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  • St. John’s wort has been described as a naturally occurring MAOI. Therefore, using St. John’s wort with any class of antidepressants can lead to exacerbation of side effects, including headache, dizziness, nausea, agitation, anxiety, lethargy, and lack of coherence. St. John’s wort may also interact and affect plasma levels of many other medications as well.

It may be beneficial to assess the progress with the medication knowledge survey. This is a very dynamic process with individuals with depression. If there is severe mental illness, be aware that the individual with depression may not be the one administering or managing the medication.

Following are questions that may beneficial for a full assessment. Again it is important to put these questions in words and phrases that the individual is comfortable with and are congruent with their health literacy, culture, and language.

  • How many meds are prescribed?

  • How do you remember to take your meds?

  • What if any side effects do you experience?

  • Do you keep a seven-day supply of medication on hand?

  • Do you ever skip doses?

  • Do you ever take half doses?

  • Do you ever postpone refills?

  • Do you ever substitute one drug for another?

  • What issues keep you from taking your meds? Side effects, for example?

    • Concerns about safety

    • Doubts about effectiveness

    • Language or literacy difficulties

    • Confusion about which drug to take

  • What problems do you encounter when refilling your prescriptions? For example, do you use more than one pharmacy?

  • How often do you see the mental health provider?

  • Who coordinates your prescriptions and medical care?

  • Do you think the meds are needed?

Antidepressants and other psychotropic drugs must be taken for three to four weeks before full therapeutic effect occurs. Individuals may stop the medications too soon because they feel better, they do not feel better, or because of untoward side effects. The opportunity for education to promote adherence might include attempting to work through side effects, encouraging the individual to stay on meds for four to nine months to prevent recurrence of




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