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St john's wort in germany: a part of general practice ST JOHN'S WORT IN GERMANY: A PART OF GENERAL PRACTICE
In Germany the use of St John's Wort for elderly depressed people is by no means confined to specialists such as Dr Volz. Rather, it is part of ordinary clinical practice, prescribed by GPs. As part of my attempt to get a picture of usage patterns of St John's Wort in Germany, I distributed my survey questionnaires to pharmacies there and received several replies from elderly users of the herb. My colleague, Dr Alexander Neumeister, a psychiatrist in Vienna, interviewed some of these respondents. Here are three of their stories.
Elsa, a 65-year-old retired nurse, has always regarded herself as an anxious and sorrowful person, never as happy as others. She was treated on and off with the early anti-depressants, but stopped them after a few days because she could not tolerate their side-effects. After her retirement she became markedly depressed and a GP urged her to take St John's Wort. Although she was convinced it would not work, she agreed to do so because it was an herbal extract. Within two weeks of starting the herbal anti-depressant (900 mg per day) she felt her anxiety and depression lift, and is now able to enjoy her life. She spends her time taking care of her grandchildren and going on holiday. She has observed no side-effects.
Irene, an 80-year-old retired schoolteacher, had never suffered depression until three years ago when she developed heart problems. She had several heart attacks and suffered from angina whenever she exercised. She was on medications for high blood pressure. Hospitalized for these problems, she was extremely fearful but regarded these fears as excessive because, as she put it, her life was not at immediate risk and others in hospital were more seriously ill than herself. She had difficulty falling asleep and sleeping through the night, and stopped socializing with friends even though she had previously been a gregarious person. Her doctor prescribed St John's Wort, starting with 300 mg at night. At this low dosage it did not help her, but when he increased the dosage to 900 mg per day, her sleep pattern improved, her depression lifted and she no longer felt anxious. At about the same time she began to feel better physically. She has remained on St John's Wort for three years without suffering any relapse of her depressive symptoms.
Gerda, a 72-year-old housewife, describes herself as a very nervous person with many physical symptoms, especially abdominal pains after eating, for which she has taken medications over the years. She had observed a seasonal pattern to her physical and emotional problems, which became worse during the winter. Six months ago she began to feel so depressed, anxious and irritable that her children took her to a psychiatrist. He initially prescribed Lustral, but she developed feelings of nausea, became more anxious and agitated and stopped the medication after two weeks.
On St John's Wort her anxiety has settled down and her abdominal pains have almost disappeared. In addition, she no longer has need for daily pain medications.
There is no reason to believe that St John's Wort will not prove equally effective and well tolerated in elderly individuals in Britain and the US as it has proved in Germany. Even though relatively few older people have taken the herb for depression in the US, here are a few reports that have come to my attention. By now there must certainly be many more such success stories.
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