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St john’s wort in the elderly: frieda’s story (a depressed pianist) ST JOHN’S WORT IN THE ELDERLY: FRIEDA’S STORY (A DEPRESSED PIANIST)
If Gabrielle is convinced that St John's Wort has helped her depression, for Frieda, a 77-year-old concert pianist, the jury is still out on the matter. Her psychiatrist, Dr Thomas Wehr, is more certain that it has helped with the quality of her sleep at night and wakefulness during the day.
Born in Hungary, Frieda was a child prodigy who learned to play the piano at age two-and-a-half while still in nappies. Seventy-five years later she is still playing the piano, currently in an upscale department store, where she is so popular that families have written to the store management telling them what a treasure they have in her. Not only does she play standard classical and popular music, but also entertains the children with theme songs from their favourite TV programmes. To all outward appearances Frieda is a cheerful person and few would suspect that she is depressed. T am a gay depressive, and I don't mean in the sexual sense of the word,' she declares with the dramatic flair one would expect from a concert pianist.
What most people do not know is that Frieda no longer enjoys the many things that used to delight and enchant her. She has withdrawn from people and has not finished reading a book nor been to a concert performance for the past three years. Life feels very difficult. She is pressed for money and everything seems like an effort. Her thoughts often turn to gloomy themes and she is beset by all sorts of imaginary fears. For example, on her recent visit to her GP she worried that she would get lost or trip in his surgery. Even worse, she dwells at times on thoughts of taking an overdose of medications and being done with her suffering once and for all.
Frieda's history with anti-depressants is an unhappy one. She compares herself to an overweight person who has tried a number of diets but has ended up heavier than she was at the beginning. She feels that every anti-depressant she has tried has left her worse off than she was before. She claims to be the first person to give 'a bad report on Prozac'. She can't remember what the problems were with Lustral and Wellbutrin, both of which she tried with untoward effects. She believes Efexor caused 'brain activity while I was asleep - terrifying dreams' that disturbed her nights and left her exhausted during the day.
When St John's Wort began to garner attention in the media, Frieda read up on it in a book of herbs and decided to try it. Frieda discontinued the Efexor and after 10 days shifted to St John's Wort. This is the first anti-depressant she has ever taken that has not troubled her with side-effects. She is highly circumspect about the reason for her improved sleep and energy level, wondering whether it might be due exclusively to being off Efexor as opposed to an effect of the herbal anti-depressant. Her psychiatrist has recommended that she increase the dosage to see whether the improvement continues. In the meanwhile her suicidal ideas have left her and she is guardedly optimistic that further positive developments may follow.
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What your doctor should know; women tell their stories