What About Natural Options

Some people are averse to medications because they believe them to be "unnatural," as most have been manufactured in laboratories. They would prefer something derived from a plant or other natural substance. I usually advise evaluating the risks and benefits of both options. In terms of risks, the "naturals" are often touted as having fewer side effects, but it is also more difficult to determine their purity (important in deciding about dosage). There is often a great deal of variability from one brand to another, and the inactive ingredients (apart from the active substance itself) are often not spelled out. With a medication developed in a laboratory, you know more precisely what you are taking.

In terms of benefit, there are some individuals (including some in our practice) who have responded to herbal remedies and many who have responded to prescribed medication. One criterion for approval of prescribed medication, however, is that efficacy has been demonstrated above and beyond the efficacy of a placebo (sugar pill) in large numbers of people. Over-the-counter herbal remedies do not have to meet this standard.

The most commonly used herbal remedy for depression is St. John's Wort. Unlike many such remedies, St. John's Wort has been subjected to a number of studies in adults, both in Europe and North America. Results from Europe appeared very promising, but a large North American study recently could not demonstrate efficacy above and beyond the efficacy of a placebo. Still, if you or your teen is very concerned about the risk of side effects with pharmaceuticals and/or has failed to respond to one or more standard antidepressant medications, it may be worth considering. Studies tell you how hundreds of people respond on the average, but they cannot predict how a particular individual will respond. No studies to date have examined St. John's Wort in adolescents or children. St. John's Wort can interact with some prescription drugs, particularly other antidepressants, so check with your doctor or pharmacist first if your teen is already taking another medication.



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