Our expert says:
Actually ( also for Zeena!) I'm not against st John's Wort, though I believe we need to get it into perspective -- there is some evidence that it can help mild Depressions, but when it does so, it does so by EXACTLY the same sort of cemical effects as does Prozac and its relatives. It isn't helping in some mysterious alternative way, as some of its hawkers try to imply.
What does rile me is the false assertions that herbal remedies are somehow "natural" and inherently better than chemical remedies. They're not natural ( our ancestors did NOT wander round chewing most of these herbs, actually ), and if one means naturally-occurring, well, then the presence of similar chemicals in the Wort and in Prozac, suggests that Prozac would be considered "natural", too. And natural doesn't automatically mean healthy and good for you --- arsenic and strychnine are totally natural, but really not good for us at all.
My main concern about herbal remedies is this. One is that they're always dirty. When you swallow Prozac, you're consuming one single chemical entity, Fluoxetine ; which is easier to evaluate for safety and effectiveness, ans 20 mg of it in one tablet is the same as 20 mg of it in another tablet. When one takes any herb, such as the Wort, though it is likely to contain some of the substance you want, the exact amount is always unpredictable, and is always accompanied by a host of other chemicals. most of which no-one on earth knows anything about. So it is far harder to get reliability of effect, and far harder to know what benefits and risks will be involved. Also, there are rarely proper studies of the efectiveness and safety of herbal remedies, and especally in a country like SA where the health authorities seem to have totally given up any interest in monitoring the accuracy of benefit claims made for products, and in requiring proof of effectiveness and safety, especially when a drug remedy is allowed to pretend to be a "dietary supplement", high caution is the only sensible approach.
I'm puzzled by the inconsistency of people who on the one hand get very anxious about possible harm caused by such technological creations as genetically modified foods ( merely making more eficient a process farmers have used for centuries ) and without any actually existing evidence of harm ; they on the other hand cheerfully devour any form of herbal remedy or "supplement" though very much less is known about their safety, and many of those marketing companies invest little or nothing in appropriate reseach to check this.
Anyhow, to return to your precise question.
Though I have seen sme evidence that the Wort can be effective in treating MILD depression ( not severe Depression) in single episodes, I have not seen any research on its effectiveness in a chronic condition like Dysthymia, or to safety and effectiveness in really long-term use. Also, studies have suggested that in treating Dysthymia with the Prozacs of this world, the same or a higher dose than needed in treating ordinary Depression seems to be useful, but not lower doses. This would suggest that a very low dose Przac like St Johns Wort may not be enough to be helpful.
( BY the way, do remember, if you need Fluoxetine again, to check out as there are other generic forms than Lilly-Fluoxetine, which may be equivalent and even cheaper ).
Serotonin is one of the major chemicals involved in our brain's regulation of our mood ( not the only one ) ; and it seems likely that while all of us are capable of becoming Depressed under the right, or rather the wrong circumstances in terms of life experiences, some of us are more vulnerable, perhaps with an inherently less stable set of mood regulation mechanisms, and are capable of being pushed into a Depression either by purely chemical events, or by less intense or less long-lasting life experiences than others.
Be wary of the drinking, a you know, because though it may help one feel a little better in the short term, especially to the extent that anxiety is part of the picture, it doesn't help in the long-term, is a potent cause of worsening Depression, and may interere with the actions of remedies for Depression.
Where Depression is signifcantly severe and recurrent, modrn expert consensus leans towards considering long-term use of a drug like Fluoxetine. As you've found, there can be a high risk of recurrence if one stops the medication, and apart from the suffering experienced, it can take longer to re-establish control of the condition if one has to start again periodically.
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