This means reiearning to have a ‘normal’ bad day without reacting with fear that ‘it is all coming back’. Returning to ‘normal’ means we will have bad days, just like everyone else.

We will probably have days when we feel unwell. It doesn’t mean a return of the disorder—it means we are feeling unwell. We need to make sure we are eating properly and getting enough sleep. If not, we will feel tired and irritable just like everyone does when they neglect themselves.

Recovery is worth every step. At times the working-through process is difficult. Don’t lose sight of the overall picture which can be changed from one of fear and anxiety to one of clarity and freedom.

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Panic disorder is an extremely unpleasant condition characterized by brief but debilitating spells of anxiety, that often come out of the blue and are accompanied by the very physical symptoms this woman reported. During panic attacks, the patient often feels trapped in the throes of a medical emergency and wracked by fears of impending death. Visits to the emergency room invariably yield negative results and a diagnosis of panic disorder is often made at that time. If the panic attacks continue unchecked, anxiety may become chronic as the person anticipates the next onslaught of the disorder. The final step in the progression of the disorder is a reluctance to leave home for fear that an attack will occur in an uncontrollable setting. This last symptom gives this disorder its alternate name – agoraphobia, or fear of venturing into open places.

Thus far there have been no studies of the effects of St John’s Wort in panic disorder, but this is yet another condition for which other anti-depressants have proven to be very helpful. Since there appear to be certain pharmacological resemblances between the mode of action of St John’s Wort and that of other anti-depressants, there is every reason to predict that the herbal anti-depressant might also work for panic disorder patients, just as it appears to have done for Judy and the young German woman mentioned above. One cautionary note, however, to bear in mind if you are considering using the herb for this condition. Many people with panic disorder are extremely sensitive to all anti-depressants, becoming more anxious and jittery after receiving their first antidepressant tablets. It is therefore commonplace in using conventional anti-depressants in the treatment of panic disorder to start with very low dosages and move the dosage up very gradually as the patient becomes more able to tolerate the medication. After a while it may be possible to raise the anti-depressant dosage to conventional levels without undue discomfort to the patient. Following these general principles, I would suggest that anyone attempting to treat panic disorder with St John’s Wort obtain it in the form of a tincture, start treatment with no more than one-tenth of the recommended number of drops per day, and move up from there (or down if even this low dose feels too much), being guided by levels of side-effects in determining the dosing progression. Once a comfortable therapeutic dosage has been reached, I recommend switching to the Kira brand of St John’s Wort

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