St. John's Wort: nature's antidepressant?

by Jeff Siegel

Its a common plant, available without a prescription, and costs much less than its more well-recognized cousins. Does it really work?

Sally Guthrie gets phone calls from colleagues almost every day all seem to be looking for the same information. Their question: "What should we tell people about St. Johns Wort?"

"And I really dont know what to tell them," says Guthrie, an associate professor of pharmacology at the University of Michigan in Ann Arbor and one of the countrys leading experts on the plant whose therapeutic properties, say its proponents, rival prescription antidepressant medications and cost a lot less.

But Guthries hesitation is not the usual sort of standard medical resistance to anything unconventional. Talk to any number of professionals, including psychiatrists, and theyll tell you theyre intrigued by the possibilities offered by St. Johns Wort. What they dont want to do is prescribe it for severe mental problems without knowing more about it first.

St. Johns Wort a flowering plant known botanically as Hypericum perforatum grows wild in Europe and the United States (especially in Oregon and northern California). It seems to affect the brain and control mood swings in the same way that drugs like Prozac do. St. Johns Wort, in fact, has been used to treat stress and anxiety for hundreds of years. In Germany, for example, it outsells any other antidepressant medication.

St. Johns Wort appears to have few side effects, which isnt the case for many standard antidepressants. Some of the other antidepressant drugs, especially the older ones, affect everything form blood pressure to sex drive. Like many antidepressants, however, psychiatrists are concerned about the effects of St. Johns Wort in combination with other drugs.

Most authorities believe that hypericin is the active component in St. Johns Wort, but this has yet to be established conclusively. There are more than a half dozen potential active ingredients, and many variations among that number. This uncertainty notwithstanding, the plant is usually formulated and sold as a tablet, with hypericin as the active ingredient.

In 1996, the British Medical Journal published a review of 23 clinical studies (many conducted in Germany) that measured the effectiveness of St. Johns Wort. Many of the studies showed that patients were less depressed when taking St. Johns Wort than when taking placebos. However, the studies were very small and of short duration.

A new study funded by the National Institutes of Health, the National Center for Complementary and Alternative Medicine, the Office of Dietary Supplements, and the National Institutes of Mental Health will provide more information. The study, which is in progress, is the first large-scale, controlled clinical trial in the United States to assess whether the herb has a significant therapeutic effect in patients with clinical depression.

Until then, you should be careful about if and how you take St. Johns Wort. Dont use it if you are already on a standard antidepressant, or any other medications, without consulting your doctor first.

Since St. Johns Wort is classified as a dietary supplement, it is not regulated by the U.S. Food and Drug Administration. You can buy it almost anywhere without a prescription and there is no standard pill or dose. Some manufacturers may standardize their product using hypericin as the active ingredient; some may not. Some may include other supplements, like ginkgo biloba or kava kava. Guthries advice: look for a reputable manufacturer, preferably a German one, and use the 300 mg pill with hypericin.