Given the way in which the study was designed, it is difficult to draw definite conclusions from it. Because there was no placebo group, the evidence for a specific effect for St John’s Wort was not completely clear-cut. Nevertheless, the anti-depressant results of St John’s Wort were promising. In addition, light therapy enhances the effects of the anti-depressant and the antidepressant cuts down the amount of time needed in front of the light box. There is no reason to suppose that the same beneficial interaction will not occur when it comes to the use of St John’s Wort. In my opinion, Sarah’s happy experience with using these two treatments in conjunction will prove to be the norm.

There are different ways in which light therapy and St John’s Wort can be combined. You could reason that since light therapy is the more established of the two treatments for SAD, it would make sense to begin to use light treatment as you enter the usual season of risk. As soon as it feels as though the light therapy is not fully doing the job, you could then add St John’s Wort. Another approach would be to start with St John’s Wort and add in light therapy only if it is necessary.

Although Kasper’s group found no harmful effects to the eye after four weeks of light therapy used in conjunction with St John’s Wort, there is a theoretical concern that the light-sensitizing effects of the herbal anti-depressant may produce harmful effects to the eyes over the long haul. Since such speculations by definition involve watching people over long periods, it will not be possible to answer them definitively for years to come. Even so, it is good to be aware of this possible interaction and to use less light if you are also taking St John’s Wort than you would if you were only using the light treatment. This should be easily managed as you will be benefiting from two remedies rather than just one. In addition, we have a natural inclination to do with as little light therapy as is needed to obtain an anti-depressant response.

One tip worth bearing in mind whenever you use an antidepressant to treat SAD or the winter blues is that the dosage needed usually varies depending on the season. For example, 300 to 600 mg of St John’s Wort might be sufficient in the autumn and spring, but larger doses may be necessary to combat the more severe symptoms that may occur in the depths of winter.

*29\75\2*

If a steady reduction plan is followed, the symptoms will be much less severe. The aim is to avoid sudden drops in the level of the drug in the blood. This is when the symptoms are at their worst. Slow withdrawal is safe. Whilst there still may be some discomfort, and you may get impatient, the results will be worth your efforts.

The symptoms mentioned on pages 28 to 75 are mainly the experiences of people who have tried to reduce too quickly without medical help. If you understand what is temporarily happening to your body and mind, you will not get so anxious about withdrawal. The support of your doctor and family is most important at this time.

Dependence on any substance can be degrading, but you must remember that this is a therapeutic dependence, and therefore you should not feel ashamed. These drugs were given to you as a medicine. Suppose penicillin had dependence-producing properties, and it was given to you for some life-threatening disease. Would you feel guilty about the resulting dependence?

It is a sad fact that many people feel guilty, not only about their dependence on the drugs, but also about the nervous illness for which the drug was originally prescribed.

Some of the ‘addicts’ do not have a history of nervous illness. It may be they were prescribed for a temporary life problem, or back injury, and were then given years of un-queried repeat prescriptions. So many times a tearful person will say, ‘What can I do? I feel confused and emotionally dead on the pills, but I am afraid to stop them in case my original illness comes back.’ The truth is that if the drugs have been taken continuously for more than 3-4 months, they may be having very little therapeutic effect on the original symptoms. The user may only be avoiding withdrawal symptoms by continuing medication, and still suffer the toxic effects of the drugs into the bargain!

*4\49\8*