Depression is a mental health minefield in and of itself -- regardless
of any ancillary physical problems. Obviously, your ob-gyn is trying
to address your INCREASED "monthly" mood difficulties, which is great.
However, be advised that it's RARE for a NON-psychiatric specialist
to be thoroughly informed on the full range of antidepressants -- both
new And old. This is Not to imply that your ob-gyn doesn't have much
of a clue; it simply reflects the fact that he [or she] has his Own
Speciality Minefield to keep up with and navigate through -- that, and
the additional truth that pharmaceutical companies constantly push
their "latest and greatest" drugs to physicians as well as to the
public, often almost ignoring "older" but still highly effective meds.
"Newer," though, isn't automatically "better" (or best for You), and
with psychotropic meds in particular, it can take several trys to find
the most effective med(s) and dosage for any one individual.
You stated that your periods only increased your depressive symptoms,
so obviously there's more going on and that's why you've also been
undergoing some "talk" therapy (a major Plus for you, by the way!).
I've assumed that your talk therapist does specialize in mental
health, but doesn't prescribe medications (in most states that's
restricted to psychiatrists). While many non-prescribing M.H.
specialists are very knowledgeable about psychiatric meds, and yours
may well be in that group, I'd still suggest that you consult a
psychiatrist. That person may confirm that lexapro's The One to try
out first, or they may have a better answer for you: replacing the
lexapro, or changing the dosage, or adding in another SUITABLE drug.
The key here is "suitable" -- which, in my humble opinion, does NOT
include St. John's Wort or any other over-the-counter drug. As you
most adroitly noted, standardization remains a huge problem in that
industry, and this certainly includes "purity" of product -- how it's
derived, consistency, and what it may be mixed with (knowingly or
unknowingly). Even assuming appropriate purity and dose, as with any
drug there Are potential side effects as well possible drug-to-drug
interactions. Neither has been thoroughly researched/documented, and
the same goes for proving its clinical effectiveness. While there are
some positive clinical reports, they don't outweigh the rest. At
least not yet.
Still, I know there are pros who are willing to have their patients
give it a try, and perhaps one day it will become a mainstream
treatment. I must confess that I, too, found some of the personal
rave reports on St. John's Wort tempting during my own therapy for
depression. However, I'd spent several years volunteering in the
mental health field (first with a drug crisis center, then with the
local NAMI chapter) where I heard and saw far too many sad and bad
tales of the consequences of mixing "meds" outside the purview of a
solid, well-informed pro. So I resisted that temptation years ago,
and still do today. Too many unknowns surround these herbal/OTC
drugs, making them too risky for my taste. Besides, the cache of
scripted antidepressants has never been broader or deeper or
potentially more effective. As for Their Side Effects, well, every
drug has a list of them. I prefer to have that list in hand so I can
cull out the drugs likely to be a problem for the "rest" of me, and of
the remaining meds, know the possible complications to watch out for.
My suggestions, then, are to ditch the OTC/herbal options, give the
lexapro a try, continue talk therapy, and add in an experienced
psychiatrist (try to get referrals). In general, be wary of web
sites. If you're looking for a Specific Answer (like Favorable views
of St. John's), you'll find it, even if it's not the answer you really
need. WebMD.com is a good site; it's part of Medscape which I use.
Also check out National Institutes of Health (www.NIH.gov/) and
National Alliance on Mental Illness (www.NAMI.org/). Both are
excellent resources, and NAMI has state and local affiliates and
members. |
