St. John's Wort


WebMD Feature

European physicians routinely prescribe an herb called Hypericum perforatum, the botanical name for St. John's Wort, for their patients with mild depression . If you're one of the many Americans who suffer from this, St. John's Wort is also available -- but only as a dietary supplement.

You can find St. John's Wort in health food stores, neighborhood pharmacies, supermarkets -- wherever you can find vitamins and other dietary supplements, such as ginkgo or echinacea. The labeling notes its contribution to emotional balance and positive outlook or promoting a sense of well-being for people with mild -- not major or severe -- depression. That's all the Food and Drug Administration (FDA) allows. Manufacturers can't advertise it as a treatment for depression -- and doctors can't prescribe it.

But lack of FDA recognition of Hypericum as an anti-depressant hasn't prevented an enthusiastic U.S. response. Why the interest in an alternative treatment? The available antidepressant drugs have a high success rate, but they also carry the unwanted baggage of side effects. Depending on the specific drug, these can include sleep disturbance, weight gain, impaired concentration and memory, disorientation, dry mouth and, most notably, sexual dysfunction. A month's supply of St. John's Wort costs substantially less than a month's supply of Prozac or any other anti-depressant drug -- although it probably won't be covered by your insurance plan or HMO.

Is It Effective?

Is St. John's Wort useful for the treatment of mild depression? Reportedly, it's as effective as standard antidepressant medication, most people experience no side effects and for the small percentage who do have a reaction, the most common occurrences are mild gastrointestinal irritations, allergic reactions, fatigue and restlessness. Hypersensitivity to sunlight has also been identified as a possible side effect.

So why isn't St. John's Wort included in the "official" depression-treatment arsenal? To date, there have been no controlled studies in the United States evaluating the effectiveness of St. John's Wort in alleviating the symptoms of depression, determining what its side effects may be, or comparing it to mainstream antidepressant medications. And according to the National Institute of Mental Health (NIMH), none of the European studies had a sufficiently large sample or were of sufficiently long duration to evaluate adequately the herb's effectiveness and the effects of long-term usage. But that's about to change.

U.S. Studies

The Office of Alternative Medicine and the NIMH, both part of the National Institutes of Health, recently launched the first U.S. clinical trial of Hypericum. The study, according to Benedetto Vitiello, M.D., NIMH project officer, was prompted by the large number of people taking it. The study's purpose is to "address the knowledge gap" -- provide patients and physicians with information about Hypericum's antidepressant properties and any side effects. The three-year study is being carried out by the Duke University Medical Center in Durham, North Carolina.

If you're one of the many for whom mild depression is a reality, three years may seem like a long time to wait for information about a treatment that seems too good to be true -- and it may be. You need to remember that long-term use may produce side effects, even when short-term use doesn't. To date, there have been no long-term studies of Hypericum. The other important thing to remember is that other physical diseases can mimic depression. If you're experiencing the common symptoms of depression -- sadness, loss of interest in pleasurable activities, decreased energy, disturbed sleep, feelings of hopelessness, don't rush out to buy a bottle of St. John's Wort. Get a thorough medical exam -- and then discuss with your doctor the pros and cons of St. John's Wort and other antidepressants.

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Last Editorial Review: 1/30/2005