St. John's Wort
Article by Don Goldberg
| St. John’s Wort
What propelled St. John’s wort to the status of superstar herbal antidepressant was a study published in the British Medical Journal in 1996. The study was titled, "St. John’s wort for depression-an overview and meta-analysis of randomized clinical trials." The reason it garnered such media attention was because it was a meta-analysis, which means it wasn’t one study. The authors thoroughly reviewed 23 previously published studies and pooled the results. Most of these studies were published in foreign journals and in foreign languages such as German, and thus had not attracted the attention of the mainstream American media. St. John’s wort was well-known in the alternative health field and countless articles had been published about it in a variety of alternative (or complementary, as some wish to be called) health magazines. This herb has been popular in Germany and many other European countries for years, prescribed more often than pharmaceutical antidepressants.
The objective of the researchers was, in their own words, "To investigate if extracts of Hypericum perforatum (St. John’s wort) are more effective than placebo in the treatment of depression, are as effective as standard antidepressive treatment, and have fewer side effects than standard antidepressant drugs."
The pooling of patients from 23 studies yielded 1,757 patients with mainly mild or moderately severe depression. Fifteen of these studies were placebo-controlled, meaning that some patients were given the herb and other patients were given a placebo, or dummy pill. Neither group would know until the end of the study which of them was given the real medicine. Doing a placebo-controlled study is essential in order to avoid the expectations and hopes patients feel when they are placed on a medicine. In addition to these fifteen studies, eight others evaluated the effectiveness of this herb compared to another antidepressant drug treatment. For instance, one such study compared maprotiline (Ludiomil) to St. John’s wort (Harrer 1994). The effectiveness of the herb was similar to the drug. Patients on maprotiline, however, complained of unpleasant side effects such as tiredness and dry mouth.
The overall interpretation of this meta-analysis showed that St. John’s wort was superior to the placebo and as effective as a pharmaceutical antidepressant-and with significantly fewer side effects. In fact, more than half of the patients on prescription antidepressant drugs reported side effects, compared to less than 20 percent of those on the herb. The researchers conclude, "There is evidence that extracts of hypericum are more effective than placebo for the treatment of mild to moderately severe depressive disorders."
Who is a candidate for St. John’s wort?
Anyone who has mild or moderate depression is a candidate for a trialwith St. John’s wort. Studies have not evaluated the role of this herb in severe depression or those who are suicidal.
Depression, as you may have already guessed from your interaction with people over the years, is very common in the United States. It is estimated that up to 17 percent of the population at some point in their lives succumb to this disorder (Kessler 1994).
There are various forms of depression. Some are due to genetic reasons which lead to deficiencies in certain brain chemicals or hormones. Many of us know of certain families where depression is rampant. Family members suffer from chronic low mood, and there is a prevalence of inte