Biology 202
2002 Second Paper
On Serendip

This country has its share of major health issues, and Depression has remained a prominent one. With a prevalence rate of one in twenty suffering from this psychological disease in the US, (1) it is no wonder that many varying treatment options now exist for sufferers. The most common approach to treating Depression is with some form of psychotherapy coupled with prescription drugs. However, this traditional course of treatment now has the so called 'alternative' approaches to contend with. One such alternative therapy is Hypericum, an herb that is more commonly known as St. John's Wort. There is a bubbling debate between believers in the herbal treatment and non-believers (comprised mostly of doctors and researchers) who think St. John's Wort does nothing for Depression. From both sides of the debate, however, there have been some interesting findings.

There is a common understanding that St. John's Wort was named after John the Baptist. Hypericum perforatum is its Latin name. St. John's Wort is a naturally occurring plant characterized by its black-spotted yellow flowers. Historically it has been hailed as an effective treatment for an array of ailments, including digestive disorders, lung ailments, skin abrasions, and as a general inducer of state of 'well being'.

From its supporting side, the argument is that St. John's Wort should be treated as comparable to prescription antidepressants and as just another available option for the millions who are depressed in this country. Supporters often site the fact that German doctors endorse millions of doses of the herb daily, and elsewhere in Europe, the medical community readily acknowledges its positive effects. They also argue that the process of prescribing the right antidepressant to a patient is an extremely time consuming and pain staking process, as one medication might be changed to another and dosages fluctuate in an attempt to stabilize the patients mood. The process can take close to a year. With St. John's Wort, however, the herb is easily obtainable, does not need a prescription, and is available at a much lower cost than prescription drugs. It also boasts few side effects and mild ones at that, versus the multiple side effects that go along with such popular prescription antidepressants such as Prozac. (2)

Now we will turn to the other side of the coin, as it were. The US Food and Drug Administration has not yet approved St. John's Wort as an effective treatment for depression. This lack of approval is mostly due to the fact that little research has been conducted on the effects of St. John's Wort. That is, until recently.

In April 2001 and again this month (April 2002) The Journal of the American Medical Association (JAMA) published the results of clinical trials conducted to test whether St. John's Wort works to treat Depression. (3, 4, 5) Both times the results did not favor the use of the herb. The most recent JAMA report concluded, "...hypericum should not be substituted for standard clinical care of proven efficacy, including antidepressant medications and specific psychotherapies, for the treatment of major depression of moderate severity." (3)

When interviewed about the results of the JAMA reports, Psychiatrist Mark I. Levy, MD (University of California, San Francisco) expressed concern with the popular belief that St. John's Wort treats Depression. "The danger is the illusion of effect, given that untreated depression has a 15% death rate. If people think they are going to treat it [Depression] by taking a relatively ineffective medication, that scares me." (5) In other words, there are likely thousands of people using St. John's Wort who are remaining under-treated for an extremely serious and potentially deadly psychiatric disease. Considering the research results and the prevailing popularity of Hypericum, this is indeed a valid concern.

Countering this, however, from the pro- Hypericum side, is the fact that no one ever claimed St. John's Wort could treat severe forms of depression, and that for mild forms of the disease, St. John's Wort can be effective in allaying symptoms. (4)

Turning again to the con side, Hypericum has serious interactions with prescription drugs. And not just a few, but many, including, HIV/AIDS medications, cancer, and heart treatment drugs. In most cases, these drugs are non-negotiable: i.e. a patient has no choice as to whether they take them or not, as their life depends on the drug(s). With millions of Americans taking drugs for these and other common conditions, and millions suffering from Depression, there is bound to be overlap. So, for millions of people already on prescription drugs for things like heart disease, if they are also depressed, St. John's Wort should truly not be considered as a treatment option. (5, 6)

So what is a consumer to do? When battling Depression, or even a periodic sad mood, a cheap, accessible, over-the-counter mood-booster seems like a miracle. And many consumers think of St. John's Wort in that way. For mild forms of depression, the herb appears to be quite an effective treatment. For more severe forms, this appears not to be the case, say researchers, but there are still some patients who swear by it.

However, because of the high probability of severe interaction with other drugs, it is best to consult your doctor or psychiatrist before self-prescribing St. John's Wort. And that goes for all other over-the-counter treatments as well.

While finding as many ways as possible to treat Depression is a priority for medical researchers, and the wish of all sufferers and others effected by it, it is also imperative that one not get carried away with new discoveries. Consult medical doctors, go through the research, weigh both sides of the coin, and then make a personal decision as to which treatment will best help your condition.

Resources Cited:

1) CNN.com Health , article on St. John's Wort

2) Hypericum.com , basic information about the herb Hypericum perforatum

3) JAMA April 2002 Report on the Hypericum efficacy research study

4) WebMD (Online consumer medical information) , article "Are Herbs Good Medicine?"

5) WebMD , article "St. John's Wort Not Effective - Again", after release of JAMA report

6) WebMD , article "A Dangerous Prescription", mixing herbs with prescription drugs

For More Information:

7) Newsweek article "A Natural Mood Booster", treating Depression with St. John's Wort

8) National Institute of Mental Health (NIMH), "Information About St. John's Wort" page

9) National Center for Complementary and Alternative Medicine , St. John's Wort Fact Sheet

10) National Center for Complementary and Alternative Medicine , St. John's Wort Q & A

11) Health World Online , index of articles on Depression and herbal remedies


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