Elsa, a 65-year-old retired nurse, has always regarded herself as an anxious and sorrowful person, never as happy as others. She was treated on and off with the early anti-depressants, but stopped them after a few days because she could not tolerate their side-effects. After her retirement she became markedly depressed and a GP urged her to take St John’s Wort. Although she was convinced it would not work, she agreed to do so because it was an herbal extract. Within two weeks of starting the herbal anti-depressant (900 mg per day) she felt her anxiety and depression lift, and is now able to enjoy her life. She spends her time taking care of her grandchildren and going on holiday. She has observed no side-effects.

Irene, an 80-year-old retired schoolteacher, had never suffered depression until three years ago when she developed heart problems. She had several heart attacks and suffered from angina whenever she exercised. She was on medications for high blood pressure. Hospitalized for these problems, she was extremely fearful but regarded these fears as excessive because, as she put it, her life was not at immediate risk and others in hospital were more seriously ill than herself. She had difficulty falling asleep and sleeping through the night, and stopped socializing with friends even though she had previously been a gregarious person. Her doctor prescribed St John’s Wort, starting with 300 mg at night. At this low dosage it did not help her, but when he increased the dosage to 900 mg per day, her sleep pattern improved, her depression lifted and she no longer felt anxious. At about the same time she began to feel better physically. She has remained on St John’s Wort for three years without suffering any relapse of her depressive symptoms.

Gerda, a 72-year-old housewife, describes herself as a very nervous person with many physical symptoms, especially abdominal pains after eating, for which she has taken medications over the years. She had observed a seasonal pattern to her physical and emotional problems, which became worse during the winter. Six months ago she began to feel so depressed, anxious and irritable that her children took her to a psychiatrist. He initially prescribed Lustral, but she developed feelings of nausea, became more anxious and agitated and stopped the medication after two weeks.

On St John’s Wort her anxiety has settled down and her abdominal pains have almost disappeared. In addition, she no longer has need for daily pain medications.

There is no reason to believe that St John’s Wort will not prove equally effective and well tolerated in elderly individuals in Britain and the US as it has proved in Germany. Even though relatively few older people have taken the herb for depression in the US, here are a few reports that have come to my attention. By now there must certainly be many more such success stories.

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People in withdrawal need a great deal of care and understanding. It is a help to be relieved of as much responsibility as possible, particularly in the early days. Read all the literature you can find on the subject and attend group meetings with your partner if possible. Take care of yourself too, it can be exhausting looking after someone in withdrawal.

Complementary Medicine

Many people have found comfort and relief from withdrawal symptoms or symptoms that pre-dated taking drugs when they have consulted practitioners of alternative medicine (see page 108 for Useful Addresses). Seek out a registered practitioner and do not expect miracles after one or two visits. It is essential to follow a course of treatment. Some of these treatments are available on the National Health. Many people are reluctant to spend money on their health, yet willing to give up a great deal of their weekly wage for cigarettes or alcohol.

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The pain resembles toothache, and unfortunately many people have had a full dental extraction in an attempt to gain relief. The pain persists after dental treatment, and even people who have had dentures for years have experienced this ‘toothache’. The jaw pain (and all pain associated with withdrawal) goes, but if it is too much to bear, see your doctor. Many people have had dramatic relief from a drug called Tegretol. It is the drug used for the notoriously painful condition trigeminal neuralgia. Withdrawal jaw pain closely resembles this. Aspirin or Paracetemol rarely help this pain. Some people have been helped by having their neck and shoulders massaged, or by sucking ice, or rinsing their mouths with whisky. Others have been helped by having a removable plastic shield, called an occlusion splint, fitted over their bottom teeth. They wear this at night and it prevents jaw clenching. Ask your dentist for advice.

Trigeminal neuralgia can be a symptom of depression. Perhaps that is where the old term ‘face ache’ for a miserable person comes from.

Stinging or aching in the front teeth is also reported. Check that you are eating properly. Low blood sugar can trigger off this jaw pain.

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Most people cut down on coffee, tea and coke because they realize their withdrawal symptoms are much worse after taking them.

Cigarettes in Withdrawal

Some people stop smoking completely because of the metallic taste in the mouth. Others smoke compulsively. You will feel better if you try to cut them down.

Dinner: Supper: same as lunch plus fruit, crispbread with cheese, meat paste, cottage cheese, etc. Milk drink or weak tea.

Insomnia

The rebound insomnia experienced in withdrawal can be severe. Your normal sleeping pattern may not return for weeks or months. Try to accept this. It will come back in time.

Even people who are well and not on drugs can have disturbing symptoms, e.g. depersonalization (not being in touch with themselves), and de-realization (not being in touch with reality), when they are deprived of sleep.

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There are many views on how best to withdraw. Discuss with your doctor which way would be best for you.

Points in Favour of Rapid Withdrawal:

1. A drug-free state is reached earlier.

2. There is psychological benefit from not having to swallow an abhorrent substance any longer than necessary.

3. Best method for impatient people.

4. Best method for short-term users.

Here is an example- of Professor Malcolm Lader’s recommendations. It is not safe to withdraw faster than this.

RAPID WITHDRAWAL TABLE

VALIUM (DIAZEPAM) 15 mg (2 mg tablets)

Week No. Morning Lunchtime Evening Total

1. 2 tabs. 2 tabs. 2 tabs. 6 tabs. = 12 mg

2. 1 1\2 tabs. 1 1\2 tabs. 1 1\2 tabs. 4 1\2 tabs.= 9 mg

3. 1 tab. 1 tab. 1 tab. 3 tabs. = 6 mg

4. 1\2 tab. 1\2 tab. 1\2 tab. 1 1\2 tabs.= 3 mg

For a dose of 30 mg Valium daily, six weeks is the minimum withdrawal period. If this method is too quick to tolerate, change to a slower one.

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