CAN ST JOHN’S WORT WORK AT FIRST AND THEN STOP WORKING? WHAT SHOULD I DO IF THAT HAPPENS?

Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.

It is not uncommon for an anti-depressant that works initially to stop working after a period, which may range from weeks to years. St John’s Wort is no exception in this regard and depressive symptoms may recur after an initial response. A relapse of this kind may be due to a worsening of the depression, which is sometimes the result of a definable cause such as a personal loss, a new stress or the onset of winter. Wherever possible, the first-line response to such a setback is to deal with the underlying cause, for example to obtain extra support from friends and family, adopt strategies to help deal with the stress or increase the amount of environmental light.

If the trigger for relapse cannot be identified or if the steps to correct it by making environmental changes are unsuccessful, medication adjustments can be made, including increasing the dosage of St John’s Wort or adding another anti-depressant. Sometimes a person develops what is known as tolerance to an antidepressant, which means that certain chemical changes in the brain override the beneficial effects of the medication. In this case it can pay to switch to another medication or to add a medication specifically designed to potentiate the effects of the anti-depressant. Drugs such as lithium carbonate and synthetic thyroid hormone have been reported to be effective potentiators of conventional anti-depressants and may be of value when added to St John’s Wort as well. If the medication situation is complicated enough to warrant potentiation of an anti-depressant, it is certainly necessary for a highly skilled doctor to be involved in treatment decisions. The purpose of providing you with this information is so that you can understand some of the steps your doctor is likely to consider in dealing with the delayed development of unresponsiveness to an anti-depressant.

One possible reason why St John’s Wort may stop working is that the composition of active ingredients may vary from one batch of St John’s Wort to another. You might suspect this to be the case if you purchased a new batch of St John’s Wort just before noticing the change in anti-depressant effect. Reliability of quality control is one reason why I recommend the brand of St John’s Wort with the best documented and most reliable track record, namely Kira™, so as to minimize the likelihood of relapses due to inconsistencies between batches.

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