USING ST JOHN’S WORT IN SEASONAL AFFECTIVE DISORDER (SAD): HOW LONG SHOULD YOU CONTINUE TO TREAT YOUR WINTER DEPRESSION?

In general, those who recover spontaneously from their winter depressions during the summer months are able to stop their antidepressant treatments – be they light or medications – when long sunny days arrive. The same principle should apply to St John’s Wort and I would recommend that those who normally feel fine in the summer discontinue the herbal anti-depressant at that time. On the other hand, there are those who feel somewhat down all year round, only more so in the winter. These people are likely to benefit from St John’s Wort all year round.

For a further information about the effects of the seasons on mood and behaviour, and strategies to deal with the difficulties caused by the short dark days of winter or other forms of light deprivation, I refer the interested reader to my book Winter Blues (Guilford Publications, 1993), which deals with these topics in greater detail.

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COMING OFF TRANQUILLIZERS: VISUALIZATION

Continue the relaxation session by taking time to get as comfortable as possible on the floor using blankets, cushions or coats. You may not feel cold when you lie down but as you relax your temperature could go down. (People who feel unhappy on the floor can be supported in a chair.) Lie down, shoulders relaxed, palms up. If you have back pain you may be more comfortable with your knees slightly bent and your feet on the floor.

Start with five minutes abdominal breathing, and try to be aware of your breathing during the session. Arrange for someone to play a relaxation tape. Choose one that has a passage of soothing music at the end. Close your eyes and imagine you are with the group or with someone who has made you feel secure in the past. Let the tape ‘wash over you’ without struggling to concentrate.

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WITHDRAWAL SYMPTOMS: CHEST SYMPTOMS AND PALPITATIONS AND EYE PROBLEMS

Chest Symptoms and Palpitations

Always see your doctor if you have chest pain have experienced tightness, numbness or pain in the chest or down the left arm. This could be another rebound effect. After you have been reassured by your doctor, accept the temporary discomfort, it will pass. Abdominal breathing often helps.

It is not surprising that people become convinced that there is something wrong with their hearts when they experience palpitations or missed beats. If you were running for a bus and your heart rate increased, it would not worry you. Because you are cutting down on drugs that have slowed the heart rate, you can expect a similar effect.

Eye Problems

Sore eyes and visual disturbances are common. Users often change their spectacles several times during withdrawal. Check with your oculist to make sure, but you will probably find that the blurred vision and sore eyes will clear up as withdrawal progresses. Pads of cotton wool soaked with witch-hazel on closed eyes may be soothing. Tinted lenses are helpful if you are sensitive to light.

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WITHDRAWAL SYMPTOMS: HYPERVENTILATION (OVER-BREATHING)

Clients find it very hard to believe that so many symptoms can be due simply to not breathing properly. Rapid, shallow breathing is very common in withdrawal. It may be due to spasm (tension) in respiratory muscles, or it may be that the central mechanism in the brain is temporarily disturbed. This does not mean that you will stop breathing, but it does mean you will have to practise abdominal breathing.

When someone is anxious, over-breathing is usually present (again part of the ‘fright and flight’ response), but in withdrawal it seems different. Users in hospital for acute withdrawal have been observed to over-breathe even whilst asleep.

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HOW DO I COME OFF MY PILLS? ACUTE WITHDRAWAL IN HOSPITAL

The speed at which you can withdraw may depend on what is happening in your life. If you have a stressful job, particularly where driving or operating machinery is involved, or have young children or a sick person depending on you, it may have to be taken slowly.

Acute Withdrawal in Hospital

If sick leave is possible, your doctor may be able to arrange hospital admission. This is usually advisable after a long drug history, or where the side-effects are causing chronic ill health. A four to six week stay is usual with at least two weeks without the drugs before leaving hospital. For some, there will still be a recovery period after discharge.

Since this is essentially a medical problem, a pharmacological or drug dependence unit is preferable. Some people refuse a bed in a psychiatric hospital. Others are eager to come off their drugs quickly and will go anywhere. Resist well-meaning therapists who attempt psychological probing in early withdrawal. You may not have deep psychological problems. Even if you have, it is not the time for the ‘Why do you hate your father?’ approach. It should be a time for rest and reassurance. Deep conflicts will arise spontaneously if they need to.

Try not to develop a ‘pill phobia’. Accepting other drugs temporarily to keep you comfortable could help your recovery.

It is exciting to see the physical changes that appear as people come off their tranquillizers—eyes lose the dull glazed look, skin colour and texture improve, and hair comes back to life.

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