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St. John’s Wort — First Line of Defense Against Mild Depression
By Donald Brown, ND

Healthnotes Newswire —A study published in the current issue of the British Medical Journal (BMJ) suggests that the herbal product St. John’s wort (Hypericum perforatum) may be among the most effective and safest initial treatments for mild to moderate depression.1

The German trial, which reportedly is the largest to date using St. John’s wort, found that people with mild to moderate depression given 500 mg of the herbal extract per day experienced as much symptom relief as those given 150 mg per day of the common antidepressant imipramine (Tofranil®).

The six-week trial also found that people given St. John’s wort were much less likely to report side effects than were those given imipramine. The authors conclude that the results of this study and others “provide compelling evidence that hypericum (St. John’s wort) is therapeutically equivalent to other antidepressants.” They also add, “In view of hypericum’s comparable efficacy to other antidepressants and its safety record, hypericum should be considered for first line treatment in mild to moderate depression, especially in the primary care setting.”

This study follows on the heels of an earlier trial reported in Healthnotes Newswire on April 20, 2000. Sounding a tone similar to that of the new report, the earlier trial found that a comparable dose of St. John’s wort extract treated people with mild to moderate depression as effectively as the popular antidepressant Prozac®.2 Again, side effects were fewer and less severe in the group given St. John’s wort than in the group given Prozac.

Both of these trials challenge previous assumptions about the dose of St. John’s wort needed to effectively treat mild depression. Earlier trials comparing St. John’s wort to even lower doses of imipramine and another standard antidepressant, amitriptyline (Elavil®), have used daily doses ranging from 900 to 1,050 mg.3 4 The results of these trials suggest that 500 mg of St. John’s wort per day may be all that’s needed to treat mild depression.

Before deciding to take St. John’s wort for depression, consumers should consult a doctor. Depression can be a warning sign for an underlying disease such as anemia or low thyroid function. Be sure an antidepressant—drug or herbal—is the proper treatment.

Also, it’s important to remember that mixing St. John’s wort with other medications may be dangerous. Taking St. John’s wort with prescription antidepressants, including Prozac or Zoloft®, may lead to confusion, muscle twitching, and sweating.5 Equally important, St. John’s wort may reduce blood levels of some prescription drugs.6 7 8 9 It is best to avoid the use of St. John’s wort when taking warfarin, coumadin, theophylline, cyclosporine, indinavir, or even birth control pills.

References
1.Woelk H. Comparison of St. John’s wort and imipramine for treating depression: randomized controlled trial. BMJ 2000;321:536–9.
2. Schrader D. Equivalence of St. John’s wort extract (ZE 117) and fluoxetine: a randomized, controlled study in mild–moderate depression. International Clin Psychopharmacol 2000;15:61–8.
3. Philipp M, Kohnen R, Hiller KO. Hypericum extract versus imipramine or placebo in patients with moderate depression: randomized multicenter study of treatment for eight weeks. BMJ 1999;319:1534–9.
4. Wheatley D. LI 160, an extract of St. John’s wort versus amitriptyline in mildly to moderately depressed outpatients—controlled six-week clinical trial. Pharmacopsychiatry 1997;30(Suppl):77–80.
5. Demott K. St. John’s wort tied to serotonin syndrome. Clinical Psychiatry News 1998;26:28.
6. Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St. John’s wort. Lancet 2000;355:547–8 [letter].
7. Ernst E. Second thoughts about safety of St. John’s wort. Lancet 1999;354:2014–6 [letter].
8. Ruschitzka F, Meier P, Turina M, et al. Acute transplant rejection due to Saint John’s wort. Lancet 2000;355:548–9 [letter].
9. Brown D. Follow-up regarding St. John’s wort interaction with digoxin and other drugs. Healthnotes Rev Complementary Integrative Med 2000;7:32.

Donald Brown, ND, is a naturopathic physician and one of the leading authorities in the United States on evidence-based herbal medicine. He is the founder and director of Natural Product Research Consultants, Inc., and serves on the Advisory Board of the American Botanical Council and the President’s Advisory Board of Bastyr University.