“I have already tried all the medications my physician recommended for depression. None of them worked and each brought about severe side effects, therefore I asked my physician whether we could try St. John’s wort. He was even more surprised than I was when it worked out so well.”
—Nancy, 42
To ward off evil, Germans hung St. John’s wort over their doorways. Pre-Christians stuffed it into amulets around their necks, and even St. Columba himself hid a branch of the herb inside his robes. It was believed that this plant was able to make warlocks fly and fend off the evil eye. And for 2,000 years, St. John’s wort ( Hypericum perforatum ) has been used by herbal healers for its antidepressant qualities.
Several well-known ancient doctors such as Hippocrates (460–377 b.c.), Dioscorides (a.d. 41–68), Galen (a.d. 150–200), and Pliny (a.d. 23–79) used St. John’s wort for the treatment of menstrual disorders. By the Middle Ages, herbalists were recommending and prescribing it both for depression and anxiety, and in the mid-nineteenth century, the Shakers (master herbalists and giants of the mail-order seed business) sold St. John’s wort as a medication for “low spirits.”
St. John’s wort contains any species of the large and widespread genus Hypericum, a sturdy perennial weed with yellow, five-petal flowers. In the rangelands of the American West, it’s also called “noxious weed”—the bane of cowboys due to the fact that it competed with native plants and threatened grazing livestock with potentially toxic side effects of fatal sun sensitivity.
The sizes of this plant can be enormously varied, from the tiny, 4-inch matted Hypericum anagalloides (bog St. John’s wort) to the towering H. perforatum, which can reach as many as 32 feet tall. This is this huge form that is used for the treatment of depression, not its attractive cousin most often sold in nurseries. Each of the lanced leaves of H. perforatum is covered with minuscule purple-black dots that contain hypericin, which is responsible for the reddish stain that results when you rub the foliage against your skin. It has an unusual odor and a bitter, harsh taste.
St. John’s wort constitutes one of the most systematically examined medicinal herbs. Most of the research has been conducted in Germany and other European countries. All the studies found the plant to be very safe with few side effects. Actually, in more than 2,000 years of use, there has never been a reported human death associated with this plant—contrary to aspirin, for instance, which kills about five hundred people every year due to overdose. Millions of European citizens use St. John’s wort to treat chronic depression; one German brand is prescribed at a rate of seven to one over Prozac.
How St. John’s Wort Works
When St. John’s Wort is used every day for at least one month, it seems to help mildly depressed people get back general mental balance, normalizing mood and mental attitude. It is not clear how exactly it manages to do this, however European researchers have discovered that it is more effective than placebo and as effective as some older and well known antidepressants.
In reply to the public clamor concerning the plant, the United States introduced the first clinical trial in 1997 comparing St. John’s wort with SSRIs in the treatment of moderate depression. The three-year research, sponsored by the National Institute of Mental Health, the Office of Alternative Medicine, and the Office of Dietary Supplements, involved 336 patients with major depression randomly chosen in an eight-week trial to one of 3 treatments (St. John’s wort, an SSRI such as Prozac or Paxil, or placebo). Scientists hope that the research will provide concrete answers about whether St. John’s wort is as good as the best antidepressant medications for clinical depression. According to NIMH director, Steven Hyman, M.D, the research is the first rigorous clinical trial of the herb that is huge enough and long enough to determine completely whether it works,.
An overview of 23 clinical trials in Europe, published in August 1996 issue of the British Medical Journal, discovered that the herb may be also useful in cases of mild to moderate depression. Researchers who analyzed data from these randomized trials discovered that St. John’s wort was much more effective than a placebo. Its response rates are similar to (or even slightly better than) older antidepressant medications —without the considerable prospective side effects. The plant was also better tolerated by the patients than traditional antidepressant medicines.
One of the most impressive studies was carried out in Austria, with 105 men and women diagnosed with the symptoms of depression. Half of the patients took a 300- milligram dose three times daily for a one-month period; the rest of the group took a sugar pill prepared to look and taste exactly like the herbal extract. All the patients were examined for depression every two weeks. Two-thirds of those taking St. John’s wort responded with a 50 percent reduction in depression. They reported that they were sleeping much better and observed improvements in feelings of sorrow, hopelessness, helplessness, and uselessness.
According to Wayne Jonas, M.D., director of OAM, this European study, though encouraging, still left some unanswered questions about exactly how the herb works. In spite of the great number of European studies, none of them looked at long-term use. Moreover, published studies have used several varied doses, which makes it difficult to compare findings.
Researchers suspect that the reddish pigment, hypericin, contained in St. John’s wort is primarily responsible for boosting mood through its action on the chemistry of the brain, influencing serotonin and dopamine by interfering with the breakdown of neurotransmitters. It is not clear yet, whether whole plant extracts are more effective antidepressant medications than is hypericin alone.
Side Effects
Among others, one of the greatest benefits of St. John’s wort that herbalists mention is its apparent mild side effect profile. Only several people feel nauseated when taking the medication on an empty stomach. Research on animal indicates that taking huge amounts of the herb may make the skin more sensitive to the sun.
If you are sensitive to caffeine, St. John’s wort may make you a bit irritated or anxious (particularly if you combine caffeine with the herb). Nevertheless, many researchers are convinced that St. John’s wort is chemically similar to Prozac, and Prozac can activate feelings of anxiety in particular patients.
According to several studies, St. John’s wort may interfere with a key medication used in AIDS cocktails, as well as a medication that is used for transplant patients. Two studies published in The Lancet discovered that St. John’s wort dulls the effectiveness of both the HIV medicine indinavir and the transplant drug cyclosporin. The FDA is currently working with drug producers to insert a caution against using the herb with these medications. Even though both studies only used several participants, the strength of the findings meant that the results were important.
Some specialists are also convinced the herb can have an influence on anesthesia during a surgery. If you are just about to undergo elective operation, you should immediately inform your anesthesiologist if you have taken St. John’s wort within the past two weeks.
However, a lot of the side effects (particularly the milder ones) go away after the body adjusts to the herb. It may help to reduce the dosage until you become accustomed to St. John’s wort.
Obviously, if you do experience some serious horrible side effects, you should consult your healthcare provider promptly and give up taking the herb. All symptoms should disappear within a few days after the last dose is taken.
Drug Interactions
You should never take St. John’s wort with any other antidepressant medications, particularly an MAOI or an SSRI.
Due to the fact that St. John’s wort may be quite similar to an SSRI, you should always wait at least two weeks before giving up taking the herb and starting an MAOI (and vice versa).
Some anesthesiologists suggest that anyone considering surgery requiring anesthesia should give up taking the herb two weeks before the operation. At least several studies have indicated that St. John’s wort may work in ways similar to an MAOI, and MAOIs can lead to problems during anesthesia. Until the study has definitively proven the exact chemical action of St. John’s wort, it’s better to be safe.
How much should you take?
According to studies, the most effective dosage is 300 milligrams of the hypericum extract three times daily, for a total of 900 milligrams. The majority of people do well when taking the herb in the morning, as soon as they get up, with the second dose about three hours later, and the last dose three hours after that. Other patients prefer taking two doses at breakfast and a third at lunchtime. Most specialists suggest taking St. John’s wort early in the day so as not to interfere with sleep —a problem some people have with the herb. Due to the fact that the side effects appear seldom even in considerably higher doses, you can take four 250-milligram capsules daily, if the only herb you can find occurs in this amount.
Herbalists don’t recommend more than 300 milligrams daily for children or the elderly patients, but no studies have been done on the safety of this herb for the treatment of children.
After six weeks, you should assess how you’re doing on the 900-milligrams-a-day schedule. (It may take this long to observe an effect, just as it can take weeks to observe the effects of antidepressant medications.) Research indicates that it can take hypericum longer to reach its full effectiveness than prescription antidepressant drugs (antidepressants themselves may take as long as a month to begin working).
In case you do not feel any response to St. John’s wort, you should immediately consult your healthcare provider and discuss taking a prescription antidepressant drugs instead. Obviously, not everybody responds to St. John’s wort, exactly the same as not everybody feels any response to antidepressant medications. It is very relevant not to decide after one week or two that the herb just isn’t helping your depression.
Forms of St. John’s Wort
St. John’s Wort is available in the form of a standardized tablet or capsule, oil, extract, spray, and essence. You can buy dried leaves as well with which to make a tea, or grow the herb yourself.
* Tablets: This is the most popular form of St. John’s Wort taken by patients and it is also the easiest to find. You can buy the tablets at most drugstores, discount department stores, and food stores. Some brands are made from standardized extracts. Look for 300-milligram tablets standardized to 0.3 percent. You should take one tablet three times daily.
* Oil: Top quality oils are available at natural food stores. Look for bottles with a rich, red color liquid; that indicates that the compound was made when the flowers were the freshest. The oil will keep up to two years if it is stored in a dark place.
* Extract: An extract of St. John’s wort is the best choice for the treatment of mild depression and fighting viruses. Commercial extracts are standardized to 0.05 percent hypericin. For correct dosage, follow the instructions placed on the bottle.
* Spray: Oral spray versions of St. John’s wort were approved in May 2000. The spray must be taken under the tongue or inside the cheek for instant absorption directly into the bloodstream, bypassing the stomach.
* Tinctures: A few brands are available in natural food stores. Read the label to be sure that it was harvested in the wild. 40 drops of tincture, three times a day constitute a proper and safe dose.
When buying St. John’s wort (or any botanical), remember these tips:
* Buy it from only trustworthy sources.
* Be sure that the product is standardized.
* Make sure the product is dated, and immediately throw away anything expired.
* Avoid overdosing.
* Never use St. John’s wort for severe conditions without the advice or supervision of a qualified health practitioner.
* Don’t use St. John’s wort (or any herb) when you are pregnant or while breast-feeding a baby without the approval of your healthcare provider.
* Never use St. John’s wort with any other antidepressant medication, or combine with any other medication (including nonprescription drugs) without the advice of your physician.
Furthermore, be conscious that St. John’s wort is regarded as a supplement, not a medication. The herb is not regulated by the FDA which means that it is not checked for either contents or potency. In other words, a product may or may not contain what the label suggests. Producers of the wort can legally call a product “hypericum” or “St. John’s wort” even if it contains a little quantity of the herb.
St. John’s Wort and the Elderly
People over 65 years of age and people who are chronically or seriously ill are at greater risk than others of experiencing depression. Unfortunately, the same people are more vulnerable to the side effects of traditional antidepressant drugs. In other cases, conventional antidepressant medications may interact unpleasantly with other medicines the elderly patients are already taking. Due to these reasons, St. John’s wort may be especially helpful, because in most cases the side effects are rare and not severe.
SAM-e
Another natural antidepressant is SAM-e. It is not a herb, hormone, vitamin, or any type of nutrient, but a stabilized, synthetic form of S-adenosylmethionine (SAM), a chemical substance produced naturally by all animals. In the human body, SAM-e is believed to be indispensable to at least 35 biochemical processes, such as maintaining the structure of cell membranes and producing the substances that are fundamental to transmitting nerve impulses and influencing emotions and moods. SAM-e reportedly works to alleviate depression by boosting dopamine and serotonin neurotransmitter metabolism and receptor function, and perhaps repairing myelin surrounding nerve cells. The research on SAM-e has discovered that it constitutes an effective treatment for mild to moderate depression, working faster than tricyclic antidepressant drugs such as imipramine (Tofranil).
This substance was introduced to the United States from Italy and gained a lot of publicity, including enthusiastic articles in Newsweek, media coverage, promotional books, full-page adverts in newspapers and magazines, and lots of Web sites. Supporters are convinced that SAM-e is an effective treatment for depression, arthritis, and liver disease. Similarly to other supplements, it not controlled by the FDA.
The potential benefits and risks connected with SAM-e are still not clear. In Europe, it is sold as a prescription drug for arthritis, depression, and liver disease, but in the United States it is available without prescription. One potential problem associated with SAM-e is that this substance is converted into homocysteine in the body, and high levels of homocysteine may increase the risk of heart disease. Opponents are afraid that SAM-e may promote excessive levels of homocysteine. Marketers of SAM-e recommend a daily dose of 400 milligrams, but there is no standardized dose in the current market. Moreover, raw SAM-e is thught to degrade quickly unless stored at appropriate temperatures. You don’t have any guarantee that pills in the store have been handled appropriately. SAM-e is extremely expensive; a daily dose can cost anywhere from $2.50 to $18.
SAM-e has no value for healthy people, therefore it should not be taken as a tonic or mood booster. It does not prevent any popular disease, and it will not repair the liver damage resulting from heavy drinking. Side effects of SAM-e include: stomach upset and other gastrointestinal problems.
Two brands of SAM-e (Nature Made and GNC) are imported from the original producer in Italy in the form of enteric-coated tablets which protect the compound from breaking down. In Italy, SAM-e is so popular that it outsells Prozac.
Conclusion
In this chapter, you have learned about several alternatives to traditional antidepressant medications that may be an option for patients with mild symptoms of depression. Click here and you’ll read about some of the newest treatments currently being researched.
