Frequently Asked Questions
Herb FAQ's
St. John's Wort FAQ's
Herb FAQ's
Taking Herbs
Q: Do herbs really work?
A: Yes! About 80% of the world's population uses
herbal medicines, from the most basic folk remedies to the well-researched
phytomedicines of Europe and Asia. Doctors who can choose whether
to prescribe herbs or pharmaceuticals often make herbs their first
choice. For example, in Germany, doctors prescribe St John's wort
20 to 1 over the leading antidepressant drug since the herb is just
as effective, costs less, and has none of the drug's side effects.
Q: Why is research necessary to prove that herbs work?
A: Research studies are the backbone of conventional medicine.
They have provided us with a wealth of valuable information in all
fields, including human biology and the health sciences. The whole
issue, however, is complicated by nonscientific factors that influence
which therapies are given funds for research and which are not.
Research is costly, running into the millions, and most natural
products do not have any major funding behind them. In Europe -
where many herbal medicines are classified alongside pharmaceutical
products, prescribed by doctors, and covered by the national health
plans - it's a different story. Because herbal medicine is accepted
in Europe as a legitimate form of therapy, the drug companies there
have the financial incentive to do the necessary research.
Q: How can I work with my doctor when he seems to be so
against herbal medicines?
A: In the best of all possible worlds, your doctor would
be familiar with herbal remedies and would prescribe them as needed.
I believe most doctors are motivated and curious to find the best,
least harmful approaches to helping their patients. I therefore
recommend that outake this book or something similar to your doctor
to introduce him to the benefits of herbal medicine. He may be skeptical,
but draw his attention to the scientific references at the back
of the book and encourage him in a non-arguementative way to look
them up and read them. Sharing this knowledge can help you, your
doctor, and his or her other patients.
Remember, there are times when it's important to seek professional
medical help - for example, in cases of high blood pressure, liver
ailment, enlarged prostrate, severe depression, or deteriorating
mental function. All are potentially serious conditions and should
be checked out before you embark on a self-treatment program.
Q: What is echinacea?
A: Echinacea purpurea, or purple coneflower, is a
decorative plant that has been one of the most popular herbal medications
in both the United States and Europe for over a century. Echinacea
is the primary remedy for minor respiratory infections in Germany,
where doctors write over 1.3 million prescriptions for it annually.
Native Americans used the related species, Echinacea angustifolia,
for a wide variety of problems, including respiratory infections,
inflammation of the eyes, toothache, and snakebite. In the nineteenth
century, before the advent of sulfa drugs, echinacea was the number-one
cold and flu remedy in the United States.
Q: What does echinacea do?
A: Echinacea is useful for treating colds and flus, ear
infections, bronchitis, bladder infections, and even yeast infections.
Echinacea can be used both to increase your resistance to illness
as well as to relieve the symptoms once a cold or flu begins. Unlike
antibiotics, which do little if anything in these cases, studies
show at least a 20% drop in occurrence of illness and reduction
in symptoms. It works best for those who are prone to get colds,
since it boosts their weak immune system.
Q: Can children take echinacea?
A. Yes. As we all know, once children start day care or
school, they often pick up colds, flus and ear infections from exposure
to other kids. An excellent preventive measure during the cold and
flu season is a daily dose of echinacea. Children prefer a glycerin
based tincture or a tea, which can be given two to three times a
day. A two-day break is recommended every 8 weeks. One of my patients
brought in her five-year-old son, who had been catching every bug
that came to school, then passed it on to the rest of the family.
I suggested the glycerin-based tincture for him, and the alcohol-based
tincture for the mother. Both remained free of illness for the rest
of the season!
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Garlic
Q: What is garlic?
A: Besides keeping vampires away, garlic is useful as a
plant medication. The human cultivation of garlic (Allium sativum)
goes back at least 5000 years, and today this herbal medicine can
be found almost everywhere in the world, from Polynesia to Siberia.
In the first century A.D., Dioscorides, Hippocrates, and other ancient
Greek physicians recommended garlic for many conditions including
respiratory problems, parasites, and poor digestion. Garlic is principally
used to prevent and treat heart disease, hardening of the arteries,
high blood pressure, and high levels of cholesterol and triglycerides.
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Q: Can garlic reduce cholesterol levels?
A: High blood levels of cholesterol and triglycerides, which
are lipids (fats), are related to a higher incidence of heart disease.
Thus, physicians recommend keeping your cholesterol and triglyceride
levels down. Especially important to control is your low density
lipoprotein (LDL), or "bad" cholesterol. The high density lipoprotein
(HDL) form, or "good" cholesterol, is protective, while LDL form
is destructive to the arteries.
At least twenty-eight controlled clinical studies have shown that
garlic can lower total cholesterol levels by about 9 to 12 percent,
as well as improve the ratio of good to bad cholesterol. In a 1990
German study, 261 patients were given either 800 mg of standardized
garlic or a placebo daily. Over the course of sixteen weeks, patients
in the garlic group had a 12-percent drop in total cholesterol and
a 17-percent decrease in their triglyceride levels.
A European study comparing garlic to the drug bezafibrate found
garlic to be just as effective at lowering cholesterol, and without
the drug's side effects. Like prescription drugs, garlic appears
to interfere with the manufacture of cholesterol in the body. Some
studies have been less successful. The differences may be due to
manufactring differences in the particular garlic used.
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Ginkgo Biloba
Q: What is Ginkgo biloba?
A: Ginkgo biloba, or ginkgo, as it's commonly known,
is the most widely prescribed herb in Germany. More than 6 million
prescriptions are written there for ginkgo in a typical year. Used
mainly to treat failing mental faculties, including memory loss,
in the elderly, it is also used for a variety of circulatory problems.
Over 200 million years old, the ginkgo is the oldest surviving species
of tree on the planet, and individual trees may live for 1000 years.
The bi-lobed, that is double lobed leaf gives the plant the name
"biloba.". Since the 1950s, the focus of medical research has been
on the extracts of ginkgo leaves.
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Q: What is Alzheimer's disease, and how does ginkgo help
it?
A: A serious and increasing problem, Alzheimer's disease,
or "senile dementia,", literally means "impaired mental function
of the elderly". It affects approximately 4 million Americans, which
includes nearly 30 percent of the people over the age of 85.
It has been found that ginkgo improves memory and the ability to
concentrate, elevates the mood, and relieves dizziness and anxiety.
Moreover, taking ginkgo actually stops or significantly slows down
the progression of Alzheimer's. This can enhance quality of life
and improve the ability to function adequately. It can take up to
twelve weeks of treatment to take full effect, so don't give up
too quickly. However, be aware that while ginkgo can reduce the
symptoms and progression of Alzheimer's in many people, it will
not cure the disease.
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Ginseng
Q: What is ginseng?
A: Ginseng is one of the most venerable herbs. It has been
in continuous use in China, to restore vital energy, for over 2000
years. There are actually three different herbs commonly called
ginseng - Asian ginseng (Panax ginseng), American ginseng
(Panax quinquefolius), and Siberian ginseng (Eleutherococcus
senticosus). The last herb is actually not ginseng at all although
it is believed to function in a similar way. Sometimes called adaptogens,
the ginsengs increase resistance to stress, enhance mental alertness,
and improve stamina and immunity.
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Q: What is ginseng used for today?
A: Ginseng appears to protect us from stress, which is a
significant health problem in modern day life. As a part of the
adaptogenic effects, ginseng also stimulates the mind, increases
physical performance, strengthens immunity, and helps the hormones
to better regulate bodily functions. It helps to protect the liver,
which might account for its ability to speed the processing of alcohol
in the body. Ginseng also increases oxygenation in the cells and
tissues of the body, thereby boosting endurance, alertness, and
visual-motor coordination. Its effect on brain function makes it
useful for the elderly, and it combines well with ginkgo for maximum
effect.
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Kava
Q: What is kava?
A: Kava (Piper methysticum) is a member of the pepper
family that has been cultivated by Pacific Islanders for over 3000
years for use as a social and ceremonial drink. The first description
of kava came to the west with Captain James Cook, who traveled through
the South Seas in a number of celebrated voyages. To this day, when
village elders or others in the Pacific Islands come together for
a significant meeting, they begin with an elaborate kava ceremony.
Currently, kava is used in Europe and increasingly in the United
States to treat stress, anxiety, and insomnia.
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Q: What about its use for sleep?
A: Kava is an excellent bedtime sedative, to be taken in
place of prescription drugs. It has the advantage of not suppressing
rapid eye movement (REM) sleep, the stage in which dreaming and
inner mental processing takes place. People report waking up refreshed
and ready to start the day. The commonly used sedatives - the benzodiazepines
such as Restoril, Ativan, or Valium - suppress REM sleep and often
lead to a groggy, hungover feeling the next morning. Moreover, these
prescription drugs are addictive, causing a withdrawal syndrome
that includes rebound insomnia, which is often worse than the original
problem.
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Q: Can kava help athletes?
A: In my book Kava: Nature's
Answer to Stress, Anxiety, and Insomnia, I describe where a
colleague of mine gave kava to professional hockey players to help
them to focus. It was a tremendous success. Dose is around 70 mg
of kavalactones (eg 250 mg of 30% extract = 75 mg.; 2000 mg would
be 60 mg). It's best to experiment - everyone is different, weight
nothwithstanding.
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Q: Is kava useful for treating menopausal symptoms?
A: Clinical experience and research, including an eight
week study, show kava to be an excellent treatment for menopausal
symptoms, including anxiety and hot flashes. In treating menopausal
symptoms, kava is often combined with other herbs, such as black
cohosh and dong quai, and other supplements as well.
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Q: I don't see anywhere if Kava interracts with Synthroid,
Warfarin, Pulmicort or Ativan, all of which I use daily, or indeed
with Ventolin which I use only rarely. No use asking my family doctor.
He tells me he knows absolutely nothing about herbs and doesn't
want the responsibility of recommending anything other than standard
medicine. I would dearly love to get off the 1 mg Ativan I take
every night, but insomnia has cardiac consequences for me.
A: Kava is useful for replacing Ativan. You can use Valerian
as well. See the appropriate section in my kava
book. A gradual weaning from Ativan is best done under your
doctor's supervision. You could show him that section in my book,
too. Remember, kava potentiates Ativan, so combine with care, on
a gradual replacement schedule. You might consider other products
as well to help you deal with your medical problems.
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Milk Thistle
Q: What is milk thistle?
A: The seeds, fruit, and leaves of milk thistle (Silybum
marianum) have been used for medicinal purposes for more than
2,000 years. The Roman writer Pliny the Elder, who live from A.D.
23 to 79, reported that the juice of milk thistle mixed with honey
"could carry off bile." In Europe, the herb was widely used up through
the early twentieth century for the treatment of liver ailments,
as well as insufficient lactation.
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Q: How does milk thistle work?
A: Silymarin is a powerful antioxidant. We are constantly
exposed to toxins such as cigarette smoke, car exhaust, pesticides,
and other chemicals in our air, food, and water. This is in addition
to the toxins that our bodies produce as by-products of our own
metabolism. All these toxins produce free radicals, which cause
cell damage. They can, however, be neutralized by substances called
antioxidants. Two major antioxidants produced by the body, glutathione
and superoxide dismutase (SOD), are greatly enhanced by silymarin.
Thus, milk thistle acts as an antioxidant in the liver, protecting
it from free-radical damage. Animal studies suggest that milk thistle
extract can also protect against many poisons, from toluene, a common
solvent, to acetaminophen, the main ingredient in Tylenol.
In Europe, doctors often prescribe milk thistle as extra protection
for patients taking medications that are known to case liver problems.
I often recommend it to patients who are on medications such as
antidepressants, which are metabolized (broken down) in the liver.
Milk thistle can also protect against future toxic exposure.
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St. John's Wort
Q: What is St. John's wort?
A: St. John's wort (Hypericum perforatum) is becoming
the top natural treatment for mild to moderate depression, with
all the benefits of prescription antidepressants, without the side
effects, and at one-tenth the cost. St. John's wort is a bushy perennial
plant with yellow flowers that commonly grows wild. It is native
to many parts of the world, including Europe, Asia, and the United
States. It gets its unusual name from St. John the Baptist, since
it was traditionally collected on St. John's Day, June 24. "Wort"
is the Old English word for "plant."
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Q: What about using St. John's wort for stress and anxiety?
A: While St. John's wort won't take the stress away, it
will help you deal with it better. The herb should be taken regularly,
at the ususl doses, and not just before stressful events, since
it needs to build up in the system to be the most effective. You
can also add kava, 70 mg or so of standardized extract (30-percent
kavalactones), three times daily at times of increased stress.
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Q: I have seasonal affective disorder (SAD), or the "winter
blues." Can St. John's wort help?
A: St. John's wort has been quite successful in the treatment
of SAD. The lack of sunlight that occurs in autumn and winter triggers
biochemical changes in the brain and leads to such symptoms as depression,
impaired concentration, anxiety, marked decrease in energy and libido,
and carbohydrate cravings. It is especially common in countries
at the extreme northern and southern latitudes, where there is less
sunlight during the winter months. Yet, when affected individuals
get their required dose of sunlight, they feel energetic and ready
to get on with their lives. In a study comparing St. John's wort
to light therapy the researchers concluded that St. John's wort
is as effective as light therapy. This herb really does "bring light
into dark places."
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Saw Palmetto
Q: What is saw palmetto?
A: Saw palmetto (Serenoa repens) is an extract of
the saw palmetto berry, the fruit of a short palm tree that grows
in the southeastern United States, mainly in Florida and Georgia.
It is used to treat benign prostatic hyperplasia, or simply prostrate
enlargement. A traditional Native American remedy for urinary tract
problems, saw palmetto was researched in the 1960's by French scientists,
who developed the extract.
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Q: What results can I expect from saw palmetto?
A: About 90 percent of men respond to saw palmetto to some
extent, beginning after approximately four to six weeks of treatment.
Furthermore, while the prostate tends to continue to grow when left
untreated, saw palmetto causes a small but definite shrinkage. In
other words, it does not simply relieve symptoms, but may actually
stop prostate enlargement.
There have been many double-blind studies comparing the benefits
of saw palmetto with a placebo, and the results have been excellent.
The herb significantly improved the urinary-flow rate and other
symptoms of prostate disease. Moreover, the response is rapid. For
example, in one month-long study involving 110 patients taking 320
mg of saw palmetto daily, there was significant increase in urinary
flow, and a decrease in nighttime urination.
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Purchasing Herbs
Q: What forms do herbs come in, and which are best?
A: Herbs can be purchased as teas, tinctures, tablets, and
capsules. Teas and tinctures, being liquid, may be absorbed by the
body more rapidly than the other forms. Many herbalists recommend
the liquid forms because, in tasting the herb, we begin the process
of allowing it to heal us. Tablets and capsules are made from measured
amounts of herb, and are the most common and convenient forms. Gelatin
or vegetable-based capsules filled with powdered dried herb come
in a variety of sizes and strengths, so you need to read the labels
to endure the proper dose. Tablets are powdered herb compressed
into a solid pill, often with a variety of inert ingredients as
fillers.
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Q: Why doesn't the label tell you what the herb should
be used for and what side effects you may encounter?
A: Most herbal products are regulated as dietary supplements.
In 1994, the FDA's Dietary Supplement Health and Education Act (DSHEA)
set new guidelines regarding the quality, labeling, packaging, and
marketing of supplements. DSHEA allows manufacturers to make "statements
of nutritional support for conventional vitamins and minerals,"
but since herbs aren't nutritional in the conventional sense, DSHEA
allows them to make only what they call "structure and function
claims."
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Q: What can be said on the label?
A: The label can explain how the vitamin or herb affects
the structure or function of the body. However, it can make no therapeutic
or prevention claims, such as, "Treats headaches fast," or "Cures
the common cold." A saw palmetto label can say, "Helps maintain
urinary and prostate health in men fifty and over." But it cannot
say, "Helps treat the symptoms associated with benign prostatic
hypertrophy", which is the actual reason men use it. That would
mention the condition and the treatment, and be considered a drug
claim.
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St. John's Wort FAQ's
St. John's Wort and Sex
Q: Does St. John's Wort interfere with sexual desire?
Before taking St. John's Wort I never had a problem with my sexual
drive and would wake up most every morning with a strong libido.
Now I am having problems just mustering up the urge and it is a
major concern for me and my wife. I am a 36 year old male. Any comments?
A: Since St. John's Wort raises serotonin levels, it can
in fact interfere with libido in some people. In others, due to
individual biochemical make-up, there may be an increase in libido.
You could try switching to a different natural antidepressant, as
described in St. John's Wort: Nature's
Blues Buster, one that does not raise serotonin, but enhances
the other feel good neurotransmitters. SAMe,
tyrosine are good possibilities. See too my new book, Natural
Highs, for various combinations to raise your mood.
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Does St. John's Wort Effect Birth Control Medication?
Q: I have been experiencing depression lately and
wanted to try taking St. Johns Wort. One of my friends told me that
it may decrease the effectiveness of birth control pills. Is there
any truth to this?
A: There have been 2 reported cases of pregnancy while
being on the pill and with concurrent use of St. John's Wort. It
is best, then not to take a chance. However, not only are other
natural products available for depression, as discussed in my St.
John's Wort book, but you should be aware that being on the
pill can cause depression. Both Vitamins C and B6 are depleted by
the pill, so you should consider supplemention with 1000-2000 mg
daily of Vitamin C and a 100 mg daily of Vitamin B6, with a Vitamin
B complex as well (or a multivitamin that has B complex) to balance
the B6.
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Do I need a Doctor?
Q: I am interested in taking St. John's Wort. However,
I would like to be under a doctor's care while doing so. After reading
your book, I feel that I am more familiar with the use of the herb
than most doctors I know.
Could you please recommend a physician in my area who might be familiar
with St. John's Wort and the types of physiological reactions associated
with it?
A: You could easily administer the herb yourself - it's
very safe. I have no particular referrals in your area, however
you can find an experienced doctor using the physician referral
listings in the Resources section of
this site. Best of luck on your search - and let me know if you
find someone you like so I can pass along your recommendation.
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St. John's Wort in Relation to Antidepressants
Q: Thank you, Dr. Cass, for your informative, and
to the point "protocol for switching from an anti-depressant to
SJW". I recently brought up my desire to switch with my psychiatrist,
and was displeased to find that he was not willing to help me at
all, commenting only that if "this stuff were so great, they wouldn't
have 'had' to make Prozac, and it's cousins". He gave me little
help, which resulted in my first attempt to get off 30 mg./Paxil
a day disastrous!! My husband found your book for me, and the 2nd
attempt was a breeze. I had no withdrawal symptoms, whatsoever!!
My main reason for change was simply the prohibitive cost of the
Paxil, at $65/month. Thank you once again!!
A: Congratulations on your persistence. I would still prefer
that rather than discounting patients' wishes, psychiatrists would
work with people who are motivated to help themselves, and to do
it naturally wherever possible. Keep me posted on the long-term
results.
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Q: Thanks for your outstanding book. I think SJW
is great. However it hasn't seemed to work for me . I've suffered
from mild-moderate depression/anxiety off-and-on for over a year,
and constant stress problems during that time which hinders my work
I've completed an anti-candida program (even though I'm a man),
eat a great diet, and get moderate daily excercise I have a great
family. To combat the anxiety/depression I have taken SJW for about
6-7 weeks (3x/day, 300 mg., 0.3-0.5%) with no apparent effect; in
fact, the last week has been a bad one. My M.D., an internist, wants
to switch me to Paxil He advised just stopping the SJW and starting
the Paxil, but is this safe? Please advise.
A: It's OK to just switch--no problem with seronin syndrome
or MAO inhibitor effect. However, have you considered other causes
of depression, such as low thyroid, or food and chemical sensitivities,
as discussed in book? While I am not averse to medication, it's
more useful to find the root cause.
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Q: I am weaning off from Prozac, am taking 20 mg
twice a week. I had started with 20 mg everyday about 3-4 years
back. Can I start taking St. John's wort along with Prozac now.
Please advise. I would appreciate it.
A: It should not be a problem. I recommend you let your
doctor know, and monitor your blood pressure. While there are no
reported problems, it's always better to err on the side of caution.
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Q: I'm currently taking 60 mg of Prozac with side
effects of not sleeping well at night and restlessness. I wondered
if a lower dose of Prozac together with St. John's Wort would be
an option I've already asked my psychiatrist about the use of St.
John's Wort and he hasn't been too helpful So I've decided to do
some research myself.
A: These are common side effect of Prozac. I don't think
that simply combining would be the answer.your dose is already in
the upper range, and it may produce an overload, with even more
side effects. There is not a lot of data, so we are all doing our
best to try new ways while execising appropriate caution. Most useful
would be to gradually decrease the Prozac while adding in the SJW
as described in my book. Adding Kava would also help with the restlessness.
Perhaps your doctor would be more comfortable trying this if you
show him the book, particularly research information and Appendix
C.
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Q: Last year I went through several life changes,
marriage, relocation and career change. Prior to these events I
experienced a lot of anxiety (nervousness, lack of concentration,
insomnia, mild anxiety attacks) with moderate depression.
I started taking St. John's Wort (300mg, 0.3% standardized hypericin
3x/day), it seemed to start working after the 5th week, my anxiety
lessened and I was able to concentrate better. I continued to take
it for another month and a half. At this time all my life changes
were taking place and I noticed that the Hypericum did not seem
to be as effective as before.
I had no energy, felt depressed, anxious and numb to things. So
I met with my doctor and was prescribed 50mg/day Zoloft. After about
4 weeks I had more energy, less anxiety, less depression. I have
been on Zoloft now for 3 months but would like to try to switch
back to Hypericum since side effects were minimal.
Given my experience with Hypericum is it wise of me to switch back
and give it another try? Should I try a different dosage?
A: I would recommend you read the appendix in my book re:
switching from medication to SJW, under your doctor's supervision.
Your response is hard to predict. Consider that you may be low in
tryptophane, which produces serotonin, so adding 5-Hytroxytryptophane
(5-HT), and Vitamin B6 to help metabolize it, may be a solution.
The SSRI's such as Zoloft require that you have enough serotonin
to inhibit. This combination is best done under the care of an orthomolecular
doctor.
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Q: My eight year old daughter has been on Zoloft for over
1 year due to a major trauma in her life, we now have taken her
off of it and she has gone through a huge change, she says she is
miserable, and has asked for the Zoloft back. I take St. John's
Wort and have noticed a major improvement History of depression
in the family both side, and my sister is on Zoloft When can children
be given SJW? We need to do something - my child is miserable, and
these are to be the best years of her life.
A: I agree that a natural product would be preferable.
My first choice would be to take her to an orthomolecular psychiatrist,
and you can check my resource list
for doctors in your area. Otherwise, since this does run in your
family, and she responded to Zoloft, the SJW (which has similar
effects to serotonin) is worth a good try.
Dose is based on weight, relative to adult's weight, as mentioned
on page 86. I also think that therapy of the kind I describe, brief,
to the point, though deep, would be an excellent choice e.g. EMDR.
(see my book, read Francine Shapiro's on EDMR, and other Q &
A's on this site). Major trauma is best treated in this way, and
not simply with drugs, or even herbs. I wish you well. Let me know
what happens.
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Q: How does your St. John Wort product compare to Zoloft?
My brother has recently been prescribed Zoloft but would much prefer
a more natural method to assist in the control of his depression.
Thank you for your assistance.
A: While the research is not done yet, my own experience
has been that many people do as well and many, even better on SJW,
without the side effects. Meanwhile, the National Institutes of
Health is currently conducting a study comparing Zoloft and SJW
in major depression. The results will be available in a year or
so. In the meantime, I recommend trying SJW first before going to
Zoloft.
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Q: My son, 18 years of age, was just diagnosed with dysthymia.
His doctor would like to start him on an antidepressant for this
disorder. Is SJW something that would be a alternative to Zoloft
or Prozac? If yes, would the standard dosage be adequate?
A: You are right on! Research has shown that St. John's
wort is a comparable treatment for mild to moderate depression,
without the side effects (and expense!) of medication. The standard
dosage and schedule should be adequate.
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Q: I'm currently taking St. John's Wort with the Paxil
and it's helped the habituation effect, but I'm considering switching
to Serzone because of the sexual dysfunction I've experience with
Paxil and Zoloft.
I've taken antidepressants for a little over 3 years (after the
birth of my second child) I don't want to remain on these drugs
forever To sum it up, I don't believe their safety has been proven
for long term use.
A: See appendix in book to share with your doctor regarding
combining St. John's Wort with antidepressants, and a program for
weaning yourself off the drugs if that works for you. If you do
need the medication, please continue, under your doctor's care.
Evaluation by an orthomolecular/alternative/complementary physician
would be useful. See back of book for directory of resources to
find someone in your area. One source is ACAM (American College
for the Advancement of Medicine) 800-532-3688 or www.acam.org.
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Length of Treatment
Q: How long should I continue to take SJW after I start
to feel better? Is there a maximum time recommended?
A: 6 months is the general recommended time, then taper
off and see how you are feeling. You can always go back on it, or
continue on a lower maintenance dose. In Europe, people have been
on it for years with no problem.
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Q: May St John's Wort be taken as other supplements for
it's overall benefits by someone who is not necessarily suffering
from depression?
A: There are better herbs for "tonic' effects. Often people
do feel better on it--they may have had a low-grade depression and
not realized it. others, who don't need it, find it makes them more
irritable. So, your choice!
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St. John's Wort for Anxiety
Q: Dear Dr. Cass, I came upon your website and was very
interested to know if you have found through your studies that Kava
helps in the treatment of social anxiety? I have a son in college
who suffers from social anxiety and I'm hoping there is a natural
remedy to help ease his anxiety. He does not date, is very introverted,
and this problem has caused him to drop some classes because of
his fear of oral presentations. I've read a lot about Paxil that
scares me. Any help you can give me will be greatly appreciated.
A: Although Kava is typically used for anxiety, and would
be useful here, I would recommend that you begin with St John's
Wort, since a factor in social anxiety disorder is low serotonin.
This is why Paxil, an SSRI, is often prescribed. Similarly, SJW
can also raise serotonin levels, without the drug's side effects.
I recommend that he take it at clinical doses (900 mg daily) for
a few weeks, and augment with Kava, if necessary, also in clinical
doses (60-75 mg 2-3 times daily). You may also check out my St
John's Wort and Kava books which
discuss the condition and its treatment.
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Q: I have been using the SJW and feeling better from the
anxiety attacks that have been plaguing me for over a month and
read/heard conflicting news that concerns me. Maybe you can clarify
- you say that clearly SJW does not act as an MAOI and then I hear
other doctors say they have read reports by pharmocologists who
say it does and that if one takes it one should not be eating cheese
, and a bunch of other foods - can you separate the wheat from the
chaff here?
A: Those reports are based on old information, which attributed
its actions to being an MAO-B inhibitor. While it has very mild
MAOI activity, these are not nearly strong enough to warrant food
restrictions.
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Q: I have been diagnosed with General Anxiety Disorder
and am currently taking Xanax to temporarily temper my anxiety.
My doctor is suggesting that I start a program using Prozac and
slowly decrease and cease the use of the Xanax. I read your book
on St. John's Wort, read about depression, but did not find information
on the herb used for my type of anxiety disorder I would appreciate
your feedback on the herb as it relates to alleviating anxiety.
I want to make an educated decision as to how to approach this and
would appreciate your expertise.
A: You are one the right track. SJW can be used successfully
for GAD. I'd recommend gradually going off Xanax, under your doctor's
supervision, and starting SJW. Also, Kava is useful for GAD, 200mg
of 30%, 2-3 times daily. See my kava book for more details. Magnesium
i also useful for anxiety, 400-800 mg/day. Also, EMDR can help with
underlying psychological aspects.These are all mentioned in the
SJW book.
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Q: I've been told GABA might help.
A: GABA, "nature's valium," is an amino acid that has an
anti-anxiety effect. It will work if you indeed have a gaba deficiency.
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Q: I am about to embark on cognitive therapy, and have
just started massage and acupuncture. Do you feel that the cognitive
therapy along with the SJW is known to bring good results? I want
to get to the root of my fear-based patterns so I was hoping the
cognitive therapy would help and don't want to have to always relay
on an herb or what not to make me feel back in balance. Thanks!
A: Great idea. SJW is an excellent adjunct to whatever
else you are doing. in fact, it can help stabilize your brain to
enhance learning during the therapy process.
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St John's Wort and Bipolar Disorder
Q: Our daughter was diagnosed with bipolar disorder several
years ago and despite several different combination of medicines,
she continues to have frequent depressions. She recently started
on Effexor Are there any more studies on using St. John Wart or
any other natural substances for bipolar disorder?
A: I would recommend consultation with an orthomolecular
psychiatrist, to evaluate her for levels of various amino acids,
and other relevant nutrients. Even if SJW helps to some degree,
bipolar disorder does need more complete medical supervision. Please
check the guide in the back of my book for resources in your area.
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Weight Gain
Q: After taking SJW for 5 months I have experienced a
7 lb. weight gain. Before this, my weight had been stable for years
Does SJW cause an increase in appetite or a change in metabolism?
A: This is the first I have heard of a weight gain. I would
love to hear from anyone reading this who may be able to shed light
on this.
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Sleep Problems
Q: I currently take SJW 300 mg 3 times a day along with
Gingko Biloba 3 times a day and a B Complex vitamin 1 time a day.
Since I am having some insomnia problems (I can't sleep the entire
night, I awaken early), I am thinking about adding Kava before bedtime.
A: The SJW should help regulate your sleep, since it enhances
melatonin naturally. Other additions could be kava and melatonin
(1-3 mg.) at bed-time. Also consider your blood sugar level, which
tends to dip in the ealy morning hours. Eat protein at bedtime to
counter this. See my book for
details on hypoglycemia, and for other sleep enhancing supplements.
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Q: St. John's Wort has made me feel better, but there
are still many times when I don't have any energy and it's due usually
to not sleeping well. I don't think I have really slept well in
the last ten years and that's what may played a part in my having
moderate depression symptoms. I get regular exercise, but I hardly
ever sleep more than four hours at a stretch and never more than
seven hours straight. Taking SJW hasn't seemed to help my sleeping
patterns. Do you have any suggestions?
A: SJW can sometimes be overly activating, so it should
be taken at least 8 hrs before sleep. In fact, the entire dose can
be taken at once, first thing in the morning, to avoid this effect.
My other suggestion is to add Kava at bedtime, with dosage based
on individual response. Start with 1 or 2 caps or tablets of 60-75
mg of kavalactones each (or equivalent amount of tincture) at bedtime.
Increase if necessary. For details, see Kava:
Nature's Answer to Stress, Anxiety, and Insomnia.
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Q: Is it lack of sleep that causes depression or is it
depression that causes lack of sleep?
A: Both are true. and they tend to create a vicious cycle.
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PMS
Q: My wife is interested in the use of SJW to combat her
week of PMS each month.
A: She can take it as needed, beginning mid-cycle. Most
women find though, that by taking it all month long they feel better
in general.
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With Alcohol
Q: Can drinking red wine nullify or in any way
hinder the positive effects of SJW?
A: No. I do mention in the book that unlike with other
antidepressants, it's okay to drink in moderation when taking SJW,
with no harmful effects.
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Side Effects
Q: I have been taking St. John's Wort for 8 weeks. It
works beautifully, however I get dizzy and have headaches. The severity
of the dizziness and headaches seems to be increasing. I take the
standard dosage 3 times a day. Is there anything I can do to reduce
the dizziness?
A: You may be extra sensitive to St. John's Wort which
the side effects may indicate. I would suggest you check your blood
pressure, looking for hypertension (high blood pressure). If it
is high, stop the herb. Otherwise, try reducing your dose to 2 or
even 1 daily and observing. If these effects persist, it would be
best for you to stop taking it.
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Pregnancy
Q: Can you please tell me if it is safe to take St. John's
Wort during pregnancy?
A: We generally don't recommend taking almost anything
during pregnancy because we don't want the responsibility in case
a problem occurs, and the herb is usually the first to be blamed!
That being said, the animal data shows St. John's Wort is safe,
i.e. no effects on reproduction, fetal development, etc. You could
also consider taking SAMe (see article
on this website) since it is a metabolite that is found in our own
bodies naturally. Also important to take, especially during pregnancy
and for some time afterward, is fish oil. It elevates mood, and
is great for baby's brain and other development. It helps with fertility,
too, in women wanting to become pregnant. Dose is 3-6 gms/day. Use
health food store brands, or the ethylEPA from Vitamin
Research Products.
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Miscellaneous
Q: I'm currently taking Paxil for my depression and it's
a great relief to know there are alternatives However, I've been
working with my physician to withdraw from it and she believes that
I need to remain on it for a few more months because of the rebound
depression that I experienced at a reduced dose. I believe the reason
I suffer from episodes of depression, severe enough to require medication,
is related to my childhood experiences. Although I was raised in
an upper-middle class home, my Mother and Father neglected me and
I was molested by my brother for a number of years.
A: It's good for you to be able to express all this, and
the process is healing in its own way. There is help available for
you! Early psychological trauma such as yours is often treated very
well with EMDR, mentioned in my book (pp 40-41). You can contact
a therapist in your area through www.emdria.org
or through EMDR.org.
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Q: I believe that my depression could be related to a
chemical imbalance. I had blood tests last year because my doctor
also suspected thyroid disease, but the tests were normal In your
book you refer to an individual who suffered from thyroid dysfunction
and was treated with thyroid hormone from natural sources.
I suspect that I may indeed have a underactive thyroid because of
the symptoms I suffer from: depression, thinning hair, numbness
in the hands and feet, I'm always cold, and I experience heavier
than normal periods My weight isn't a problem because I'm a long
distance runner My diet is good (I follow the "Zone" diet-which
I thought would help with the depression-it hasn't).
My question is, where would I get natural thyroid medication?
A: You sound like you're on the right track. However, dessicated
thyroid from natural sources is available by prescription only.
You would need to see a physician who is open to treating thyroid
conditions by clinical evidence, not just lab tests. As I mention,
body temperature is a good measure or thyroid function See references
to Broda Barnes in my book, and use the list of resources for alternative
and complementary physicians. He or she would look for any other
imbalance, as well, and treat accordingly.
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Q: Yesterday the woman who told me about SJW said she
got good results from increasing her dose to 5 or 6 300 mg. 0.3-0.5%
capsules per day. Her story: After being very depressed while going
through a divorce she could barely work. She took SJW 3x/day with
no effect after 3 weeks a health store owner advised her to go up.
She says that day she began to feel MUCH better and has for over
a month. She's sure it's not a placebo effect. I know your book
says this shouldn't happen, but is it worth a try?
A: Yes. There are some people who require more, and go
up to 1800 mg/day. In fact, research using this dose for severely
depressed patients showed good results.
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Q: In reading your book "St. John's Wort" you mention
the Ginkgo Biloba has an antidepressant action. My question is:
to overcome anxiety and depression, would I be overdosing if both
herbs are taken at the same time?
A: I would suggest starting with the SJW for
a week or 2, then add the Ginkgo if necessary. They act in different
ways, and are not 'overkill.' It's just a good idea to begin one
new product at a time to gauge the result. Also, you might then
add Kava, 200 mg of 30% standardized, 2-3 times daily for anxiety,
if needed. Let me know what happens.
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