According to one report, overdoses yielded an annual rate of 30.1 deaths per one million prescriptions of antidepressant. No one has ever died from an overdose of St. John's wort.

Making the Right Decision
There is a role for both herbs and drugs in psychiatric treatment. There are circumstances when one or the other is called for, and there are situations when both are needed in combination. During my years of clinical practice, I have found that herbs should be the first line of defense. Their more gentle actions are often all that is needed to resolve the imbalances leading to depression. The more concentrated synthetic medications should be reserved for those times when their benefits outweigh their costs.

Synthetic antidepressants are highly purified, chemical substances that can provide many benefits, and can be a valuable resource in the treatment of severe depression and bipolar disorder. But they all have potentially harmful side effects. This is why a prescription is required from a psychiatrist or other medical practitioner. He or she is the one who can make an educated decision as to the best choice of drug. Your role as the patient is to be good observer and reporter, and to help guide this process, before and during treatment.

So far, as I've said, the value of St. John's wort has been proven only in the treatment of mild to moderate depression and seasonal affective disorder. While the herb may be an excellent adjunctive treatment for the treatment of major depression, there is not yet enough evidence to establish its usefulness as the sole medication for this disorder. I recommend that if you suffer from either major depression or bipolar disorder and want to use St. John's wort, you do so in consultation with a psychiatrist.

If you are dissatisfied with how your doctor responds to your questions about medications or herbs, I urge you to get a second opinion. I have heard many stories about patients who, after complaining of side effects to their doctors, were ignored or brushed off with "you can't possibly be having such side effects.". Sometimes, doctors have even increased the dosage, which only aggravates the problem. Remember, your doctor isn't living inside your body. Only you know how you feel. You have a right to be heard, and to have your doctor work with you on fine-tuning your medication needs.

I think you now understand why I always use St. John's wort as my first resort. This herb may not be able to help everyone, but it is unlikely to ever hurt anyone. Its side effects are always mild and temporary, and they occur far less frequently than with the other treatments. There are further considerations to keep in mind when you take St. John's wort. In the next chapter, I will discuss other natural supplements you can take to round out your treatment program.