A happy combination Q: I would like to wean off of my prescription antidepressant and take St. John's wort instead. But I'm wondering if it's safe to start taking the St. John's wort while I'm still taking my prescription? JVW: My colleague and regular Nutrition & Healing columnist Kerry Bone is an herbalist with years of experience using St. John's wort for treating patients with depression. Here is what Kerry has to say: Under professional supervision -- and this is an important caveat -- there appears to be little problem associated with combining St. John's wort with most antidepressants. (There's less of a problem than with combining antidepressants themselves, yet most doctors don't hesitate to do that.) But there are a few important exceptions to be aware of. St. John's wort actually decreases the activities of the tricyclic antidepressant drugs amitriptyline (Tryptanol, Endep, Tryptine, and Amtrol) and nortriptyline (Allegron). Right now there aren't any published case reports of problems associated with using other tricyclic antidepressants with St John's wort. The situation for SSRI drugs is a little more complex. A few case reports blame the combination of St. John's wort and SSRIs (mainly sertraline, or Zoloft) for causing serotonin syndrome. Serotonin syndrome is a rare adverse reaction that can be caused by taking SSRIs on their own or by combining SSRIs with other antidepressant drugs -- particularly the older class of antidepressants known as monoamine oxidase inhibitors (MAOIs). Basically, what happens is that too much serotonin is formed in the brain, which leads to symptoms such as agitation, tremors, diarrhea, and mental overstimulation. Most of the supposed cases of serotonin syndrome resulting from St. John's wort and SSRIs have occurred in elderly people, which suggests that they are particularly vulnerable. That being said, the quality of all these case reports is low. And in 22 years as an herbalist, I have never witnessed such a reaction in my clinic. So if this reaction really does occur, it's quite rare. In my opinion, a more plausible theory is that the SSRIs caused the adverse reaction on their own, and the St. John's wort was merely an innocent bystander. Whatever the case, it's still good to be cautious. So before you decide to take St. John's wort -- with or without antidepressant drugs -- make sure you consult with a professional skilled and knowledgeable in natural medicine." For a list of such physicians in your area, contact the American College for Advancement in Medicine at (800)532-3688 or visit their website at www.acam.org. | 
