds like venlafaxine!

EW

Fewer perhaps, but not enough to be labelled benign. It can cause a nasty photosensitive rash (I've seen this several times), liver disturbance, constipation and other problems. Interactions are important. Safety in significant overdose is not established.

Safety is always relative. I'm not arguing about the possible efficacy, just that the choice to take any drug (be it chemically synthesized or natural-derived) is always a balance of risk and benefit. The purveyors of herbal remedies use the word 'natural' to imply 'it must be safe'. This is misleading.

The reason I think it should be POM is twofold. Firstly it would help to ensure it was used correctly, at decent doses for sensible durations when it is an appropraite choice vs other options. Secondly it would help to prevent the issues of interactions between prescribed and OTC medication of which the prescriber is unaware.

Bruce

PS Prescription Only Medicine/Over The Counter!

quote:

Originally posted by Bruce Woodhouse:
The reason I think it should be POM is twofold. Firstly it would help to ensure it was used correctly, at decent doses for sensible durations when it is an appropraite choice vs other options. Secondly it would help to prevent the issues of interactions between prescribed and OTC medication of which the prescriber is unaware.

Bruce

PS Prescription Only Medicine/Over The Counter!

Hmm. Okay, but that would mean a lot of patients suffering from dysthemia/mild depression would end up not getting it [SJW]. Your argument could be applied to a good many OTC drugs. I know what you're getting at, but it smacks of excessive nannying to me.

For what it's worth, I've taken HUGE doses of SJW in the past and so far as I could tell all it did was leave a funny taste in my mouth. Other people seem to have found it more useful.

All the best,

EW

Believe me I'm not looking for extra work! I just see too many people who've taken SJW in a way which is totally unlikley to be useful (too little/too short/too intermittently) or where other interventions (no drug at all/a more powerful drug/social or pschodynamic interventions/alcohol issues etc etc) are more appropriate instead or as an adjunct. Basically I'd like more people to have the option of something potentially helpful but I think the assessment and monitoring of its use should take place in a professional environment. This might save people wasting their time/money.

Yes it does sound a bit nannying, but I think most people are poor at self treatment when it comes to mood issues. This may be why brief interventions by GP's have been shown to be very effective for mild depression in the absence of drugs.

Licensing SJW as a POM might also encourage better research into who benefits, optimum doses/duration etc.

Bruce

quote:

Originally posted by Bruce Woodhouse:
alcohol issues etc etc

Bruce,

quick question if I may - how does alcohol affect the activity of SSRI's (Prozac, Citalopram, Paroxetine, etc)?

cheers, Martin

Small quantities probably not much, may slightly potentiate the effects of the alcohol, make slightly drowsy or drunk sooner than normal. A few people say they feel rotten the next day if they drink on SSRI's but this is not 'unsafe' just unpleasant.

Heavier drinking on a regular basis probably interferes with metabolism of the drug significantly, but the effect of the alcohol on mood is more likely to be the issue overall. I've heard a psychiatrist say to a patient who wanted a one-off a binge at a wedding to just omit the previous day dose.

Bruce

quote:

Originally posted by Bruce Woodhouse:
Small quantities probably not much, may slightly potentiate the effects of the alcohol, make slightly drowsy or drunk sooner than normal. A few people say they feel rotten the next day if they drink on SSRI's but this is not 'unsafe' just unpleasant.

My girlfriend used to find that half of a 330ml bottle of lager would make her depressed for days.

It took her many months to wean herself off Paroxetine, too. She was down to 1/4 of a 10mg tablet for several months before she was able to stop taking them completely.

The first time she tried to stop taking them (cold turkey) she had a huge crash. Scratch that Christmas!

quote:

Heavier drinking on a regular basis probably interferes with metabolism of the drug significantly

Sorry, does that mean that it will linger in the system, and the active ingredient will accumulate in the body, or that it will be destroyed more quickly than it should be?

Thanks, Martin

quote:

Originally posted by J.N.:
I've used the herbal remedy of St John's Wort to positive effect in the past.

Admittedly; it was for mild depression, but it really worked for me. It's herbal, so uses natural ingredients and is freely available from Chemists.

John.

get yourself a 552, you'll feel much better honest.

quote:

Originally posted by Mick Parry:
bjorne

Most people who are "depressed" are suffering from an attitude of mind more than anything else.

How many pills did we have during the last war, answer hardly any but people got stuck and did what they had to do. There was cause to be depressed with you got bombed out and in this day and age we have it made, so depression is mainly in the mind (no pun intended)

I object to spending my taxes on financing the issuing of pills of a dubious nature to a bunch of self pitying whingers.

The money could better be diverted into more deserving areas such as cancer research or whatever.

Regards

Mick

I don't believe that I just read that.

Richard

There is no excuse for being depressed in this day and age. Most "depressed" people need a good kick up the ass rather than pills which make the pharmacutical industry an absolute fortune at the tax payers expense.

You read the word depression, I read self pity.

Regards

Mick

quote:

Originally posted by Mick Parry:
Most "depressed" people need a good kick up the ass rather than pills which make the pharmacutical industry an absolute fortune at the tax payers expense.

Oh thank the Lord, I'll live happily ever after! Just get me mate round with a good pair of cloggs on and that'll be it...!

And no I feel no guilt about cost. I haven't seen a doctor before in all my life, have never claimed benefits of any kind, and Lord knows you name it I've paid it! I think the "kitty" can stretch to a little mirtazapine and 5 mins of my GP's time once every 28 days for a short while. Believe it or not, not all sick people are spongers!!

EW

There is no difference between saying that and saying people who have cancer need to give themselves a good kick up the ass. I'd like to see you say that to somebody who has weeks to live.

Mick, I read a lot of your posts and most of the time you come across as an ignorant, attention seeking luddite.

Do you enjoy offending people?

Richard

I am merely realistic. Nothing more and nothing less.

Regards

Mick

Mick claims to have come from humble surroundings. Post-war Plymouth was still full of bomb sites and affordable accomodation was hard to find even for those in full-time work. This was true of many British cities of course.

I wonder whether Mick suffered from "Grumbling Appendix"? 1950's doctor speak for stress-related stomach problems and depression from being constantly bullied at school? Or was he the bully he seems to project now?

I remember reading more than once that depression was internalised anger. But offer it only as a secondhand observation.