A few months ago, Cathy was diagnosed with depression. Her psychiatrist prescribed Zoloft, but after taking it for a while, she felt like it wasn’t helping, so she stopped taking it and started using the herbal supplement St. John’s wort instead. It would be wise for Cathy to:

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When evaluating what Cathy should do, we must consider safety and medical supervision for antidepressant treatment and herbal supplements.
Option 1: 'increase her dosage periodically to better treat her symptoms' is not appropriate. Adjusting antidepressant dosage should only be done under a clinician’s guidance; self-adjusting can lead to adverse effects, withdrawal symptoms, or interactions with other substances.
Option 2: 'take the St. John’s wort and Zoloft together to increase their effectiveness' is risky. St. John’s wort can interact with selective serotonin reuptake inhibitors (like Zoloft/sertraline) and potentially cause excessive serotonin activity, leading to serotonin syndrome, as well as other interactions that may alter drug levels.
Option 3: 'stop seeing her psychiatrist if she feels that the St. John’s wort is working' ignores the need for professional monitoring. Even if symptoms improve, a clinician needs to assess overall treatment, possible side effects, and the rationale for continuing or modifying therapy; stopping professional care prematurely is unsafe.
Option 4: 'tell her psychiatrist that she is using St. John’s wort' is the prudent choice. Open communication allows the psychiatrist to assess risks, adjust prescriptions safely, monitor for interactions, and provide guidance on whether to continue, discontinue, or substitute treatments.
In summary, because St. John’s wort can interact with sertraline and affect depression management, the safest course is to inform the psychiatrist to ensure coordinated care and patient safety.

A few months ago, Cathy was diagnosed with depression. Her psychiatrist prescribed Zoloft, but after taking it for a while, she felt like it wasn’t helping, so she stopped taking it and started using the herbal supplement St. John’s wort instead. It would be wise for Cathy to:

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