Are herbal remedies, such as St John's Wort, any good for depression?

ST JOHN's WORT, or hypericum, a type of herb, is often sold in capsule form in health shops and some pharmacies as treatment for mid to moderate depression. It may affect the neurotransmitters in the brain in a similar way to SSRI antidepressant drugs.

There is a significant amount of research to show that St John's Wort is effective as an antidepressant, with fewer side effects than medical drugs. However, it has been known to affect some prescribed medicines including anticoagulant drugs and the contraceptive pill so check with your medical practitioner.

Remember that using St John's Wort is still relying on an external agent to manipulate body chemistry. It is important to understand that in order to cure depression properly and prevent relapse, the skills outlined in the Depression Learning Path are essential.

Research into the use of St John's Wort to treat depression

St John's Wort and depression

St John's Wort was tested in a double-blind study of 105 patients suffering from mild-moderate depression. The patients were male and female , 20 to 64 years of age, and diagnosed as having neurotic depression or temporary depressive mood. They were then divided into two groups and monitored over a period of four weeks. One group were given 300mg of St John's Wort extract, three times daily, and the other group were given a placebo. All of the patients were given psychiatric evaluations before the start of the study , and after two and four weeks of treatment.

The results revealed that, after the four weeks, 67% of the Hypericum group had responded positively to the treatment without any adverse side effects whereas only 28% of the placebo group showed any signs of improvement.

The authors of the study state clearly that the study was deliberately confined to patients affected by mild forms of depression because, for those patients, the possible risks of traditional antidepressants often outweighed any expected benefits. Indeed many patients within that category were known to refuse medications because of the possible side effects. Therefore, whilst there was no evidence to suggest that Hypericum would be of any benefit to patients suffering from the more serious forms of depression, in relation to the lesser but more common forms of depression, the researchers recommend: 'Hypericum should be used as a remedy of choice'.

Harrer. G, and Sommer.H., Treatment of Mild/Moderate Depressions With Hypericum, Phytomedicine, Vol. 1, 1994, pp 3 - 8.

St John's Wort (Hypericum) beats depression

The number of visits to alternative medicine practitioners in this country is estimated at 425 million, which is more than the number of visits to allopathic primary care physicians in 1990. Patients' use of St. John's Wort (SJW) has followed this sweeping trend. The purpose of our study was to examine the reasons people choose to self-medicate with SJW instead of seeking care from a conventional health care provider.

The researchers used open-ended interviews with key questions to elicit information. Twenty-two current users of SJW (21 women; 20 white; mean age = 45 years) in a Southern city participated. All interviews were transcribed, and descriptive participant quotes were extracted by a research assistant. Quotes were reviewed for each key question for similarities and contextual themes.

Four dominant decision-making themes were consistently noted. These were: (1) Personal Health Care Values: the patients had a history of alternative medicine use and a belief in the need for personal control of health; (2) Mood: all SJW users reported a depressed mood and occasionally irritability, cognitive difficulties, social isolation, and hormonal mood changes; (3) Perceptions of Seriousness of Disease and Risks of Treatment: SJW users reported the self-diagnosis of 'minor' depression, high risks of prescription drugs, and a perception of safety with herbal remedies; and (4) Accessibility Issues: subjects had barriers to and lack of knowledge of traditional health care providers and awareness of the ease of use and popularity of SJW. Also of note was the fact that some SJW users did not inform their primary care providers that they were taking the herb (6 of 22). Users reported moderate effectiveness and few side effects of SJW.

SJW users report depression, ease of access to alternative medicines, and a history of exposure to and belief in the safety of herbal remedies. Users saw little benefit to providing information about SJW to primary care physicians.

Wagner PJ, Jester D, LeClair B, Taylor AT, Woodward L, Lambert J Department of Family Medicine, Medical College of Georgia, Augusta 30912-3500, USA. pwagner@mail.mcg.edu

Hypericum & depression - a review of the research

A comprehensive evaluation of the benefits and adverse effects of newer pharmacotherapies and herbal treatments for depressive disorders in adults and children was undertaken..

Literature published between 1980 to January 1998 was identified from a specialized registry of controlled trials, meta-analyses, and experts. The registry contained trials addressing depression that had been identified from multiple electronic bibliographic databases, hand searches of journals, and pharmaceutical companies. The search, which yielded 1,277 records, combined terms 'depression,' 'depressive disorder,' or 'dysthymic disorder' with a list of 32 specific 'newer' antidepressant and herbal treatments.

Randomized controlled trials were reviewed if they (1) were at least 6 weeks in duration; (2) compared a 'newer' antidepressant with another antidepressant (newer or older), placebo, or psychosocial intervention; (3) involved participants with depressive disorders; and (4) had a clinical outcome. 315 trials that met these criteria.

Data was independently abstracted from each trial by two persons. The researchers looked at the response rate, total discontinuation rates (dropouts), and discontinuation rates due to adverse events. Response rates were defined as a 50 percent or greater improvement in symptoms as assessed by a depression symptoms rating scale or a rating of much or very much improved as assessed by a global assessment method.

There were 264 trials that evaluated antidepressants in patients (adults and children) with major depression. Of these, there were 14 trials evaluating hypericum (St. John's wort), and a review of these studies revealed that the herb was more effective than placebo in treating mild to moderately severe depressive disorders (risk ratio 1.9, 95% CI 1.2 to 2.8). However, the question as to whether hypericum (St. John's wort) is as effective as standard antidepressant agents given in adequate doses was not established.

Mulrow CD, Williams JW Jr, Trivedi M, Chiquette E, Aguilar C, Cornell JE, Badgett R, Noel PH, Lawrence V, Lee S, Luther M, Ramirez G, Richardson WS, Stamm K. Treatment of depression--newer pharmacotherapies. Psychopharmacol Bull 1998;34(4):409-795