Stephanie said:
but I would do the meds first, ideagirl. I'm just really lazy and from all this it seems to me a pill a day would be much easier for a person too impatient to spend time meditating and making other lifestyle changes.
St John's Wort, SAMe and 5-HTP are all "a pill a day"-type meds (or "a few pills a day," depending on your needs--same as prescription meds). They all come as pills in bottles, they're no more difficult to use than prescription drugs (and they're a lot cheaper--in the US at least, where prescription drugs cost 5 times as much as they do in any other country...). Of course it's better to make the lifestyle changes too, but you don't have to. The herbal stuff works on its own, regardless of whether you meditate or whatever.
I'm actually speaking from experience here--my doctor is an MD who's also licensed in holistic medicine, and this is always her approach: try the alternative stuff first, and only turn to prescription drugs if it doesn't work (or doesn't work as well as you'd hoped--for example, if it turned out that the depression was too deep for herbs to snap you out of it). Aside from the lower cost of herbs, etc., the two main reasons for starting with herbs and only moving to prescription drugs if they don't help enough are:
(1) Side effects--the herbal/vitamin/etc. treatments for depression have zero side effects (with the exception of the fact that St. John's Wort can affect how you absorb other medication), but the prescription antidepressants all have side effects, ranging all the way from sexual dysfunction to suicidal thoughts (!). So you would always try the thing with no side effects first, and only risk the side effects if the herbal stuff didn't work.
(2) Withdrawal and drug interactions--many prescription antidepressants include warnings about interactions; for example, with several of them, you can't safely drink alcohol AT ALL (not even wine with dinner) while you're taking them. The combination can destroy your kidneys, or make you so drowsy you can't even function, etc. Also, once you're taking a prescription antidepressant, with several of them you can't stop cold turkey: if you decide it's not working or the side effects are so bad you don't want to continue, you have to taper off gradually under a doctor's supervision. This makes it more complicated to take prescription antidepressants than herbal ones--another reason that doctors will start with the herbal stuff first.
Stephanie said:
Also, you'd have to experiment with the alternative approaches to see which worked for you - if any. So you might just possibly be depressed for a very long time before you came up with the right combination of techniques.
The same is true for prescription antidepressants. *shrug* Depression isn't a simple thing, it's not like an infection where you can just give 500mg of antibiotics and kill the infection in all patients. It's very subjective, and in addition to the different ways a given substance (herb, drug, etc.) affects different people, side effects are different for everyone. For example, I know millions of women take Ortho-Cept birth control pills, but when I tried them, I was immediately slammed with a depression so intense I could not get out of bed for three days. Obviously, I had to change which brand of pill I took. Antidepressants are the same--a drug that works great for millions of people might whack you hard with an unbearable side effect.
Stephanie said:
Something else - how can a clinically depressed person (one who doesn't have the energy to get out of bed in the morning) even attempt all of these avenues of treatment?
Not being able to get out of bed = severe depression. Most clinical depression is not that debilitating. In any event, getting herbs is no more difficult than getting prescription antidepressants--if they can do one, they can do the other. Oftentimes the person's spouse or best friend or whatever will drag them to the doctor.
Stephanie said:
And I wonder if anyone's done just that reverse order you mentioned - gone from the holistic/homeopathic route to better results with prescription medication like Zoloft et al?
Oh, I'm sure they have. And vice versa. Just because different substances affect people different ways--Zoloft might literally save one person's life but not help another person at all, and the same is true of the herbal antidepressants. One rule of thumb is that really, really severe depression generally can't be cured by herbal/natural remedies alone; you have to catch the depression earlier, before it gets that bad, for the natural stuff to work. Sometimes people are so depressed that prescription meds don't work and they have to get electroshock therapy (yes, they still use that!). A friend of mine who's bipolar (manic-depressive) tells me that she's using something called cranial-magnetic therapy, or something to that effect, which sounds a bit like electroshock, but milder. She can't take any medication right now, including herbal remedies, because she's breastfeeding.
But basically, just as depression can run the gamut between feeling down and trying to commit suicide, depression treatments run the gamut between St. John's Wort tea (which helps if you're just slightly down, or want to avoid depression), to concentrated St. John's Wort or SAMe or 5-HTP in pills, to Zoloft, Wellbutrin, etc., to electroshock therapy!