If you have ever felt sad, discouraged, dejected, distressed, disheartened, depressed, demoralized, melancholic, or worried, you may have considered taking St. Johns Wort. St. Johns Wort is not a skin disease but a popular herbal remedy derived from the dried above-ground parts of the Hypericum perforatum plant that has been extensively used for decades in Europe to treat depression. There have been many studies suggesting that St. Johns Wort is effective for mild to moderate depression and best of all, it has few if any side effects . It also appears to work by boosting the level of brain serotonin in a way similar to the popular SSRI class of antidepressants.

Many people have opted for the herbal approach to depression and approximately $195 million was spent by 1.5 million Americans for St. Johns Wort in the year 2000 (NY Times, 4/18/2001). So why spend lots of money to buy prescription SSRI anti-depressants such as Zoloft, Wellbutrin, Paxil or Prozac when you can purchase St. Johns Wort at a much lower price, without a prescription at your local drug store?

One problem with using St. Johns Wort is the difficulty in ascertaining the right dosage of the herbal remedy. The Los Angeles Times (Monday, August 31, 1998) sent bottles of St. Johns Wort manufactured by ten different companies to an independent laboratory to measure the amount of the active ingredient. The result: the amount of hypericin, the active ingredient in St. Johns Wort varied from 30 to 140% of the amount indicated on the label. The herbal remedy companies all complained that the laboratory didnt perform the test correctly. The Los Angeles Times responded by sending the bottles to a second laboratory which confirmed the first measurements. Imagine that you are a psychotherapist or patient treating yourself (not recommended but frequently done) deciding on what dosage of St. Johns Wort to use. One suggestion: if it works for you, continue taking the same preparation from the same company since the amount of active ingredient may vary considerably between companies.

Now a report in the Journal of the American Medical Association challenges previous studies of the effectiveness of St. Johns Wort in the treatment of depression ¹. This study was designed and conducted by 11 academic medical centers. Depression was ascertained by standardized testing and two hundred individuals with clinical depression (diagnosed by standardized psychological testing) were randomly assigned to receive either placebo or St. Johns Wort in a double-blind controlled study. Both groups received one week of placebo and then they received either three 300 mg doses of St. Johns Wort or three identical looking and tasting placebo pills each day. These researchers found that after 4 weeks of treatment, there was no significant difference in the level of depression as ascertained by changes in psychological test scores in these two groups. Even when they looked at a subset of less depressed patients, there did not appear to be any significant difference between St. Johns Wort and the placebo.

This is a very important study as it represents the first well-controlled study of St. Johns Wort for the treatment of objectively defined depression. Previous studies must be considered in the light of this study since they lacked the experimental rigor and control of the JAMA study. Critics of this study will point to the fact that the subjects in this study were probably more depressed than those in other studies of St. Johns Wort. While this is probably true, it is surprising that St. Johns Wort did not have an effect on the less depressed subset of patients in this study.

So, if you or your relative, friend or patient is taking St. Johns Wort, what should you do? First, as always, I recommend that you consult your health professional who specializes in depression before doing anything. You may require psychotherapy in addition to medication. Second, you should learn about the advantages and disadvantages of the alternatives to St. Johns Wort.

If St. Johns Wort appears to be helping your depression, I would not recommend discontinuing usage until other studies confirm this multicenter study. The good news is that this study as well as previous ones found few side effects, so taking St. Johns Wort is not likely to be harmful.

Information provided in this article is for informational purposes and is not meant to substitute for the advice furnished by your own physician or other medical professional. This content should not be utilized for diagnosing or treating a health problem or disease, or prescribing any medication. Before taking any health product, you should read all product packaging. If you have or suspect that you have a medical problem, contact your health care provider. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.