Dearest: Tonight's guest is a medical journalist, writer and editor. She has authored TWENTY-TWO books covering the gamut of medical subjects. Her two newest books, both of which we shall focus on tonight, are: "The Perimenopause Handbook," and "The "The Hypericum Handbook - St. John's Wort: Nature's Anti-depressant." My guest tonight, C A R O L T U R K I N G T O N has worked for numerous newspapers and as a stringer for TIME Magazine - as a medical writer/editor at Duke University Medical Center and was the senior writer in Clinical Psychology for the newspaper of the American Psychological Association in Washington, DC. After five years of focusing on medical and psychological issues for the APA, Carol turned to freelancing, which she's been doing for the past 10 years. Carol is a member of the American Society of Journalists and Authors, the American Medical Writers' Association, and the division of media psychology of the American Psychological Association. Carol says, "Women's issues are one of the areas in which I'm particularly interested." Her articles have appeared in numerous national publications including, "Vogue," "USA Weekend," "Psychology Today," "Self," "Redbook," "Modern Maturity," and "New Woman." Dearest: Carol, welcome to Power Surge :) You say in your book that depression affects more than 17 million adult Americans each year (many of them in menopause, I'd guess) and that it costs the nation up to 44 billion dollars to treat them. With a safe, effective and natural remedy like St. John's Wort having been used for thousands of years, why is it only just taking off in the U.S., and why are so many doctors still prescribing prescription anti-depressants? Thanks :) Carol Turkington: Well, there are two parts to that question. First, there have only recently been studies that summarized how successful St. John's Wort is. The most recent study was published in a respected British journal and got everyone's attention. Second, SJW has been proven to be effective for only mild to moderate depression. We just don't know how well it works for severe depression. Those drugs you mentioned have been proven to work very well for severe depression and some people just don't respond to SJW. Dearest: Thanks for the excellent answer, Carol. Let's go to the audience questions. JPLJAXX: Would you suggest that anybody currently on an anti- depressant medication attempt SJW? Carol Turkington: That's a good question. First, you should NOT stop taking your drug if you are seriously depressed. Otherwise, you could try SJW with your doctor's permission, if you first slowly go off your current drug before going onto SJW. You should NOT use both at once. LostinLAS: Is it possible to "overdose" on SJW? Carol Turkington: SJW appears to be safe even in extreme overdoses. The primary side effect is a skin sensitivity in overdose. There has never been a recorded death from SJW overdose. Dearest: Carol, what medications contraindicate the use of SJW? Carol Turkington: You will never want to combine SJW with another antidepressant, especially an MAOI. Likewise, if you are sensitive to caffeine you might not want to take both at once Also best to avoid alcohol and SJW at the same time. Dearest: Aren't there some anti-hypertensives that work as MAO inhibitors, too? Carol Turkington: Yes. I should have added that you may want to check with your doctor if you are taking ANY prescription drug if contemplating using SJW just to be safe. Dearest: Thanks so much, Carol. Kabby1217: My periods have become short and very heavy followed by 2 weeks of pale spotting. Is that perimenopause? Carol Turkington: There are many symptoms of perimenopause. Certainly, irregular bleeding can be one of them. Bleeding problems (*especially heavy bleeding) should always be checked out by your MD, because they could also be caused by other physical problems. Dearest: Remember, everyone, nothing you hear/read in Power Surge is meant as a substitute for a visit to your doctor. JKemp50857: Depression & anxiety "go together." Does SJW work on anxiety too? Carol Turkington: It can. I should also mention, however, that SJW is very similar in action to Prozac. Some people who take Prozac become very anxious. With SJW, about 1 in 400 become very anxious and have palpitations (This actually happened to me, so I know it is a potential!) Dearest: Carol, many women in Power Surge (menopause) have used SJW and, I can't remember one time I've heard of any adverse side effects. Have you had that experience? Carol Turkington: Adverse side effects are VERY rare. The most common is nausea and that only occurs in about 1 out of every 200. I should mention that in my own experience, I am extremely hypersensitive to many medications, so my experience is NOT common. In general, SJW has far fewer side effects than antidepressants. Dearest: My mother and dad, 86 and 88, both take it and have found it very effective :) (me too) LostinLAS: How long does perimenopause last? Carol Turkington: That depends on the woman! Some women have a fairly short perimenopause, others can drag on for several years. Interestingly, when I wrote the book I discovered that some women who thought they suddenly developed PMS in their early 30s were actually experiencing the signs of early menopause. Flower1217: Is SJW helpful for the fatigue that comes with perimenopause? Is anything else? Carol Turkington: SJW is not usually known to be a big help with fatigue. A few people find that it actually makes them sleepy. PZukow: I have cramps before periods and breast tenderness, 12 yrs. in perimenopause. What herbs I can take? Carol Turkington: Black cohosh and soy have been helpful... Sally1019: I'm curious just how SJW works; does it produce endorphins, serotonin, etc.? Carol Turkington: SJW works by interfering with the breakdown or reabsorption of several brain chemicals including serotonin. As a result, the level of these chemicals in the brain increases. Rat studies have shown that SJW also affects other chemicals associated with depression (dopamine and norepinephrine). Depression has been associated with all of these chemicals. as is symptoms of perimenopause. Dearest: Carol, how does one differentiate between clinical depression and passing depression - perhaps as the result of trauma, loss, stress, etc.? Carol Turkington: Good question. We all feel blue now and then, and sometimes we have a RIGHT to be depressed (trauma or loss). A depression that may need to be treated does not go away. We feel sad all the time, and lose interest in things that once brought us pleasure. Some people don't realize they are depressed, but simply feel tired all of the time. This can be a sign of mild depression. Kabby1217: Please name some common symptoms of perimenopause, if you have not already - I came in late-, thanks. Carol Turkington: Sure. Abnormal periods (heavy bleeding, or intermittent bleeding, or skipping periods); killer PMS; sore breasts; hot flashes; memory lapses; and, fatigue. Dearest: Kabby, let me remind you, too, that you'll find lots of information in Power Surge - AOL keyword: ages and stages. JPLJAXX: Prozac is ineffective for me; MAOI seem to be the only effective medication - likely that SJW won't work? Carol Turkington: It may not, since SJW and Prozac are so similar. Certainly if MAOI works, I might hesitate to stop taking it -- but certainly the dietary restrictions with MAOI are no day at the beach. You could TRY SJW, if your doc approves, it certainly wouldn't hurt you. There are, of course, many other new drugs in Prozac's class...(SSRIs). Dearest: Carol, your newest book, "The Perimenopause Handbook: What Every Woman Needs To Know About The Years Prior To Menopause"... when will it be out and how can those interested obtain it? Carol Turkington: It will be shipped to bookstores Sept. 1. (I hope!):) Dearest: I understand you were in perimenopause when you wrote it, yes? Carol Turkington: Oh, yes. I had been perimenopausal for several years and hadn't realized it. Dearest: I'm always curious how my guests who write about menopause actually treat their own. May I ask? Carol Turkington: Certainly. Dearest: (Gosh, I was wondering what I'd do if she said "NO" :) Carol Turkington: Actually, I believe you can officially call me "menopausal" now. I've been downing huge quantities of soy drinking herbal teas... Dearest: Yes! Carol Turkington: ...and using wild yam cream. I have wrestled with the problem of HRT, since I am at extremely high risk of breast cancer. My symptoms now have just about ended! Dearest: That's good to hear. I've told the women about a new soy protein shake I've been using - developed by physicians who acknowledge that there are women who can't or won't take HRT. It's called Revival and has 184 mg of natural plant estrogens, as opposed to every other soy shake on the market with only 30 mg... SIX times as much and it's helping me immeasurably :) Anyone interested feel free to email me at Dearest. Dearest: EleanordeW, former Power Surge co-host and friend, go ahead :) Cinda: (Hi EleanordeW - good to see you) EleanordeW: Hi y'all (G) EleanordeW: During perimenopause, when the periods are getting farther apart, is it normal for one to have all the symptoms of a period - cramps, backache, bloating... - but still not have the period? (can't be pregnant .. it would be an immaculate conception! LOL) Carol Turkington: Yes, and periods can fluctuate wildly -- some short, some long, heavy bleeding one month none the next. Dearest: Such fun, isn't it? :( EleanordeW: NOT! LOL Mubotulip: I've read that if estrogen levels are low, antidepressants don't work as they should. Any truth to this? Carol Turkington: Now THAT's an interesting question. I've never heard that, but it's interesting. Hormones and depression are linked. Some women experience depression when hormones fluctuate... at puberty, during PMS, during pregnancy, after birth, at perimenopause. Hormones affect the activity of neurotransmitters (including serotonin) which in turn affect the timing and release of hormones. A woman's cycle is regulated by the interaction between serotonin, dopamine and norepinephrine, together with pituitary and ovarian hormones. Dearest: Can we expect the depression to ease once we're post menopausal? Carol Turkington: I suppose, it would depend. If the depression is tied exclusively to the hormonal shifts, we could. However, depression is caused by many other things as well - including heredity. Many people who suffer from clinical depression experience four or five major depressions in a lifetime. Certainly, after the symptoms go away a lot of stress is eased!! Dearest: Thank you, Carol. Irish48236: I am experiencing bleeding, all the time almost - - how long should I wait to decide to do a hysterectomy? I have had a benign endo, biopsy and d and c.... just how long do I let it go on? Carol Turkington: First of all, a doctor should decide exactly why you are bleeding all the time. Then I'd definitely contact more than one doc -- have you had more than one opinion? Irish48236: She gave me a choice of going "natural." No, just this one. Carol Turkington: Certainly, for some people, hysterectomy IS appropriate, despite the controversy about inappropriate surgeries. Irish48236: Thank you. Dearest: Carol, can you elaborate about the photosensitivity associated with using SJW? Carol Turkington: Sure. You may read in some books that SJW causes photosensitivity, this is based on the experience in animals. For example, in Australia sheep grazed exclusively on SJW (it grows wild there) became sensitized to the sun, and died from severe sunburns. This is why ranchers consider it a noxious weed. However, in humans, even in extremely high doses - such as in research studies of HIV and AIDS patients -- there were only occasional cases of mild skin sensitivity. Dearest: Excellent, thanks :) KGil1209: Can hot flashes occur for several weeks, then go away for months, then reoccur? Carol Turkington: Yes. (And this was my experience, too). In fact, I hadn't had a hot flash in about three or four months and mine just returned. It's important to remember that menopause doesn't happen in one day. We don't wake up one morning and suddenly realize we are menopausal it is a long, gradual process of our bodies readjusting. LostinLAS: Can you build up a tolerance for SJW to a point where it is no longer effective? Carol Turkington: I have heard anecdotal reports of this, as I have heard of similar reports (occasionally) with Prozac. It is possible to slightly increase SJW and see what happens. Also, after a year, it may be a good idea to try going off SJW. There have been no long-term studies to test the effects of SJW. GRAMER13: Have you ever heard of loss of pubic hair and fluctuating blood pressure? Carol Turkington: Certainly, thinning pubic hair is a symptom of menopause, and everyone's bp fluctuates from moment to moment. GRAMER13: I am extremely anxious. Carol Turkington: Is this a severe fluctuation? GRAMER13: 170/90 to 128/84. Carol Turkington: Anxiety and high blood pressure can be related to other problems in addition to menopause. PZukow: What's good for sore breasts, mine are bad for two weeks prior to periods. Carol Turkington: First of all, I'd recommend eliminating caffeine and all products that contain it...drink plenty of fluids...healthy diet...black cohosh tea... Dearest: Thanks, Carol.. Kabby, your question, please. Kabby1217: The symptoms you describe sound like regular menopause, not perimenopause, is there really a difference? Carol Turkington: Perimenopause simply means "early menopause." The symptoms of menopause begin years before your periods stop. You won't have all of these symptoms at once, but as you begin to experience the symptoms of menopause this period is known as "early menopause." Dearest: Carol, many women take HRT because they think it will relieve their depression and only end up more depressed from the synthetic progestins, and also from some of the natural progesterones. Your thoughts on this? Thanks. Carol Turkington: I would definitely not choose HRT to relieve depression, and I agree that it can make depression worse. That's why SJW is such a nice choice to have -- it appears to work very well, is inexpensive, easy to get and doesn't cause serious side effects. Dearest: And is okay to take to counteract the progesterone effects by women on HRT? Carol Turkington: Yes Dearest: Thanks so much. You sure this is your first online chat? LOL Carol Turkington: Oh yes!! Dearest: Well, you're doing wonderfully! BARANDSTEP: What is your opinion of black cohosh, natural progest cream to restore periods. Are they safe long-term? I'm 38, with day 3 FSH over 60. Carol Turkington: Now that's a good question. I've never read anything to cause concern about black cohosh, but long-term safety with natural progesterone cream? I don't know. I haven't seen long-term studies on this. Randwarco: Is it possible to experience hot flashes 10+ years after medically induced (chemotherapy) menopause? I'm 47 now - if that's what's happening, do I treat them as if this were the first go 'round? :( Carol Turkington: Perhaps... but I would check with a doctor on this one. I am uncomfortable with the length of time that has elapsed. Dearest: I agree with what Carol says, Rand, but if it's any consolation, I've heard other women in Power Surge mention the same thing as you're experiencing. If you want to email me, I'll try to find their names. Ok? JPLJAXX: During perimenopause, is it normal to have a week of staining 2 weeks after period, then a period 1 month after staining? Carol Turkington: Yes, irregular periods -- long bleeding, short bleeding, short and long intervals between periods, are all normal. But again, any EXCESSIVE bleeding should always be checked out by a doc. CRedm10493: What do you think of being put on the pill to regulate periods during perimenopause? Carol Turkington: Good question. Many docs do this, since HRT for perimenopause can make periods even more irregular and erratic. The pill is a logical choice instead of HRT for severe perimenopausal symptoms, assuming, of course, you don't smoke and have high blood pressure. Dearest: Mubotulip, your turn :) Mubotulip: Do FSH levels fluctuate? I'm 42 and my FSH was 65. Doctor put me on HRT. Should I have checked again? Carol Turkington: Yes, FSH levels fluctuate. Especially in early menopause. LLAP18: I have had a surgical menopause and breast cancer. After the menopause, became very depressed and tried SJW, and became very nervous. Can you recommend a specific dose or brand? Carol Turkington: SJW can make you nervous. Many people report that after a week or so, this goes away. If not, I would recommend seeking help from a psychiatrist to recommend an antidepressant that will not make you anxious. There are many different ones to try, and odds are one will work. Regarding brands, this is important: you should look for SJW at 300 mg., taken three times a day. It must be standardized to 0.3% hypericin. In my opinion, the best brand is Kira, research grade SJW made by a German company - available most stores. MBrant1004: I read that a tubal ligation can bring on perimenopausal symptoms. Is this true and why? Carol Turkington: In my research, I have not discovered this problem. SagCats: I take estratest - do I need progesterone too - I had a hysterectomy in 97. Carol Turkington: I would think not. What does your doc say? SagCats: Didn't mention it. Carol Turkington: I would think not. SagCats: Thanks Dearest: How are you doing, Carol? Carol Turkington: Fine. Dearest: Great... we have six more questions. MtnMaw: I have just added St. John's Wort to my list of herbs I am taking. What should I expect? No synthetic HRT now. Carol Turkington: You should expect a reduction in depression within 4 to six weeks, although some people notice a change within about 10 days. Take it with meals to avoid nausea. You will find a general "evening out" of your mood - very gradual. MtnMaw: Thanks. Dearest: Carol, have you ever heard of anyone taking SJW on an "as needed" basis? Carol Turkington: Not really. For depression it needs to be taken every day. However, there are many other benefits, including antiviral, antibacterial and anti-inflammatory. It may work on an "as needed" basis for those. Cocograms: I am 51 and have used natural remedies for perimenopause. Up until 10 mos. ago, they worked fine. Too many hot flashes and now fibroids are kicking up. Will I ever get relief from natural remedies again? Carol Turkington: I think so. (I'm sitting here with a fan going at this very moment!) Eventually, the symptoms go away by themselves. Until then, they wax and wane. I would expect your natural remedies will work again. Don't give up! Cocograms: Thank you. Dearest: I would seriously recommend Carol's books... and Revival. I'm waning more than waxing since starting it :) E-mail me, Coco, for info about the Revival Soy. CallTakr: Info on St. Johns Wort for a 10 yr. old? Carol Turkington: Children over age 2 can take SJW - however, they should NOT take an adult dose. Younger children (should take 300 mg., and older children can take up to 600 mg. a day. Teenagers can take an adult dose (900 mg. a day). SJW is also used to treat ADHD and also Tourette's syndrome. JPLJAXX: What is your feeling about hrt in terms of protection against heart disease, osteoporosis - 42 yrs old? Carol Turkington: Whew... now there's a question! I think that the decision to take hrt to protect against heart disease and osteoporosis should depend on her own history and feelings about HRT, together with discussion with her doc. Some women with a history of Breast cancer and no history of heart disease or osteoporosis in the family may not wish to deal with HRT. Many women choose instead to begin HRT in their 60s, when the danger from heart disease and osteoporosis is much greater. Remember that only 1 out of 25 women will ever develop osteoporosis anyway. For all women to take HRT to prevent a disease for which they may not be at risk, it may not be the best health care decision. I think it's a decision that each of us must make for ourselves. JPLJAXX: No history of breast cancer; history of heart disease in family. Carol Turkington: With a history of heart disease in the family, certainly this is something you may want to consider. JPLJAXX: At my age? or older? Carol Turkington: I agree with Dr. Susan Love -- makes better sense, perhaps, to wait until you are in your early 60s -- but again, this is a very personal decision. JPLJAXX: Thanks! MsLizzieB: Has medical thinking changed that HRT can be taken before a year has passed with no periods? Carol Turkington: I think docs still don't like to give HRT in perimenopause (before periods have stopped for a year). Instead, they prescribe the pill. RCHCTH: What is the difference between Dong Quai & Black Cohosh for perimenopausal symptoms, and how much should one take? Carol Turkington: I've seen conflicting reports about dong quai and its effectiveness, but I drink black cohosh tea daily. As to exact doses, I confess to a momentary memory lapse (happens a lot these days!) Dearest: Carol, would it be okay for those few women who didn't make it into the queue due to time restraints.... to Email you at "Carol Turkington?" Carol Turkington: Certainly. Dearest: Thanks... :) Dearest: Carol, thanks for spending this time fielding our questions about St. John's Wort, depression and perimenopause. Don't forget to look for Carol Turkington's books, the newest of which is "The Perimenopause Handbook," (Contemporary Books). It won't be available in bookstores until September, but you can order it on the Net or by calling 1-800-323-4900. Also, "The Hypericum Handbook - St. John's Wort: Nature's Anti-depressant." (M. Evans & Co). Sherry1015: Thanks Carol Turkington and Dearest LLAP18: Thank you very much Irish48236: Thank you, Carol and Dearest Flower1217: Thanks!!! Geebee2000: Really enjoyed it! NNN951: Thank you, Carol and Dearest PianoMary: {S applause Z J Gragg: Thanks! Sue: Thanks for Coming!!!!!!!!!! Great Answers!!!!! Great Guest!!!! Dearest: We hope you'll return to Power Surge again.. and very soon, Carol. Thank you!!! Carol Turkington: Thank you! Had a great time -- thanks! Dearest: So did we... thanks :) You were terrific :) PianoMary: Thank you! JPLJAXX: Thanks so much - MtnMaw: Thank you Randwarco: Thanks for a great chat! PianoMary: You did so well for your first guest chat! RCHCTH: Thank you Mubotulip: Thanx LLAJ2: Thank You Irish48236: Super Fintouch33: Thanks so much Mantel6: ô¿ô Thanks Carol Turkington: Oh, thanks pianomary! :) Cinda: You did wonderfully! for a newbie Sherry1015: Love you Dearest! :) PianoMary: {S applause Sue: And the audience was very well behaved too....... Dearest: Sherry, my dear friend :) Irish48236: Thank you too sue PianoMary: Yes, we were Grandma Sue Dearest: They certainly were, Sue :) Irish48236: And cinda PZukow: Thanks to all...and it was great being here again! Geebee2000: We try, Sue :-) Dearest: Thanks, as always, to my wonderful co-hosts, Cinda and Sue :) Irish48236: Hurrah Cinda: Carol, I hope you come back for another chat! Dearest: We'll adjourn to the regular health chat room now for anyone who's interested in an open chat :) Sue: I spent many many nights down in the audience LOL Sherry1015: Got Revival this week, YUM Sue: See you there Carol Turkington: I'd love to! Dearest: Thanks, again, Carol. The transcript will be up on the Web site in about one week. Carol Turkington: Ok -- thanks, dearest! Dearest: Anyone who wants info as to where to purchase Carol Turkington's books, feel free to Email me. Read Carol Turkington's Second Transcript Disclaimer: Every guest in Power Surge is a highly respected professional whose opinions are his/her own. An appearance in Power Surge does not constitute an endorsement of a guest's views. None of these transcripts may be reprinted or reproduced without the express permission of Power Surge™ and the respective guest. Read other transcripts by returning to the Library. Dearest aka Alice Stamm Power Surge Founder, Facilitator, Host Copyright©1994- by Power Surge. 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