Herbal Relief for Depression:
St. John's Wort (Hypericum)

At least one out of every 20 Americans gets depressed each year, and many rely on anti-depressants to help them cope. A new study shows the herb St. John's Wort might be just as effective, and with fewer side effects.

The August 3, 1996 issue of the British Medical Journal contains an analysis of approximately 25 studies that suggest that St. John's Wort (Hypericum perforatum) is just as helpful as commonly used drugs, without side effects such as headaches or vomiting. Dr. Cynthia Mulrow, one of the study's authors, says the findings are not surprising. "Some of the commonly used medicines have a basis on herbs or have a basis in plants, and some of the ones were developed using plants."

Although not well known in the United States until recently, researchers in Europe have been studying it for decades. Doctors in Germany have been prescribing it for depression and insurance companies have been paying for it. It has available in herb shops in Europe and the United States, but recently has been increasingly selling out as word has been getting around about it effectiveness. It comes in liquid, capsule and dried form.

Not long ago, experiments were done where mice infected with viruses similar to HIV were given St. John's Wort extract. The virus' progress was halted. This led to testing on human HIV and AIDS patients. The results are inconclusive, though anecdotal information reports a significant improvement in some patients.

St. John's Wort contains hypericin that inhibits monoamine oxidase, a bodily chemical associated with depression. It appears that hypericin does not act alone. Like many herbal medicines, St. John's Wort relies on the complex interplay of many constituents for its antidepressant actions. Patients suffering from depression received relief, increased appetite, more interest in life, greater self-esteem and restoration of normal sleeping patterns.

St. John's Wort is available as tea, tincture, decoction, oil, and in capsule form. Teas should be made with 1-2 cups of flowers per 1 cup of boiling water. This tea can be drunk three times daily. The dosage of the tincture is 1/4 to 1 teaspoon up to three times daily.

Perhaps most notable regarding St. John's Wort extract for depression has been favorable comparisons to standard prescription antidepressive drugs. These include maprotiline hydrochloride and imipramine.

In a multicenter trial, 135 patients with depression were given either St. John's Wort (900 mg/day) or imipramine (75 mg/day) for six weeks. Therapeutic success was determined using the HAMD, Clinical Global Impression (CGI), and Depression Scale according to Zerssen. HAMD score improved by 56% in the St. John's Wort group versus 45% for the imipramine group. Differences on the CGI and Zerssen scales were slightly better for St. John's Wort although not significantly different. Adverse reactions were reported in 16% of patients taking imipramine while only 12% of those taking St. John's Wort experienced side effects.

Dr. Donald Brown of Bastyr University recommends that persons with fair skin avoid exposure to strong sunlight and other sources of ultraviolet light when taking St. John's Wort because of some cases of photosensitivity that have been reported. He also advises avoiding foods that contain tyramine, alcoholic beverages, and medications such as tyrosine, narcotics, amphetamines, and over-the-counter cold and flu remedies while taking St. John's Wort. St. John's Wort should not be taken while also taking prescription antidepressants. It is also Dr. Brown's opinion that St. John's Wort should not be used during pregnancy or lactation.

According to Jonathan Zuess, MD (author of The Natural Prozac Program), tyramine seems to primarily be a problem if a person has high blood pressure. This is due to St. John's Wort working in a similar way to drugs that are monoamine oxidase inhibitors (MAOIs).

However, studies done in the 1990's have shown that the MAOI-like effect of St. John's Wort is negligible when it's used in normal doses. So it is unlikely that it would react with tyramine. In Germany, where doctors have had the most experience with St. John's Wort, it is considered safe to use in patients with high blood pressure.

Nonetheless, if you have high blood pressure, and your doctor agrees to your use of St. John's Wort, the following precautions should be taken:

Even if you do not have high blood pressure, do not take St. John's Wort with amino acid supplements (especially phenylalanine and tyrosine). Amino acids are a form of monoamines, which can pose a danger when mixed with St. John's Wort. The monoamines that you get in your diet (such as the amino acids in meat) are less concentrated and are not a hazard.

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