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A practical guide to using st john’s wort: getting the dose right A PRACTICAL GUIDE TO USING ST JOHN’S WORT: GETTING THE DOSE RIGHT
Since the target dosage in most of the anti-depressant studies of mild-to-moderate depression has been 900 mg of Hypericum per day, this is a reasonable dose to aim for. The Kira brand of St John's Wort which, for reasons that I discuss later, is the one I recommend most highly, comes in only 135-mg dosage, at least in the UK, which would mean taking about six 135-mg pills every day. Whenever I start an anti-depressant, I always begin with a low dose and increase the dosage somewhat gradually until the final or target dose is reached. The reason for this is that some people are very sensitive to medications and it is often not possible to predict who will be very sensitive and who will not. An average dose of an anti-depressant may be far too much for such a person to tolerate, especially when just beginning the medication. If a highly sensitive person starts right out with an 'average' dose of an anti-depressant without building up to the final target dosage, unpleasant side-effects may result and the person may be disinclined ever to try the medication again. So I would rather err on the side of moving a little too slowly. In practice, this means that I start a person on 300 mg (approximately two 135-mg pills) of Hypericum once a day for two or three days, then twice a day for two or three days, then three times a day. In older people, say over 60,1 would proceed even more gradually.
If unpleasant side-effects should develop, I slow down this progression, always working within the patient's comfort zone. In other words, if you are uncomfortable with two 135-mg tablets of
Hypericum per day, don't move up on the dosage until the side-effects dissipate, as they generally will. Be sure to listen to what your body is telling you. Discomfort of any sort is a signal for you to slow down. In some sensitive people, including the elderly, a final dose of less than 900 mg, such as 600 mg (4 x 135 mg), may work best.
I should note that my practice of starting slowly differs from the widespread practice in Germany of starting with 900 mg per day - approximately two Kira tablets three times a day. According to my German colleagues, they do not experience problems with this approach.
Be sure to take the Hypericum with meals, as this minimizes the chances of developing indigestion or abdominal discomfort which may occur in certain people on the herbal remedy.
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