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posted by admin on Apr 29

The ready availability of reliable oral contraception has undoubtedly been a significant factor in relieving tens of thousands of women of tension and anxiety. On the other hand the advent of the contraceptive pill has brought tension and guilt to many women who might otherwise have been free of it.

If a woman believes that contraception is morally wrong, or if she is forbidden by her church to use it, and if she follows her conscience in these matters and does not use it, she may still suffer considerable mental tension arising from her knowledge that women all around her are using contraception. As a result, she is constantly under temptation in a manner in which other women are not. This is shown by the way in which many such women do in fact take the pill for a while, then feel guilty about taking it and stop. Then they take it again, and in the same way discontinue it; and so it goes on.

The position of course is much more difficult when husband and wife see the problem of contraception from different points of view. In such cases the unfortunate woman may have contraception forced upon her without consideration of her inner feelings at all.

It is not uncommon for couples who have religious doubts about contraception to feel that sexual withdrawal is less of a sin than chemical means of prevention. But this half measure only leads to further anxiety. There is still the tension from feelings of guilt, and added to this the woman is tensed fearing that her husband will not withdraw in time. In addition, the fact of withdrawing just at the moment when biological fulfilment demands deepest penetration

produces tension in both man and wife. This of course has been known for centuries and was considered by Freud as an important cause of anxiety.

There is yet another important social side-effect of the widespread use of the contraceptive pill. Girls who have been sexually promiscuous in the past are now relieved of much of their anxiety. However, the ready availability of the pill has undoubtedly led many girls into promiscuity who would have otherwise been continent. Many of these young women suffer nervous tension not from doubts about taking the pill itself, but from moral qualms about their new way of life.

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posted by admin on Apr 29

Most studies of the anti-depressant effects of St John’s Wort have used 300 mg three times per day. In my experience with using many other anti-depressants, however, I have been impressed by the wide variation in dosage required by different people. To some degree, this relates to the ability of a person’s liver to break the antidepressant down into inactive substances, which are then excreted.

This ability varies tremendously from person to person. To some extent, one can get an indication of how sensitive a person is going to be to a new medication by reviewing that person’s sensitivity to medications in the past. The amount of medication needed is often not related to the size of the person being treated and I have been impressed over the years by small women patients who have been able to tolerate enormous dosages of anti-depressants, in contrast to very large men who have been sensitive to tiny dosages.

I believe that there will be a range of optimal dosages for St John’s Wort as well. A good practical way to begin treatment is to start with approximately 300 mg a day, with breakfast, for a two to three days, followed by 600 mg a day (300 mg each at breakfast and lunch) for a further two to three days, followed by 900 mg a day (300 mg each at breakfast, lunch and dinner). As Kira is sold in the UK in 135-mg tablets, this would mean starting with two tablets per day, then increasing to four (two tablets twice a day) then six (two tablets three times a day). Then stay on this dosage for several weeks unless side-effects require reduction in dosage. The reason to begin with a low dosage is that whereas therapeutic effects often take weeks to appear, the side-effects of any antidepressant may occur very soon after taking it. If this should happen, one is always better off having taken a small rather than a large dosage. In addition, it sometimes takes a while for your system to get used to a new medication, and gradually increasing the dosage gives your system a chance to adjust to it.

Taking medications with meals reduces the likelihood of developing gastro-intestinal side-effects such as nausea, indigestion or abdominal pains, which may occur with St John’s Wort. The meal will not interfere with the effects of the treatment in any way. If you should develop side-effects after increasing the dosage to, say, four 135-mg pills a day and the side-effects are mild, try to remain on that dosage for at least a few days. Side-effects may settle down within a few days. If you increase the dosage without waiting for this to happen, it will most likely make the side-effects worse and discourage you from staying on the medication. It may turn out that the current dosage will be just right for you. Alternatively, if this dosage proves to be too low, once the side-effects diminish sufficiently you may be able to increase the dosage at a later time if you need to.

Taking a medication three times a day can be quite inconvenient. Somehow the midday dosage often gets missed out. It is generally much easier to the take medications twice a day, and some people have found that a twice-daily dosage of St John’s Wort (four 135-mg pills at breakfast and two at dinner) works well for them. One or two of my patients developed indigestion when they have used the herb in this way and found that taking it three times a day with meals completely resolved that side-effect. If you should happen to forget the midday dosage, however, it is preferable to double up the evening dose rather than missing one dose for the day, bringing the day’s total to six 135-mg St John’s Wort tablets. Because no one is sure of what the active ingredients are in St John’s Wort, it is impossible at this time to say what the best dosing schedule really is; more research is required to answer this question. At this time, I recommend that you start using St John’s Wort three times a day and, later on, after you have established that it works for you, it may be worth experimenting with different dosing schedules. It is possible that for some people, like the man whose wife mixed his St John’s Wort in with the breakfast vitamins, a once-a-day schedule will prove to be sufficient.

Just as it is possible that some people will not need six 135-mg St John’s Wort tablets per day but may respond fully to two or four tablets, so others may require more than six tablets per day. It is probably worth staying on six 135-mg tablets per day for at least five weeks before deciding to increase the dosage. In one study of more serious depression, 1,800 mg of Hypericum proved to be as effective as a conventional anti-depressant and the researcher running the study remarked that the frequency of side-effects did not appear to be greater than he had encountered on the more conventional lower dosage of 900 mg per day. It would be surprising to me if, just as with other anti-depressants, different people did not end up needing different amounts of Hypericum and I would encourage you and your doctor to experiment with different dosages up to 1,800 mg (approximately 13 135-mg tablets per day) provided you do not experience any particularly unpleasant side-effects and provided you give the lower dosage of 900 mg (six tablets) a fair trial of five to six weeks before increasing the dosage.

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