One subject described her mood in the following way: “Waking up in the morning tired, like you don’t want to get up in the morning. Basically, you dread waking up, and you dread the day. Depression also has done this to me: feeling all the negative feelings and not feeling any positive feelings. Not feeling any sense of hope, not caring whether—I don’t want to sound dramatic—but sometimes you get these periods where you just don’t care if you live or die.”
Perceptions of Seriousness of Disease and Risks of Treatment. Our group of SJW users distinguished their moods as mild depression. The differentiation of subthreshold depression by persons without medical training is important. Participants often stated that although they felt depressed, they were not “clinically depressed” or “seriously depressed.” If they had been “really” depressed they would have sought help; instead they chose SJW. In the words of one subject, “I think if someone was really depressed or severely depressed, I would rather them seek medical help than SJW, but pretty ordinary able-to-function people who are depressed for one reason or another, I think it’s good.” Participants also reported a belief that people should have a “joie de vivre,” an essence of joy that was required to really “live.” Many had lost that feeling and were using SJW to reclaim that joy.
The study subjects saw SJW as a safe treatment because it did not cause side effects as do prescription antidepressant medications and would not cause addiction. This safety was often attributed to its “naturalness,” but there were also some general misconceptions about how herbals and controlled medicines are regulated.
Correspondingly, the view emerged that prescribed drugs are dangerous. Interviewees stated that such drugs have major side effects, a person could easily get addicted or might easily overdose. In addition, interviewees believed that if they took antidepressants they would be “different” people with new personalities, but if they took SJW they would just be less sad. “I knew that if I had gone to a doctor and explained it, I would have probably been put on some kind of prescription, and I don’t have any desire to be on a prescription drug,” explained one participant. “I guess you can get addicted to antidepressants, but I guess I felt like there was less risk involved in SJW versus prescriptive antidepressants. I also figured that SJW was a good place to start. If SJW didn’t work, then I could go the next step, but if I jumped into the fast lane and got put on prescription drugs, I would have never given anything simple a chance.”
Accessibility Issues. Interviewees reported that sources of traditional care were not helpful in obtaining relief from depression. Many did not think to ask physicians for help (“Why would a physician know about depression?”), had experienced negative or useless counseling or psychiatric care, had tried antidepressants and found them unhelpful or burdensome, and expressed overall dissatisfaction with traditional medicines and the health care system. “There’s no possible way [physicians] can know everything. There’s no possible way you can know everything. And so, you know, you tend to study and to home in on what’s important to you and what you find interesting.”
Additionally, SJW is easy to obtain. A person does not need to “get permission” from a physician or psychiatrist; it can be bought at the supermarket or drug store. Thus embarrassment, financial cost, time to obtain—all the typical barriers—are waived, and SJW becomes almost immediately available. Further, increased promotion of SJW in the media puts it in patients’ minds when they are looking for relief.
Other Findings. The interviewees reported currently using a number of additional “helps” in their self-treatment programs, including social support, professional counseling, faith, activities such as volunteering and crafts, relaxation, modifications in diet and exercise, and an assortment of other things such as eating chocolate, smoking, and having pets. Generally, counseling was viewed as having limited use or value by the 12 participants (60%) who had counseling experience. Nine of the 20 persons in our study had no previous experience with antidepressants, 6 had tried multiple antidepressants in the past, and 5 had tried 1 antidepressant. The drug most commonly previously used was fluoxetine (Prozac) followed by sertraline (Zoloft). There was a general impression of ineffectiveness of prescription remedies (in contrast to the perception of effectiveness of SJW).
Conventional health care providers were not informed about SJW use: Only 6 of the 20 subjects had discussed taking SJW with their physicians. This was not seen as an area in which physicians would have expertise, and patients believed their physicians would discourage them from taking SJW. It didn’t occur to some subjects to consult their physicians about alternative medicine. Others did not think they were “sick,” so they did not need to address this issue with their physician. Many would tell their physician, but since they had no other need for an office visit, they thought it unnecessary to schedule a visit to discuss SJW. It was even less likely that they had discussed SJW with a pharmacist at any time.