Diary of Unknown Symptoms

Mystery of the Internal Vibration

Entry for January 22, 2007


I’ve been thinking a lot about my issues lately and I’m having a hard time trying to figure out why I’m losing my magnesium. What is the factor? My doctor wants me to take paxil and I have refused. I have a follow up appointment with him on Friday but I’m going to cancel it. I have nothing more to say to him. In fact, maybe it’s time to see another doctor.

I’ve been trying the higher dose of potassium and pantothenic acid without much success. Tonight I’m going to try St. John’s Wort again but I’ll start by taking three a day.

How does St. John’s extract work?

Originally it was thought that the action of St. John’s wort extract as an antidepressant was due to hypericin acting as an inhibitor of the enzyme monoamine oxidase (MAO) – thereby resulting in the increase of CNS monoamines such as serotonin and dopamine. However, newer information indicates that St. John’s wort possesses no in vivo inhibition of MAO.

At least two other mechanisms have been proposed: modulation of interleukin-6 activity and inhibition of the re-uptake of serotonin. The modulating effects of St. John’s wort extract on interleukin-6 (IL-6) is the most interesting as it proposes a mechanism by which St. John’s wort interacts with the link between the immune system and mood. The immune system and the nervous system share many common biochemical features and regulatory interactions. In regards to IL-6, this cytokine is heavily involved in the communication between cells within and outside the immune system. In relationship to the nervous system, IL-6 is known to modulate hypothalamic-pituitary-end organ axes, especially the hypothalamic-pituitary-adrenal (HPA) axis. The hypothesis is that an elevation in IL-6 results in activation of the HPA axis leading to elevations in CRH and other adrenal regulatory hormones – hallmark features in depression. St. John’s wort extract has shown an ability to reduce IL-6 levels, hence this action may explain the clinical effectiveness of St. John’s wort extract.

St. John’s wort extract has also been shown to inhibit the re-uptake of serotonin similar in fashion to drugs like fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). The study demonstrating a 50% serotonin re-uptake inhibition utilized the 0.3% hypericin content standardized extract at a concentration of 6.2 mcg/ml and did not attempt to identify the active inhibitors. Even though the authors of the study concluded “that the antidepressant activity of Hypericum extract is due to inhibition of serotonin uptake by postsynaptic receptors.”

An important point must be made – until pharmacokinetic studies demonstrate that St. John’s wort components pass across the blood-brain barrier a primary site of action outside the central nervous system cannot be ruled out.

Are there any other indications for St. John’s wort extract?

One of the key indications for St. John’s wort extract in my clinical practice is in the treatment of fibromyalgia. Fibromyalgia is a recently recognized disorder regarded as a common cause of chronic musculoskeletal pain and fatigue. Although fibromyalgia may be the “pop” diagnosis of the 1990s, it is a real clinical entity estimated to affect about 4% of the general population. Although fibromyalgia is a disorder that has many facets, the central cause of the pain of fibromyalgia are low levels of serotonin. As a result of a chronic low level of serotonin, the sensation of pain is great exaggerated.

Although St. John’s wort extract can certainly be effective on its own, in my clinical experience I have found that the combination of St. John’s extract (300 mg, 0.3% hypericin content), magnesium (200 to 250 mg), and 5-HTP (100 mg) three times daily seems to work better than using any of these three supplements alone.

Low magnesium levels are a common finding in patients with fibromyalgia as well as in chronic fatigue syndrome. Magnesium supplementation has produced very good results in both conditions part of which may be due to its importance to serotonin function.

One of the primary benefits with St. John’s wort as well as 5-HTP relates to their ability to improve sleep quality. One of the key findings in patients with fibromyalgia is a reduced REM sleep and an increased non-REM sleep.29 In addition, the deeper levels (stage III and IV) are not achieved for long enough periods. As a result people with fibromyalgia wake up feeling tired, wornout, and in pain. The severity of the pain of fibromyalgia correlates with the rating of sleep quality. What I mean by this statement is that when patients with fibromyalgia get a good night’s sleep they have less pain. Conversely, when they sleep poorly, they feel terrible.

What is the best dosage schedule for St. John’s wort?

The dosage of St. John’s wort preparations are based upon the hypericin content. The overwhelming majority of the studies in depression have used the St. John’s wort extract standardized to contain 0.3% hypericin at a dosage of 300 mg three times daily.

This article recommends the combination of St. John’s Wort along with  magnesium and 5-HTP for good results. Forget it, I’m not going anywhere near 5-HTP again. So basically, St. John’s Wort does exactly the same function as paxil. So when I tried it the first time with no results, why would my doctor decide to put me on paxil instead? In fact, why didn’t he tell me that if I was unhappy with taking paxil to continue with St. Johns Wort for a longer period of time?

It doesn’t make any sense!!

Advertisements

January 22, 2007 - Posted by | Health | , , , ,

No comments yet.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: