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Switching from a conventional anti-depressant to st john's wort: jake’s story SWITCHING FROM A CONVENTIONAL ANTI-DEPRESSANT TO ST JOHN'S WORT: JAKE’S STORY
Jake is a 29 year-old freelance writer and health food shop owner, who is currently trying to write and sell screenplays. He has suffered from feelings of sadness, fatigue and anxiety off and on since the age of three when his parents got divorced. He remembers being sick a lot as a child and getting into many fights at school. He was the class clown and was often in trouble with teachers.
Jake's depressions went undiagnosed until age 22, by which point he felt extremely sad and dejected. He had recently completed his university course but didn't know what he wanted to do with his life. He was working as a fund-raiser for disadvantaged children, but was tired much of the time and had a hard time performing his tasks. When he consulted me that autumn, he had quit work and was home sleeping for most of the time.
Jake had previously been treated with Prozac, but it didn't help his lack of energy, which was one of his main symptoms, and made him feel 'spacey'. I then treated him with another SSRI in high dosages. Although the drug made him feel more energetic and less down-in-the-dumps, it also made him angry and irritable and he developed a nasty edge in his dealings with other people that was quite uncharacteristic for him. To combat these unwelcome effects, I added a second mood-regulating drug, lithium carbonate. In addition, he also received psychotherapy and light therapy. This combination of treatments was quite effective and by the new year Jake had enough energy to acquire two part-time jobs and felt about as good as he could remember ever feeling. He was bothered, however, by medication side-effects such as sleep disturbance and continued aggressive feelings despite the placating effects of lithium.
After several years on this combination, Jake stopped his medications because he wanted to see how he would do without them. He felt fine until he moved to a new city with his girlfriend. He had always had difficulties with transitions and he felt the old familiar fatigue and anxiety coming back to him and consulted a GP, who restarted Jake on anti-depressants. Once again, he began to feel unpleasantly edgy. At Jake's request, the GP prescribed a different anti-depressant, Lustral, which helped his mood somewhat but decreased his sex drive a great deal. Not only was he less interested in sex, but also had difficulty with erections and orgasms. He began to avoid sex because it was uncomfortable for him not to be able to perform and affected his self-esteem.
Jake read about St John's Wort in the popular press and coinci-dentally, I had just begun to treat his mother with the herbal extract with excellent results. Since he is interested in alternative medicines, he put himself on St John's Wort, 300 mg three times a day, and gradually phased out the Lustral. His sex drive, mood and energy improved markedly following the introduction of St John's Wort. The only side-effect was mild indigestion, which responded readily to antacids and was in any case short-lived.
Jake's mood and energy levels are as good as they have ever been and he finally feels 'like a normal person'. He is grateful to the herbal remedy for helping him so much, even though he recognizes that he has also worked very hard to feel better about himself and his life. This work has involved therapy and self-reflection, regular exercise and actively avoiding toxic influences and negative attitudes. He plans to move to Los Angeles where he is more likely to succeed as a screenwriter, and feels optimistic even though his chosen course is a difficult and risky one and he has recently broken up with his girlfriend, with whom he was deeply in love.
Although Jake shifted from Lustral to St John's Wort on his own, it is certainly better to make such changes under a doctor's supervision. But Jake had clearly learned some of the key principles of anti-depressant management during his years of psychiatric care and did a good job with juggling his own medications. He recalled, for example, that you should try not to stop an antidepressant abruptly if at all possible. To do so is to court withdrawal side-effects, such as dizziness, sleep disruption and flu-like symptoms, to name just a few. Also there can be a rapid decline back into depression again. So Jake was wise to taper his Lustral gradually. In addition, Jake recognized that finding the right antidepressant is only one aspect of the treatment of depression. He is combining the herbal remedy with other healthy activities, such as therapy, self-reflection, exercise and the avoidance of negative influences. His move to Los Angeles also promises to be a healthy choice for him as it is more likely to offer him the career opportunities he needs in order to feel professionally fulfilled.
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