For Those Currently Taking Prescription Antidepressants
If one is successfully being treated with prescription antidepressants, there are no adverse side effects, and the cost is not a prohibitive factor, the first question to ask is, "Why change?"
We have no good reasons. As we've already discussed, the treatment of depression is as much an art as a science, and where the art and science of medicine have combined to successfully treat an illness, one should interfere only for good reason.
Those, however, who are currently taking prescription antidepressants and want to switch to hypericum must observe certain safeguards.
Alas, the medical research on switching from prescription antidepressants to hypericum is virtually nonexistent. From what is known about hypericum and prescription antidepressants, certain guidelines can be established.
1. Do not stop taking prescription antidepressants without proper medical care. The "rebound effect" of stopping prescription antidepressants too abruptly can be severe.
2. Do not take hypericum for severe depression or bipolar (manic-depressive) illness. Not enough research has been done on hypericum and these types of depression. As we've said, the vast majority of depressions fall in the mild to moderate range. A depression must be clearly debilitating to be termed severe. Severe depression can include hallucinations and, in some cases, suicide attempts. It may require hospitalization. The physician who prescribed the antidepressants or who is currently monitoring the course of treatment is the best person to determine whether one is severely depressed.
3. Do not take hypericum while taking mono-amino-oxidase (MAO) inhibitors such as Nardil or Parnate. It appears that hypericum works at least in part as a serotonin reuptake inhibitor (SRI). Combining an SRI with an MAO inhibitor can produce a dangerous rise in blood pressure. After stopping MAO inhibitors, one should wait four weeks before taking any SRIs -- prescription or hypericum. This caution, however, is not based on specific medical research on hypericum and MAO inhibitors, but on what is known about prescription SRIs and MAO inhibitors. Until further research is done on how and why hypericum works to alleviate the symptoms of depression, hypericum should be considered an SRI and treated accordingly.
The best way to make the transition to hypericum from SRIs -- Prozac, Paxil, Zoloft, and Effexoris not known. Medical studies exploring this question are sorely needed.
If hypericum acts as a serotonin reuptake inhibitor in the same way as prescription SRIs, then it would appear that a gradual introduction of hypericum while tapering off the prescription antidepressant would be in order.
Hypericum tends to take longer to reach maximum effect in the body than do prescription antidepressants. This may indicate that a gradual building up of hypericum over four to six weeks should precede a significant reduction in the prescription antidepressants.
One must at the same time be careful not to take too many SRIs, to avoid the medical condition known as serotonin syndrome. Here the brain has too much serotonin -- the opposite of what happens in depression -- and symptoms include sweating, agitation, confusion, lethargy, tremor, and muscle jerks. If such symptoms occur, consult your doctor immediately.
Of course, the possibility always exists that the hypericum may not treat the depression as successfully as the prescription antidepressant. It should not and cannot be assumed, just because one found successful treatment with prescription antidepressants, that hypericum will prove equally successful. A certain percentage of people will not respond to hypericum as well as they responded to prescription antidepressants.
It is reassuring, however, to know that the side effects of hypericum are few and hypericum's negative interaction with any other drug (other than, potentially, MAO inhibitors) has not been reported.
As research continues, we will attempt to keep current on the best methods of making the transition from prescription antidepressants and print them in future editions of this book.
Copyright © 1996 by Harold H. Bloomfield, M.D. and Peter McWilliams
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