More Evidence St. John’s Wort Works for Depression

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More Evidence St. John's Wort Works for Depression

http://bastyrcenter.org/content/view/688/

 

St. John's wort, a popular herbal remedy for depression, is at least

as effective as the antidepressant drug paroxetine (Paxil®) and

causes fewer side effects, reports the British Medical Journal's

online edition

(http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38356.655266.82v1;

accessed 02/2005). The results of this study add to the large body

of research showing that St. John's wort is a safe and effective

treatment for mild to moderate depression.

 

In the new study, 251 people suffering from acute depression were

randomly assigned to receive 300 mg of a St. John's wort extract

three times a day or 20 mg of paroxetine once a day for six weeks.

If after two weeks the depression had not improved by at least 20%,

the dose of St. John's wort or paroxetine was doubled for the

remainder of the study. After six weeks of treatment, the depression

had resolved in 50% of the participants taking St. John's wort and

in 35% of those taking paroxetine, a statistically significant

difference. A dosage increase was necessary at the two-week point in

57% of the people taking St. John's wort and in 48% of those taking

paroxetine. The incidence of side effects (mainly gastrointestinal

symptoms, fatigue, dizziness, headache, dry mouth, or increased

sweating) was 72% higher in the group receiving paroxetine than in

the St. John's wort group.

 

Many other studies have shown that St. John's wort is significantly

more effective than a placebo and at least as effective as certain

antidepressant drugs, including fluoxetine (Prozac®) and imipramine.

Furthermore, in most of these studies, the herbal remedy was better

tolerated than the prescription medication. Despite the strong

evidence demonstrating St. John's wort's effectiveness, its use as a

treatment for depression remains controversial.

 

The controversy stems mainly from a widely publicized negative

report published in 2001 in the Journal of the American Medical

Association (2001;285:198–86). In that study, although the remission

rate was significantly greater with St. John's wort than with a

placebo, only 14.3% of those who received the herb went into

remission, causing the authors of the report to question its

efficacy. However, the 4.9% remission rate in the placebo group was

far below the placebo response rate seen in other studies of

depression, which suggests that many of the participants recruited

for this study would have been unlikely to respond to any treatment.

 

The bulk of the evidence at this time indicates that St. John's wort

is a safe and effective alternative to antidepressant medications

for the treatment of mild or moderate depression, although severe

depression does not seem to respond to the herb. As it can interact

with a fairly large number of medications, people interested in

taking St. John's wort should be monitored by a qualified healthcare

practitioner.

 

Alan R. Gaby, MD, an expert in nutritional therapies, testified to

the White House Commission on CAM upon request in December 2001. Dr.

Gaby served as a member of the Ad-Hoc Advisory Panel of the National

Institutes of Health Office of Alternative Medicine. He is the

author of Preventing and Reversing Osteoporosis (Prima, 1994), and

co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Three

Rivers Press, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions

(Healthnotes, Three Rivers Press, 1999), Clinical Essentials Volume

1 and 2 (Healthnotes, 2000), and The Patient's Book of Natural

Healing (Prima, 1999). A former professor at Bastyr University of

Natural Health Sciences, in Kenmore, WA, where he served as the

Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor

for Healthnotes, Inc.