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To the Editor: In her Clinical Crossroads article, Dr Parry1 neglected 2 points. First, Thys-Jacobs et al2 reported that economical calcium supplementation (Tums E-X) reduced core premenstrual syndrome symptoms of negative affect by 48% in 466 patients. Neither the history nor discussion by Parry shed more light on this possible dietary variable and its interplay with this complex neurohormonal scenario.3 If the patient is now "kindling," this supplement could have been appropriate and, possibly, protective 2 to 3 years ago.
Second and of more concern is that St John's wort, a medicine used widely in Europe, was perhaps misrepresented. The National Institutes of Health are redundantly validating the experiences of clinicians.4 St John's wort was referred to by the consultant as a dangerous, "ineffective" agent because of "MAO [monoamine oxidase] inhibitor" action.1 The source of this information about Hypericum perforatum (Greek, "to overcome an apparition") is unreferenced and perhaps overlooks the fact that other important neurohormonal systems are simultaneously activated by St John's wort.5 Can Parry further amplify her concern, based on personal experience, evidence, or literature, regarding adverse (MAO inhibitor action) effect of St John' s wort?
When listening to my patients, I assume that the patient is right regarding the history. This patient notes for us that she has had horrendous adverse experience with fluoxetine ("fatigue, nightmares, and 30-lb weight gain"). Therefore, I am perplexed that the primary physician was not solicited and that the consultant would consider another selective serotonin reuptake inhibitor (SSRI)1 as the first response in discussion.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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