psychologist's experience with St. John's wort
was able to tolerate Prozac for only two days, and Zoloft for about a
week. With St. John's wort, she had no side effects and her depression
lifted within a week.
VICUS.COM (17 February 2000) -- "I cry so much of the time, and I am so tired. I can't take it anymore." Marsha looked up with her large, sad brown eyes and continued, "I can't deal with this divorce. At every turn, he is there to defeat me. Last night he called to ask if I needed money. When I told him I needed $500 to cover moving expenses, he laughed. He would only give me $50 since that's how much he thought I should have spent. By the end of the call, I was crying. I feel guilty for all I've done wrong in our marriage. Even though he's the one mistreating me and our son, he makes me feel as though the divorce and everything else is my fault."
Managing depression in patients who won't or can't take drugs
I am the second provider Marsha has come to for help. Several months ago, a psychiatrist prescribed medication. She was able to tolerate Prozac (fluoxetine) for only two days, and Zoloft (sertraline) for about a week. One drug gave her headaches, the other one dry mouth and stiffness. Halving the dose or waiting for the side effects to pass was met with stone-cold resistance. It was clear that Marsha, like many of my clients, is philosophically and/or biochemically intolerant of certain drugs to treat her depression.
Depression is an invisible illness. There are no open sores, no clinically significant blood tests, and no hard physical findings. While professionals recognize the biochemical underpinnings, laymen typically do not. Not only is depression misunderstood ("It's all in your head!"), it is stigmatized. For example, I routinely educate family members that their loved one is depressed, not "lazy."
There was no doubt that Marsha needed cognitive restructuring. She needed to learn how to take care of herself for a change, as opposed to taking the blame for everything wrong in everyone's life. She needed to take responsibility for her life, and no one else's. The ability to take responsibility presumes a measure of strength and personal power: self-esteem, knowledge of personal boundaries, verbal assertion skills, and the ability to counteract telltale irrational guilt, for starters.
Unfortunately, acquiring a more adaptive perspective would be an uphill battle, given her clinical depression. Relief would not be around the corner for this headstrong woman who was opposed to taking "drugs," and who viewed Prozac and Zoloft as a "crutch" that gave her side effects and little else.
What's a shrink to do?
I suggested that she try an herbal remedy. A rather impatient, results-oriented therapist, I was reluctant to wait the 10 to 12 weeks it would take cognitive behavior therapy to work, when concurrent herbal treatment to correct her chemical imbalance could speed her return to health.
At my suggestion, Marsha started taking St. John's wort, which is considered an effective treatment for mild to moderately severe depression The results were no less than remarkable. She experienced no side effects and her depression lifted within a week. Encouraged by her good response, Marsha worked hard in treatment and made excellent progress in acquiring the skills needed to negotiate life and prevent or mitigate future depressive episodes.
So, what happened?
Perhaps the chemical differences between St. John's wort and the prescription drugs accounted for the differences in her body's ability to tolerate drug treatment. However, I'm more inclined to believe that because Marsha was more receptive to the idea of an herbal remedy, she did not fight it. Without strong philosophical or other opposition to "a natural approach," she allowed the chemical to work with her body in balancing her brain chemistry. Alternately, or in addition to, perhaps her expectations of "a natural approach" allowed the "placebo effect" to quickly evidence its magic.
The point is, for whatever reason, that the herbal remedy succeeded where the prescription drug failed. Parenthetically, this is not an uncommon occurrence in my practice. While I was initially reluctant to recommend approaches we know less about, my patients have taught me otherwise. Today, I rely less on pharmaceuticals and more on supplements. Following a careful evaluation, I routinely recommend a natural remedy trial when a client rejects or fails standard treatment. In my experience, remedies such as St. John's wort work well in mild to moderate cases of depression. And the evidence from clinical trials continues to accumulate.
I eagerly await the results of the ongoing National Institutes of Health study on St. John's wort.
Irene Matiatos is a licensed psychologist in New Jersey and New York, where she maintains a practice as a cognitive behaviorist in all aspects of addiction and recovery phenomena.
Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, 4th edition. The Haworth Herbal Press, New York, 1999.