Contraception and St Johns Wart rant

[Milims]

Ajs - I was just wondering about tackling this problem from the other end up. You say that you are taking SJW - is it possible for you to tackle the reasons why you are taking it? Do you feel better for the longer day light and sunshine now that sping is here? Is there anyone you can tak to about why you are feeling low - a friend, someone who's been there who can help with "survival" tips, a professional who can help you learn techniques to help you cope? As someone who has been in a similar situation, as I'm sure many here have, I KNOW that it is possible to rise out of it, and, with the right tools, stay out of it. It sounds to me like you have a very loving and supportive partner (and you clearly fancy each other! ) so there's a good start.
Big hugs hun and I hope that you are soon singing in the sunshine!

[clare.donovan]

Hi Ajs88,

Im really sorry to hear that you are having a difficult time at the moment . It sounds as if your OH is really supportive though, which is invaluable.

I have a fair bit of experience with both different contraceptives and SJW. Im writing this with 3 *hats* on - the first as a Doctor, the second as a patient (I've tried several different types of contraceptive whilst trying to find the right one for me) and the third as a relative/friend of people who have used SJW. Please be advised that the below is my personal opinion, and that anyone reading it should consult with their own Doctor before starting or stoping any medication (thats the legal bit, as I wouldn't want anyone to come to any harm as a result of my post )

1) First of all, SJW is scientifically proven to be of benefit in depression (http://www2.cochrane.org/reviews/en/ab000448.html). This link is to a Cochrane review, which is the gold standard in medical research. The idea of a Cochrane review is that specialists in an area of medicine go through all the current published research from around the world, compile all the evidence and then come up with an overall opinion. They give a percentage weighting to each study depending on how large a sample group they had and how scientifically rigorous their method was. As you can see from the conclusion SJW is of benefit vs placebo and is as good as conventional ADs with less side effects.

2) Anyone who is needing treatment for low mood (irrespective of what treatment they choose) should look into the cause of the low mood and try to address that. I would recommend discussing with your Dr about the different 'talking therapy' options available to you, as there is also good evidence to show that combining both a drug therapy and a talking therapy works better than either alone. I have seen several friends benefit hugely from cognitive behavioural therapy (CBT) in combination with either SJW or conventional ADs.

3) As there are no regulations on the manufacture of SJW, each brand will have a different amount of active ingredient. If you do decide to take it you should stick to one brand of SJW to ensure that you are taking a steady dose of the active ingredient.

4) SJW has significant effects on the liver, effecting an enzyme called P450. This enzyme works by breaking products in the liver down. If you take both SJW and other medications (eg the pill and mand other medications) you are changing how well P450 breaks down the other medications, and could either over- or underdose with the other medication, which could cause you serious harm!! If you are taking SJW always make sure you tell your Dr (both GP or if admitted to hospital) as it may alter what a Dr chooses to prescribe you.

5) SJW also causes the skin to be more sensitive to sunlight, so make sure you use sun block and stay covered up.

6) With regards contraceptives there are many options out there and you will find one that is right for you - you may just have to try a couple to find the right one for you. I think the reason why the initial person was concerned is that SJW can make the pill less effective (P450 again!) and there is no evidence on how SJW might affect a developing foetus, although by the sounds of it they possibly could have explained it a little more sensitively! There are risks and benefits of every type of contraceptive, and I would advise you book a double appointment with your GP (see if they do evening appts - many surgeries do these days) and bring your other half with you too, as this decision will affect both of you, and its nice to have moral support! A double appt will ensure you are not rushed and can ask any questions you have about all the different options. No GP worth their salt will be cross with you for coming to ask for advice. You don't have to make any decisions that day, just discuss your options. I have tried many different types of contraceptive myself (4 different pills, injection and Mirena coil) and have found good and bad points with all of them. Whats right for one person is not always right for another, which is why there are so many options available. If you decide that taking SJW is right for you, then you can tailor your contraceptive choice around that. There is no right or wrong decision, just what is right for you and your partner, and to make the an informed, and the right decision, you need information. Finally, many people believe that you have to have had children to have a coil (copper or Mirena), which is not true, and this option should not be ruled out just on that basis.

Sorry for the lengthy post! I hope some of what I have written is helpful for you. As a new member of the forum I haven't posted enough times for the PM section to be activated, but if there is anything else you want to ask privately, contact one of the administrators for my email address as I don't think Im allowed post that either!

Take care,
Clare.

[Milims]

What a lovely, informative, well considered post. Thank you Clare You do realise that no you've admitted to being a doctor we'll all come to you with our ailments