Since St. John’s wort is an herb and not a medicine, there are no out-
side checks for purity and dosage size, so you never know exactly what
you’re getting, especially if you buy it off a shelf at the grocery store. And
just because it’s an herb rather than a prescription medication, there is
absolutely no reason to believe that it’s safer. The only safety in St. John’s
wort is its weakness.
In larger dosages St. John’s wort seems to operate as an MAO
inhibitor, though this is not by any means certain.
There are certainly cases of depression I see in which I think medi-
cation is not necessary or is optional. Even then I haven’t known St. John’s
wort to make a difference. If medication is necessary, so is a competent
professional to prescribe it and to monitor its effects.
At my urging, Kinesha finally decides to take Prozac. For her, it
works just like the magazine ads say it will. She feels better and
has no side effects to speak of.
Kinesha’s depression was a single episode with a family
history. Her adjustment before the episode was excellent, with
strong relationships and a responsible job. Three weeks after she
began taking Prozac, she and I agree that we have nothing more
to talk about.
Six months later, after conferring with her doctor, she
tapers off. She and her husband know they have to watch her
sleeping and energy level as early indicators of relapse. Kinesha
agrees that if she goes a whole week without laughing, it’s time
to call the doctor.Medications for People Who Don’t Think They’re Depressed
I’m sure there are hundreds of cases like Kinesha’s—people for whom
medication is enough and no psychotherapy is necessary. Generally, these
people don’t contact therapists in the first place, but many such people do
need therapists and don’t contact them either. They’re pushed into it by
friends, family members, or physicians.
“Really, I’m just fine,” Carol says. She tries to smile, but her eyes
are already brimming with tears. She dabs at them with a tissue.164 ❧Explosions into Sadness