St. John’s Wort is becoming increasingly popular mostly due to the lack of side effects. Other prescription antidepressants such as Prozac, Zoloft, and Paxil often produce effects like weight loss, sexual dysfunction, and insomnia. In a controlled study of St. John’s Wort, only 2.4% of the subjects experienced any side effects, those of which were minor. Some of these minimal effects are stomach discomfort, allergic reactions, and restlessness. Formal studies are now being conducted in the United States but this plant has been used in Europe, particularly Germany, for centuries without any reported deaths. In fact, this treatment is so popular in Germany that it is prescribed by more than seven to one over Prozac, which is a very popular antidepressant in the United States. German doctors generally write near 3 million different prescriptions per year for St. John’s Wort. People also often prefer to take natural supplements as opposed to prescription drugs when possible although in Germany, the doctors prescribe St. John’s Wort. St. John’s Wort is also significantly cheaper than prescription antidepressants, costing approximately between $6.50 and $13 per bottle for varying volumes and potencies, which averages out to about $0.25 per day. This is obviously an attractive quality of the drug, especially because antidepressants are generally taken on a long-term basis. All of these qualities-minimal side effects, natural remedy, and cost effectiveness are all selling points for this treatment, which is sold in health food stores rather than pharmacies. In fact, even Wal-Mart is trying to become a vendor of this rapidly spreading trend. You don’t need a prescription to take this, but doctor consultation is highly recommended.
Common symptoms and characteristics of depression are the well-known things like sadness, suicidal thoughts, hopelessness, worthlessness, and crying but there are also other effects like minimal energy and fatigue, decreased sex drive, weight fluctuation, and insomnia or hypersomnia. These are terrible things to feel and experience but with proper help and/or drugs, these may be minimized, or even cured. St. John’s Wort has been shown to help with the symptoms of anxiety, fatigue, and of course, the general feelings of sadness and hopelessness. In clinical studies, “patients suffering from depression received relief, increased appetite, more interest in life, greater self-esteem and restoration of normal sleeping patterns”. Once the overall depression and the feelings of helplessness and sadness subside, the physical factors seem to improve on their own, due to a more positive mental state.
St. John’s Wort is not recommended for children except under strict physician care but it has been found to be incredibly effective in adolescents, which are often a very complicated group to treat.
Patients are advised
to avoid some foods and
medicines such as alcohol, narcotics, amphetamines, tyrosine, over-the-counter
flu medicines, and foods containing tyramine, such as yeast, aged cheese,
eggplant, and soy sauce. Those who take St. John’s Wort should not
take it in conjunction with prescription antidepressants.
Women who are pregnant or
currently lactating should not take this “drug”. Also patients that
are bi-polar or manic-depressive
shouldn’t view St. John’s Wort as a possible remedy for their depression.
This plant also seems to cause photosensitivity
so patients ingesting it should try to avoid direct sunlight or other strong
UV lights and those who are already sensitive to the sun should seriously
consider that before buying St. John’s Wort.
St. John’s Wort’s beneficiary
effects cannot be felt immediately but usually after a span of 4-8
weeks, patients have usually improved a lot. In fact, studies
show that about 60% to 80% of patients ameliorate within this time span.
Also concluded from these studies, it is recognized that 15% to 20% of
the subjects didn’t respond at all to this treatment.
Many people have posed the
question: “If this extract is so beneficiary for so many different reasons
and has no major side effects, shouldn’t
we all take it just to be more healthy and hopefully prevent future
depression?” Well, no we shouldn’t, because we don’t have any scientific
evidence about the long-term effects of St. John’s Wort and there really
isn’t any concrete evidence of it making “normal” people feel better.
According to Linde, Ramirez, etc. (1996), improvement in depression of those subjects that took St. John's Wort extract also far surpassed the improvement of the placebo group. In this study, there were 15 randomized trials using subjects with mild or moderate depression and 55.1% of the subjects in the hypericum groups responded positively while only 22.3% of the placebo groups improved. The St. John's Wort groups improved almost twice as much as the placebo groups, which is pretty strong evidence that this herb has some beneficial effects in treating mild to moderate depresion.
Nordfors and Hartvig (1997) conducted 25 controlled clinical trials comparing St. John's Wort to both placebo and other standard antidepressants. In their study, they found that given a low-dose treatment of less than 1.2 mg of hypericum extract, 61% of patients improved whereas given a higher dosage of 2.7 mg, an amazing 75% of patients showed improvement. This evidence also identifies hypericum extract as a beneficial medication in the alleviation of depression.. I could not find this journal in the Eskind Biomedical library because it is German and the abstract is a little unclear as to whether these results are compared with placebo or standard antidepressants but as I understand it, these were just the overall improvements that the patients who were taking St. John's Wort made .
Schmidt and Sommer (1993) performed a randomized double-blind trial using a placebo as the control group comparing it to St. John's Wort. Those patients taking hypericum responded at a rate of 66.6% whereas only 26.7% of the placebo patients responded. This resource was also only an abstract due to the lack of German journal resources in local facilities.
I found another very non-descriptive abstract of an article written by Ernst (1995) that claims that St. John's Wort does in fact improve the symptoms of depression better than a placebo in their trials. Since the abstract was very succinct, this is the only statement made about the use of St. John's Wort in comparison to a placebo but I added it as another reference expressing the beneficial characteristics of this herbal remedy.
I could not find any studies that showed St. John's Wort as ineffective. They all proved it to be much more effective than a placebo and the majority of patients improved somewhat after four to eight weeks of taking the herbal remedy. Since the drug takes approximately four weeks to feel it's full effects, the shorter trials are more likely to be inaccurate but to the extent that, given more time, probably even more of the patients would have shown an improvement.
Linde, Ramirez etc. (1996) found the hypericum extracts to be as effective as standard antidepressants in helping alleviate depression. In this study, there were some trials that compared single hypericum preparations to standard antidepressants and some trials of combinations compared to the prescription antidepressants. In the single hypericum preparations, 63.9% of patients responded positively while 58.5% responded with the standard medication. In the combination trials, 67.7% responded to the hypericum extracts while only 50% responded to the synthetic drugs. The scores on the Hamilton depression scale were a little better in those patients that had taken the single preparation hypericum than those who took the synthetic drugs, once again proving that St. John's Wort is as effective as, if not more, than standard antidepressants.
In Ernst's study (1995), he too found that St. John's Wort is as effective as the standard antidepressants in the treatment of depression.
All studies seem to indicate that hypericum extract works as well as if not better than standard prescription antidepressants. I could not find any studies that contradicted this theory. All trials seem to point to the idea that St. John's Wort is the herbal equivalent of the synthetic antidepressants but without all of the negative side effects.
In the Linde, Ramirez, etc. (1996) trials, they found similar results. They had 0.8% of the hypericum patients drop out due to discomfort from side effects while 3.0% of patients in the standard antidepressant groups withdrew due to side effects. The total drop out rates were 4.0% for the hypericum groups and 7.7% of the standard medication groups. The total number of reported side effects were 19.8% for the hypericum groups and 35.9% for the synthetic antidepressant groups. This last quote of side effects seems to contradict the rest of this study and the other studies as well. These percentages are much higher and it's possible that these are true but it's also possible that I misunderstood the article's description.
There were also patients in this study in the St. John's Wort versus placebo trials that withdrew because of side effects. Surprisingly, 0.4% withdrew in the hypericum groups while 1.6% of the placebo patients withdrew from the study. This is unusual since placebos shouldn't have side effects and yet more of the people in the control placebo group dropped out due to side effects of which there shouldn't have been any than the experimental hypericum groups.
In these trials by Linde, Ramirez, etc., the "classification of depression was not uniform and in some studies quite vague". They also noted that they did not perform a large number of trials and therefore cannot conclude their findings as the absolute truth. The observation periods were also rather short and there have been no studies on the long term side effects.
In the abstract by Nordfors and Hartvig (1997), there is simply a statement that says that the hypericum extract's side effects were rather mild and not as common as those of the standard antidepressants. There is a more detailed description of this claim in the German journal Lakartidningen.
In Schmidt and Sommer's (1993) study, they concluded that overall the patients tolerated the hypericum pretty well. The abstract does not tell how many people were included in this study but it states that only two subjects reported minor side effects when taking St. John's Wort.
Ernst (1995) mentions that due to the lack of side effects, it is a better drug in many cases than standard antidepressants.
The lack and rarity of serious side effects with St. John's Wort is one of it's major selling points. Without this inconvenience, hypericum perforatum has serious advantages over the synthetic drugs which often have very uncomfortable side effects.
The research that I found in
esteemed medical journals all said the same thing: St. John's Wort is an
effective remedy for mild to moderate depression, proving more effective
than placebos and equal to if not superceding standard synthetic antidepressants
in alleviating the symptoms of depression. The lack of side effects
makes this remedy a more logical choice for many patients and provides
a natural way to solve some of the depression problems. Many people
are more enthusiastic about taking a cheap, effective, natural remedy that
is sold over the counter than an expensive, prescription synthetic drug
that is often accompanied by unbearable side effects. All in all,
it looks as if St. John's Wort is a wonderful alternative medicine to the
synthetic antidepressants.
Ernst, E. (1995). Johanniskraut zur antidepressiven
Therapie (St. John's wort as antidepresive
therapy). Fortschritte
der Medizin, 113 (25), 354-355.
Linde, K., Ramirez, G., et al. (1996). St John's
wort for depression---an overview and
meta-analysis of randomised
clinical trials. BMJ, 313 (7052), 253-258.
Nordfors, M. & Hartvig P. (1997). Johannesort
till heders igen mot depression (St John's
wort against depression in
favour again). Lakartidningen, 94 (25), 2365-2367.
Schmidt, U. & Sommer, H. (1993). Johanniskraut-Extrakt
zur ambulanten Therapie der
Depression. Aufmerksamkeit
und Reaktionsvermogen bleiben erhalten (St. John's wort
extract in the ambulatory
therapy of depression. Attention and reaction ability are
preserved). Fortschritte
der Medizin, 111 (19), 339-342.
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