Kelly Anne Spratt, D.O., Director of Women's Cardiovascular Health at the University of Pennsylvania Presbyterian Medical Center, answers your questions.

Q. What is your opinion on prescription medications (Prozac, in particular) versus herbal remedies such as St. John's wort? Does St. John's wort have side effects to be concerned with, or is it a fairly safe alternative to prescription medicine?

A. St. John's wort (SJW) is an herb offered for mild depression. It has been used safely in other countries for several years. Currently, trials are underway in the U.S. to compare it to one common antidepressant.

Some doctors are concerned that patients with depression may delay seeking professional help by using herbal remedies instead of getting into the health-care system. SJW is not recommended for moderate or severe depression, as these patients definitely require closer monitoring. The suggested dose of SJW is 300 mg, taken three times a day; this is difficult for some patients to remember compared to a once-daily drug.

Although herbs do not require a prescription, they are still "drugs" in that they cause changes to your body. Side effects are similar to those seen in prescription antidepressants: dizziness, dry mouth, stomach cramps, difficulty sleeping, and palpitations. Also, SJW can cause increased sensitivity to the sun, so be especially careful if you are fair skinned. And if you are pregnant, do not use this or any herbal product without checking with your doctor.

When selecting an SJW product, look for a well-known manufacturer and check for the USP (United States Pharmacopoeia) seal which establishes standards for strength, quality, and purity.

Do not use SJW and a prescription antidepressant at the same time without permission from your doctor.

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