Alan Ringold, M.D., is a psychiatrist in private practice in Palo Alto, California. He is particularly astute when it comes to drug interactions, and he clearly made the right call in the following situation.

“I evaluated a menopausal woman who had recovered from lymphoma five years before I saw her. I diagnosed depression, and I recommended medication, but she was reluctant to take anything other than St. John’s Wort. Soon after starting this, she informed me that she was having night sweats. She was terrified that this was a recurrence of her lymphoma. She was about to see her oncologist, but I asked her first to discontinue the St. John’s Wort. Her nights sweats disappeared after four days. Apparently, the St. John’s Wort was inducing the metabolism of the estrogen in her hormone replacement therapy, causing her to once again have menopausal symptoms. Her ‘night sweats’ were the equivalent of menopausal hot flashes.”