(Dr. Steven Bratman's First Visit to Power Surge)

OnlineHost:     Dr. Steven Bratman has entered the room.


Dearest:	My guest tonight in Power Surge is a physician who 
integrates conventional medicine with alternative methods. He
believes that alternative medicine strengthens has both strengths and
weaknesses, just like conventional medicine.

Dearest:	Dr. Bratman is the author of 
"Beat Depression with St. John's Wort", and

"The Alternative Medicine Sourcebook: A Realistic Evaluation of 
Alternative Medicine", and the upcoming

"Alternative Medicine Ratings Guide: An Expert Panel Ranks the Best
Alternative Treatments for Over 90 Conditions"


Dearest:	He lectures widely, consults for medical boards on issues 
of alternative medicine and publishes essays in national magazines.

Dr. Bratman. Is St. John's Wort truly as effective in many 
cases as Prozac? Thanks and welcome to Power Surge :)


Dr. Steven Bratman:	St. John's wort has never been 
compared directly with Prozac; however, for mild to 
moderate depression, the herb seems to be about as 
effective as any conventional antidepressant. 


Dearest:	That's interesting, Dr. Bratman, I've 
heard numerous references to St. John's Wort as 
"effective as Prozac."


Dearest:	RCHCTH, go ahead, please :)


RCHCTH:	Is there a best time of day to take St. 
John's Wort and in what starting dosage? 


Dr. Steven Bratman:	The best way to take St. John's wort is 
three times a day, although you can get away with twice
a day if necessary.  The dosage is fixed at 300 mg 3x a 
day of an extract standardized to contain .3% hypericin.  
That's how it's used in Germany, which is where it was 
developed.   So that's considered optimal here. 


Dearest:	MARFGR, go ahead, please :)


MARFGR:	Taking Paxil & Buspar for anxiety/
depression.  Paxil makes me nauseous, Buspar makes
 me jumpy.  Could I benefit from trying St. John's Wort?


Dr. Steven Bratman:	St. John's wort is a good substitute for 
Paxil if your depression is mild to moderate.  It's not 
directly an anti-anxiety agent like Buspar, however.   
	All anti-depressants help anxiety to some extent, 
but sometimes a separate anti-anxiety treatment is 
necessary.  In the realm of natural treatments, that might 
be Kava. 


Dearest:	Dr. Bratman, women have asked if
they can take St. John's Wort while on other
medications, such as Xanax or Valium.. What's your 
feeling about this?


Dr. Steven Bratman:	There are no known problems mixing 
St. John's wort with any medications.  This doesn't
guarantee no problem will ever occur, of course, but so 
far none have been discovered. 


Dearest:	Chloe, go ahead.


Chloecake:	How long before it kicks in...in weeks....


Dr. Steven Bratman:	No one really knows why antidepressants 
take a while to work, but they all do. St. John's wort is just 
like other anti-depressants in this regard.  It takes about 
4 - 6 weeks to achieve full effect.   It's important to be 
patient and keep on taking it for a while before deciding 
whether or not it's going to work for you.  


Dearest:	Dr. Bratman, since SJW is an MAO 
inhibitor, couldn't it be dangerous to take with certain 
blood pressure MAO medications?


Dr. Steven Bratman:	I'm glad you asked this question.  
Actually, SJW is not an MAO inhibitor.  That incorrect 
idea is unfortunately still widespread.   An MAO inhibitor 
is one of the first family of drug anti-depressants.  They 
work well, but they are rather dangerous.  You have to 
be careful what medications you take and even what 
you eat when you're on one.   

	Back in 1984, a couple of highly theoretical 
experiments seemed to suggest that SJW was an MAO 
inhibitor itself, but those experiments turned out to be
false alarms.  This herb is NOT an MAO inhibitor, and 
no MAO inhibitor reactions have ever been observed 
with it. 


Dearest:	Why is there so much current literature 
saying it's an MAO inhibitor if it's not?


Dr. Steven Bratman:	Each article repeats what's written in the 
other articles.  Also, the original German report on SJW 
(written in 1984) mentioned the MAO inhibitor subject, 
because that's when the misleading research had just 
been performed.  But more recent scientific articles have 
abandoned that concern.  To the best of our knowledge, 
SJW works more like Prozac than like an MAOI drug.


Dearest:	Amazing.... thanks.. VBrando, go ahead.


VBrando101:	My mom claims she can smell a certain 
smell while on St.J.Wort have you ever heard of this?	
And what about hair loss?


Dr. Steven Bratman:	No -- but I hear all kinds of things!  
People can have any reaction you think of to anything.  
I would describe her experience as unique to her. I 
know someone else who sees double when she takes 
vitamin C.  We're all different!


VBrando101:	Thanks


Dearest:	Thanks so much.... IDunno, go ahead.


IDunno2917:	Is there a difference in effectiveness 
among the many brands out there? Also my pharm. told 
me to take 2 pills daily and all the literature says 3.
Comment please.


Dearest:	One question at a time, please. We
don't want to confuse our guest  (it's enough you 
confuse the host)  :)


Dr. Steven Bratman:	Thank you for asking another good 
question.  Because SJW is sold as a food supplement in 
this country, there is little to no supervision of the quality 
of the herb sold.  There may be enormous differences in 
quality, but it's hard to know which is best.   Recently, 
Walmart has started to import the German source of ST. 
John's wort, under the brand name "KIRA."  This is the 
form of the herb used in most of the scientific studies, so 
I think it's likely to be high quality.  The German
equivalent of the FDA *does* certify the quality of 
herbs sold.  


THRVErica:  Walmart selling St. John's Wort? LOL


Dr. Steven Bratman:	Yes, it is funny that Walmart is selling it.  
Regarding dose, your pharmacist may be correct if it is
a 450mg version of SJW he/she is selling.


Dearest:	Thanks, Dr. Bratman :)
		BChilltop, your turn :)


BChilltop:	I have been taking Zoloft for several 
years. I would like to try SJW and gradually decrease 
and discontinue the Zoloft any side effects or 
suggestions?


Dr. Steven Bratman:	I will try to keep my answers brief  -- 
but I have to be careful how I answer sometimes, and 
this is one of those times.   

	Much depends on how depressed you were 
prior to starting the Zoloft.  If you were seriously 
depressed, meaning suicidal or otherwise in a deep 
depression, there is a real likelihood that your depression 
may return after you stop the medication.  	

	St. John's wort is not powerful enough for 
severe cases of depression.  However, if you, like many 
other people, started medication for mild to moderate 
depression, SJW is a very reasonable alternative.  I 
recommend that if you want to try to switch over in that 
case, that you do as follows:  cut your Zoloft dose in half, 
while adding a full dose of SJW.  Then, after 2 weeks, 
stop the Zoloft entirely.


Dearest:	Excellent reply, Dr. Bratman. Thank you :)  
		Lbear, go ahead, please.


Lbear34:	"Positive Outlook" -  is this a good 
med?  I  heard 2 weeks to notice a change, 4 for full 
effect. I just started it a week ago for anxiety and mild 
depression


Dr. Steven Bratman:	I'm not sure I understand the first part
of your question. 


Dearest:	She started taking something called 
Positive Outlook, and wants to know how long it takes 
to go into effect.  She'd heard two weeks.


Dr. Steven Bratman:	Unfortunately, I'm not sure what Positive 
Outlook is.  Does it contain SJW?  If so some people
notice an effect in 2-3 weeks, but most people don't 
notice anything for 4 weeks.  


Lbear34:	yes and Kava Kava


Dr. Steven Bratman:	Kava, however, takes effect in about a 
week.  But it isn't an anti-depressant.  It's more of a mild 
herbal calming agent. 


Dearest:	Dr. Bratman, what's your best suggestion 
for menopausal anxiety?  herbally speaking, that is :)


Dr. Steven Bratman:	Another good question, but the answer 
can't be too simple.  For anxiety itself, I recommend 
trying a combination of Kava with herbal antidepressants 
such as St. John's wort and Ginkgo. (Ginkgo works as 
an antidepressant too.)   

	Dietary changes can be helpful also.  But, for 
*menopausal* anxiety, it makes more sense to directly 
work with the menopause, than simply to treat some of 
its symptoms.  Herbal medicine for menopause, however, 
is a hugely complex subject. 


Dearest:	Thank you .... Mimi, go ahead :)


MIMISUSAN:	Had problems with nausea in the 
beginning.  Taking SJW about a month.  Is this 
common? 


Dearest:	(me, too, Mimi)


Dr. Steven Bratman:	Nausea seems to happen in about 1/2% 
of people who take SJW, according to German statistics.  
However, Americans have a higher incidence of 
side-effects with all treatments, whether herbs or drugs (!).  
In my practice, I think that nausea seems to happen in 
about 10% of cases.  It will often be minimized by 
combining SJW with food.  


Dearest:	Thank you, Dr. Bratman (and you're quite
a meticulous typist) :)  Joan, go ahead, please 


Joan5000: 	Could my son stop Klonopin, as he is 
on Pamolar, and can't get out of bed, overmedicated?  
He is also on heart meds.


Dr. Steven Bratman:	Pamelor is an anti-depressant, and 
Klonopin is a tranquilizer.  As I've mentioned previously, 
anxiety is often treated with a combination of anti-anxiety 
and anti-depressant treatments.  St. John's wort is more 
a substitute for Pamelor than for Klonopin.  However, I 
would have to know numerous details to be able to 
advise whether he should change his treatment. 


Dearest:	How old is your son, Joan? 
(sorry for his difficulty)


Joan5000:	Thanks, 38 yrs. old.  Thanks Dr.


Dearest:	Sorry... hope he's well soon, Joan.  
		Norlee, go ahead.


Norlee:	 	Is SJW  at all useful for a chronic, 
seemingly major, long term depression, as a part of
bipolar  disorder ? ( he is also on several  Rx Meds....)  
elaborate either way, please.


Dr. Steven Bratman:	SJW can be quite useful for long term 
depression.  However, this is only the case for
mild-to-moderate depression.   The language is 
somewhat awkward here.  I am referring to 
mild-to-moderate major depression, and distinguishing 
that from severe major depression.  The latter involves 
more intense symptoms, such as suicidality and other 
disabling symptoms.


Norlee:		(Son, 32.  He keeps trying to medicate 
himself....)


Dr. Steven Bratman:	  SJW is not useful for severe major 
depression.  Also, it is not directly useful for bipolar 
disorder.  The problem with using any anti-depressant 
in manic-depressive disease is that it can provoke a 
manic episode.  It sounds like your son's case is 
complex -- probably too difficult for me to address
in detail on line.  Sorry.  


Norlee:		Thanks!


Dearest:	Windock, go ahead, please :)


WINDOCK1:	I've heard some antidepressants can 
have an effect on the thyroid, any risks involved? 


Dr. Steven Bratman:	St. John's wort doesn't appear to cause 
any problems with the thyroid. 


Dearest:	Thank you, Dr. Bratman... 
		JElliotSoy, go ahead, please :)


JelliotSoy:	What are some of the other side effects 
associated with SJW? Long term use?


Dr. Steven Bratman:	The most common side-effect is mild 
allergic reaction, such as a skin rash.  Of course, such 
reactions can happen with any treatment whatsoever.   
Allergic reactions, however, occur only in .5% of the 
population.  Another rare side-effect is drowsiness.  
I've seen that one happen maybe in two or three patients.  

	Regarding long term side-effects, it is important 
to recognize that practically no herbs nor drugs have ever 
been studied over the long term.  It is simply too 
overwhelmingly expensive.  For example, if you look up 
Prozac in the PDR (physician's drug reference) you will 
read that it has never been evaluated for more than 6 
weeks. The same is true of SJW.  No long term risks 
are known -- but one can't definitively say that none 
exist. 


JelliotSoy:	I see, and I thank you, Doctor Bratman :)


JOEGLORIA:	Is this a cancer chat?


THRV Erica:	No Joe, this is a chat for women in 
menopause


Dearest:	We're discussing St. John's Wort, Joe, 
you're welcome to stay :) Who knows, maybe next week 
there'll be a St. Joe's Wort, too. Lily, go ahead.


Lily5671:	I understand that SJW is used for 
insomnia; wouldn't three times a day cause drowsiness?


Dr. Steven Bratman:	Actually, SJW doesn't treat insomnia 
directly.  Like other anti-depressants, it tends to improve
sleep after several weeks of use.  This is because 
depression can cause insomnia.  SJW is not directly a 
sleeping pill.  It does *not* cause drowsiness, except 
in very rare cases. 


Dearest:	Thank you, Dr. Bratman. MAnder, go ahead.


MAnder8733:	I am allergic to aspirin and take ritalin 
and synthroid, is there a problem taking sJw? 


Dr. Steven Bratman:	As I've mentioned earlier, there are no 
known drug interactions with SJW.  However, this 
doesn't mean there will never be one.  Also, you could 
be allergic to SJW.  Not because you're allergic to 
aspirin, but just because.


Dearest:	WoodyEllen, go ahead, please.


WoodyEllen:	Why is large amounts of water to drink 
recommended?  I bought mine at Sam's Club. 


Dearest:	You bought your water?


WoodyEllen:	No silly -- the SJW!  :o))


Dr. Steven Bratman:	I like your screen name.  I haven't heard 
of recommending water with SJW, although it wouldn't 
hurt.  Maybe Sam's Club SJW has a lot of salt in it. :-) 


WoodyEllen:	I was trying to contain space.  The SJW 
from Sam's was from the "Your Life" co. 300 mg caplets.


Dr. Steven Bratman:	I don't recognize that brand. 


Dearest:	MsLizzie, go ahead, please :)


MsLizzieB:	Anything besides calcium, magnesium, zinc, 
and garlic to control high blood pressure?


Dr. Steven Bratman:	This is slightly off the subject, but that's
fine.   You didn't mention coenzyme Q10, which is one 
of the best blood pressure treatments in alternative 
medicine.  It's widely used in Japan and also in Denmark 
as a prescription drug for that purpose.  Here, however,
it's a food supplement.  Another useful treatment is 
hawthorne.  


MsLizzieB:	Thank you very much


Dearest:	Shebird, go ahead.


Shebird474:	I've taken SJW for 8 months! 
100% Wonderful!!!  How long can I take the drug? 


Dr. Steven Bratman:	So far as we know, there is no problem 
with long term use of SJW.  However, some patients 
have told me that after a couple of years it doesn't work 
as well.  One hears the same thing about anti-depressant 
drugs too.  I recommend making positive life changes 
while taking the herb, so that when you finally stop it you 
will be less likely to fall back into depression.  


Dearest:	Thank you, Dr. Bratman.
		Shirljo, go ahead.


Shirljo:		Does SJW affect the CNS, ie: seizure 
disorder and what effect if any on seizure activity? 


Dr. Steven Bratman:	There are no known problems with 
SJW in people who have a seizure disorder.  But, again 
that is no guarantee that there never will be. 


Dearest:	EveG, go ahead, please.


Eve G 406:	How can we find a Dr with similar 
beliefs/knowledge as your's in our area? 


Dr. Steven Bratman:	This is a difficult question.   It's easier in 
large cities and on the coasts.  However, I will have to 
admit that there are a lot of alternative physicians I 
wouldn't trust, too.  Where do you live? 


Eve G 406:	(live in IL....Rockford area)


Dr. Steven Bratman:	Sorry, I don't have any recommendations 
for that area.  


Dearest:	Di, go ahead.


Di5312:	If your taking Paxil for MS, (for the 
pain and tingling ) will Sjw help the same way Paxil 
can by decreasing the symptoms?  


Dr. Steven Bratman:	It may very well.  It's definitely worth a 
try.  Anti-depressants are often good for pain in general, 
for reasons that are not understood.  SJW is no 
exception.  


Dearest:	VBrando, go ahead.


VBrando101:	Never had depression till peri-meno.  I 
now suffered 2 bouts within 3yrs.  I'm on Paxil do you 
think I should try SJW?  Doing fine on the Paxil.


Dr. Steven Bratman:	You could try it, so long as the 
depression you're referring to wasn't serious major 
depression.  As I explain in my book, Beat Depression 
with St. John's wort, this herb is only useful for 
mild-to-moderate depression, not involving suicidality 
of other disabling symptoms.   

	However, be somewhat cautious getting off of 
Paxil.  More than with most other anti-depressants, 
Paxil seems to cause strange withdrawal symptoms in
some people.  You have to take it slow.   If Paxil is 
working for you, you might want to just stay on it.  
It's not a dangerous medication.  


VBrando101:	Yes I went off it before and it was weird.
thanks


Dearest:	Chloe, go ahead.


Chloecake:	Can coenzymeQ be used in conjuction 
with prescribed high blood press meds? 


Dearest:	Good question.


Dr. Steven Bratman:	Yes.  IN Japan, COQ10 is widely used 
in conjunction with other medications.  Its effects are 
very gradual, so there is no danger of suddenly 
developing too low BP. Simply monitor your BP over 
about a 6 week period, and if it begins to fall, you may 
be able to reduce your medication (with the supervision 
of a physician, of course). 


Dearest:	Dr. Bratman, this may be out of your 
area of expertise, but I'm curious as to your thoughts 
about taking HRT (synthetic/natural) *and* using 
phytoestrogens, such as soy isoflavones, tofu, etc.?


Dr. Steven Bratman:	Aha, another huge question.   I discuss 
this at greater length in my next book, The Alternative 
Medicine Ratings Guide.   To put it briefly, there are 
numerous alternatives to estrogen for all the symptoms 
of menopause but one.  Osteoporosis, however, seems 
to be difficult to address completely through natural 
means.  

	But there are many other ramifications of the 
question.  For example, estrogen as commonly 
prescribed is actually a rather natural substance.  DHEA, 
for example, is often described as a "natural alternative 
to estrogen," but it is clearly no more nor less "natural" 
than estrogen.  There's a lot of confusing rhetoric in this
field.  


Dearest:	Thank you, Dr. B .. .RCH, go ahead.


RCHCTH:	What would you recommend in place 
of Xanax (.25mg at bedtime) for pms sleeplessness?

Dr. Steven Bratman:	Xanax is very difficult to get off of.   
Once you get used to such a powerful treatment, 
anything less may seem like nothing.  I suggest changing 
to a milder drug first, such as one of the older 
anti-depressants, and then trying to make the move to 
an alternative treatment, such as Kava at bedtime 
combined with long term SJW. 


Dearest:	IDunno, your turn.


IDunno2917:	You mentioned diet in conjunction with
SJW (good/bad). Can  you elaborate?


Dr. Steven Bratman:	I'm not sure I understand your question.  
Please clarify. 


IDunno2917:	Are there specific foods to use in 
conjuction with sjw and those to avoid.  Sorry.


Dr. Steven Bratman:	Not in particular.  However, it is always 
worthwhile to have a healthy diet.  Some foods can 
worsen depression, in particular those high in sugar or 
caffeine.  


Dearest:	Kasan, go ahead


Kasan52:	I am taking 10mg of Prinivil is there a 
problem if I take SJW twice a day?


Dr. Steven Bratman:	As I've mentioned before, there are no 
known interactions between SJW and any medication.  
However, this doesn't mean there never will be.  But 
there's another point: SJW should be taken 3x a day, 
not twice.  The proper dose is 300mg 3x a day.   You 
can take it twice a day, if you must, but it is often less 
effective that way.  


Dearest:	Dr. Bratman,  what's the "shelf-life" of 
herbs, or at least, St. John's Wort? 


Dr. Steven Bratman:	Good question.  Unfortunately, the 
answer isn't known.  You see, we don't know which 
are the active ingredients in SJW, so we don't know 
if they decay with time.  


Dearest:	Thank you.. Foxy, go ahead :)


Foxy225:	Am new to alternative meds - how do I 
know where to safely buy SJW - what dosage to start?


Dr. Steven Bratman:	It can be purchased anywhere these 
days.  Unfortunately, it's hard to know which brands are 
best.   Walmart is importing the classic German form of 
St. John's wort  under the brand name Kira, and that 
should be good. 

	I also like Enzymatic Therapy,  Nature's Way 
and Source Naturals.  The proper dose is 300mg 3x a 
day of an extract standardized to contain .3% hypericin.  
You start with that dose, and then continue with it.  
There's no need to start lower and then increase it.


Dearest:	Blush, go ahead :)


THRV Blush:	I take Vasotec and lasix for hypertension, 
will SJW interfere with those 2 drugs (you'd mentioned 
SJW may be high in sodium)? I was on Zoloft until 8 
weeks ago and feel I need something for depression 
again.  What is MAO Inhibitor? 


Dr. Steven Bratman:	I was joking when I said that SJW might
have salt in it at Sam's Club.  I made that particularly
hilarious remark because the questioner had asked 
about drinking water with it.  SJW is not high in sodium, 
and it has no known interactions with Vasotec (or any 
other drug).  

	An MAO inhibitor is a member of the oldest 
type of chemical antidepressant.  They are quite effective, 
but rather dangerous to use. They can cause severe 
reactions if you aren't careful what you eat while taking 
them. However, SJW is _not_ an MAO inhibitor.  


THRV Blush:	What does MAO stand for?


Dr. Steven Bratman:	Monoamine Oxidase. 


Dearest:	Thanks.. excellent answers, Dr. Bratman
Bitsy, please go ahead.


Bitsy2:		Hi, I had a complete hysterectomy 3 yrs 
ago, am on Premarin .625, also use a Progesterone cream.  
I am wondering about a estriol cream that can be 
prescribed - have no sexual desire since surgery.


Dearest:	Bitsy, we're discussing St. John's Wort 
and other herbs tonight. Please E-mail me, Bitsy, and I'll send 
you some information.


Bitsy2:	oh ok, sorry


Dearest:	No problem.. I have plenty of info for 
you.


Dearest:	Pplamonica, go ahead.


Pplamonica:	Is it at all beneficial for children of any 
age?


Dr. Steven Bratman:	Another good question.  First, a 
disclaimer:  SJW has never been tested in children.  Nor 
has Prozac, nor practically any drug.  Drug manufacturers 
don't want to take the risk.  Presently, the Clinton
administration is pushing an initiative to require more
testing in children.  However, even despite this lack of 
study, Prozac is commonly used in children, and so is 
SJW.  It appears to be effective in some instances.  The 
dosage is usually reduced by weight proportionately. 


Pplamonica:	Thank you 


Dearest:	Dr. Bratman, do you think, in our 
enthusiasm,  we may be over-herbicating ourselves?  :)
  

Dr. Steven Bratman:	Yes.  I have many reservations about the 
American habit of using pills to treat problems, whether 
drug, vitamin or herb.  Life is more complex than that.  


Dearest:	Exactly, and people think just because
something is called "natural" it can't give them problems.  
Such as toxicity.


Dearest:	Go ahead, Pazz.


Pazzeria: 	Do soy products also lower cholesterol 
beside being replacement for hrt.


Dr. Steven Bratman:	Soy products may be helpful for heart 
disease for various reasons, but they don't lower 
cholesterol directly.  


Pazzeria:	thank you


Dearest:	What about soy lecithin, Dr. Bratman?


Dr. Steven Bratman:	The phosphatidyl choline in lecithin can 
lower cholesterol.  The best forms are purified to contain 
almost nothing but phosphatidyl choline.  


Dearest:	Dr. Bratman, thanks for joining us tonight in Power Surge, and for
sharing so much valuable information about alternative methods and more
conventional medicine as well.

Anyone interested in buying Dr. Bratman's books:
"Beat Depression With St. John's Wort", 
"The Alternative Medicine Sourcebook,"
and his newest book, "The Alternative Medicine Ratings Guide: Top 
Experts Rate the Best Treatments and What They Can Do for You"


Dr. Steven Bratman: Thank you for having me.


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