Anna was 78 when she was first referred to Dr Volz by a local consultant. By that time, her experiences with recurrent episodes of depression went back a quarter of a century. In the early 1980s she was treated with lithium carbonate, which was discontinued when it resulted in thyroid troubles. In the early 1990s she was treated with amitriptyline, one of the older anti-depressants, which caused her severe dry mouth and, on one occasion, an episode of fainting when she got up one night to go to the toilet. Then Prozac (20 mg per day) was tried, and even though it helped her depression to some degree, it caused unbearable sleep problems. Sometimes it would take her as long as two hours to fall asleep at night and then she would wake an average of three times during the course of the night.

When Anna consulted Dr Volz, he judged her to be moderately depressed while on Prozac, scoring 21 points on the well-known Hamilton Depression Rating Scale, on which the higher the score the more depressed the individual. Because of the severe sleep difficulties, Dr Volz decided to switch Anna to St John’s Wort. He did this without any overlap between medications, immediately discontinuing her Prozac and starting St John’s Wort (900 mg per day). Four days later Anna reported an improvement in the quality of her sleep, but her mood had deteriorated slightly and she now scored 24 on the Hamilton Rating Scale. Her dosage of St John’s Wort was increased to 1,800 mg per day. After three weeks her Rating score dropped to 20, after six weeks to 15 and after another four weeks to 10. Anna’s depression continues to improve. Once again, St John’s Wort triumphed where other medications had failed.

There are several lessons to be learned from Dr Volz and his patients. For many people, like Greta, herbal remedies are simply more acceptable than synthetic drugs. Perhaps it is because we are used to eating plants that they seem more natural than pills do. Even though we need double-blind studies, which include placebo controls, to make sure that any effects of a medication are specific and not just due to a placebo effect, it is hard not to become a believer in the anti-depressant effects of St John’s Wort when one encounters patients such as Greta. Adamantly opposed to the very idea that she was depressed and uninformed about the purported anti-depressant effects of St John’s Wort, her symptoms nevertheless responded completely, suggesting a specific effect of the herbal anti-depressant. An added advantage of St John’s Wort over the older anti-depressants is that, like the SSRIs, it does not appear to have any adverse effect on electrical conduction in the heart. For this reason, Dr Volz felt quite comfortable in using it to treat Greta’s depression even though her EKG had revealed some abnormalities in her cardiac conduction.

In Anna’s case, we see the importance of persevering with an anti-depressant treatment. After she was switched from Prozac to St John’s Wort, she initially appeared to get worse before her slow but progressive improvement over the course of the next several months. Her depression was moderately severe when she first consulted Dr Volz and had apparently been somewhat worse before she started Prozac. Nevertheless, St John’s Wort successfully turned it round, indicating once again the potency of the herbal remedy. Despite this potency, the mildness of the herbal antidepressant was apparent in the ease with which this elderly woman was able to tolerate it in dosages that are very much higher than those widely recommended for the treatment of mild-to-moderate depression. This was in marked contrast with the synthetic anti-depressants she had previously taken and on which she had developed unacceptable side-effects.

*33\75\2*

Google Bookmarks Digg Reddit del.icio.us Ma.gnolia Technorati Slashdot Yahoo My Web

Random Posts