by Jackie Hart, MD
Q: My doctor prescribed the antidepressant Paxil, because he said my brain does not produce enough serotonin. I dont like the side effects and the medication is expensive. Is there an alternative?
A: Paxil is one of a class of medications called selective serotonin reuptake inhibitors (SSRIs); other SSRIs include Prozac (fluoxetine) and Zoloft (sertraline).
The herb St. Johns wort acts similarly to SSRIs and is thought to block the uptake of the neurotransmitter serotonin; circulation of serotonin for a longer period of time may help improve mood in people with depression.
I would not expect, though, that simply because St. Johns wort is an herb that it is any less costly or has fewer side effects than your current medication. In fact, your question raises some important issues about the similarities between medications and herbs (which some refer to as the "green pharmacy").
Herbs are not benign substances; if they were, they might not have the intended biologic impact. Because, like drugs, herbs can affect biochemical or other physiologic processes, they too can have side effects.
The most common side effects from St. Johns wort include stomach upset, nausea, fatigue, restlessness, and change in bowel habits, such as diarrhea or constipation. Common side effects of SSRIs include nausea, insomnia, nervousness, decreased libido, and erectile dysfunction.
In addition to potential side effects and a cost probably comparable to that of SSRIs, St. Johns wort has recently come under greater and greater scrutiny because of some newly discovered negative interactions with a few medications. For example:
With that in mind, I would recommend deciding between medications and alternatives on the basis of what is best for your health, which you can determine together with your physician.
Q: My doctor prescribed the antidepressant Paxil, because he said my brain does not produce enough serotonin. I dont like the side effects and the medication is expensive. Is there an alternative?
A: Paxil is one of a class of medications called selective serotonin reuptake inhibitors (SSRIs); other SSRIs include Prozac (fluoxetine) and Zoloft (sertraline).
The herb St. Johns wort acts similarly to SSRIs and is thought to block the uptake of the neurotransmitter serotonin; circulation of serotonin for a longer period of time may help improve mood in people with depression.
I would not expect, though, that simply because St. Johns wort is an herb that it is any less costly or has fewer side effects than your current medication. In fact, your question raises some important issues about the similarities between medications and herbs (which some refer to as the "green pharmacy").
Herbs are not benign substances; if they were, they might not have the intended biologic impact. Because, like drugs, herbs can affect biochemical or other physiologic processes, they too can have side effects.
The most common side effects from St. Johns wort include stomach upset, nausea, fatigue, restlessness, and change in bowel habits, such as diarrhea or constipation. Common side effects of SSRIs include nausea, insomnia, nervousness, decreased libido, and erectile dysfunction.
In addition to potential side effects and a cost probably comparable to that of SSRIs, St. Johns wort has recently come under greater and greater scrutiny because of some newly discovered negative interactions with a few medications. For example:
- St. Johns wort should not be taken together with other antidepressants, including SSRIs.
- St. Johns wort seems to reduce levels of indinavir, a medication used for HIV.
- There have been a few case reports of women having spotting in between their menstrual periods when they took St. Johns wort with oral contraceptives.
- Most recently, St. Johns wort has been associated with reduced levels of cyclosporin, a medication used to reduce severe inflammation from rheumatoid arthritis and for immunosuppression, such as that experienced after organ transplantation.
With that in mind, I would recommend deciding between medications and alternatives on the basis of what is best for your health, which you can determine together with your physician.