Depression: Should I go herbal or the medication route?

 
I have some patients who come to me for Depression who wonder whether St. John’s Wort is adequate in the treatment of Depression. My answer is it depends on the severity of the Depression. 
 
In mild to moderate cases where the Depression has been experienced for 3-6 months or less I would suggest the possibility of St. John’s Wort as a chemical remedy. There has been some recent promising research showing the effectiveness of St. John’s Wort in these cases. The advantage of using St. John’s Wort is not only in its effectiveness but it has fewer side effects than antidepressants. Antidepressants can have side effects such as weight gain, sexual dysfunction, fatigue and insomnia for some. Usually I see these side effects in the higher doses of antidepressants. There are some antidepressants that are worse than others as far as side effects are concerned.
 
If the Depression has been going on for greater than 3 months and especially for recurrent types of Depression I would suggest trying an antidepressant. Both St. John’s Wort and antidepressants increase Serotonin and other neurotransmitters.
 
This article is not meant to say that other forms of help should not be tried. I am a strong believer of Cognitive Behavioral Therapy (CBT) which seems to have the most promising research out as far as effectiveness. However, in the more severe types of depression the best combination appears to be a therapy like CBT combined with an antidepressant. That appears to be the quickest route to the remission of moderate to severe Depression.  
 
If you are not sure what type of treatment is best for you I would suggest you confer with a mental health specialist who prescribes, either a Psychiatric Mental Health Practitioner (Sometimes called an Advanced Practice Nurse) or a Medical Doctor. In some states Clinical Nurse Specialists (CNS) in mental health can also do the evaluations and prescribe medication.

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