St. John's Wort and Depression

St. John’s wort (Hypericum perforatum) is frequently prescribed in Germany for the treatment of mild to moderate depression. Research has indicated that using St. John’s wort can significantly relieve the symptoms of depression, with people showing an improvement in mood and ability to carry out their daily routine. In addition, symptoms such as sadness, worthlessness, hopelessness, and insomnia also decrease.

Numerous clinical studies have reported that St. John’s wort is more effective than placebo, with results similar to SSRIs. A study at the University of Vienna analyzed three double-blind trials that included 544 out-patients suffering from mild to moderate depression who received St. John’s wort or placebo. Researchers concluded that St. John’s wort reduced the symptoms of depression more effectively than placebo and accelerated the recovery from depression.

One review of 23 randomized trials that included a total of 1,757 outpatients with mainly mild to moderately severe depressive disorders noted that here was “evidence that extracts of hypericum are more effective than placebo for the treatment of mild to moderately severe depressive disorders."

Other double-blind, placebo-controlled studies have examined the effectiveness of St. John's wort for the treatment of mild to moderate major depression, and most have found the herb at least as effective as antidepressant medications. St. John’s wort extract has been compared favorably to the prescription antidepressants paroxetine (Paxil), citalopram (Celexa), imipramine (Tofranil), amitriptyline (Elavil), fluoxetine (Prozac), maprotiline (Ludiomil), and sertraline (Zoloft). In these studies, the improvement in depressive symptoms in people taking St. John’s wort was similar or better than the antidepressants, often with far fewer side effects. One clinical trial compared a higher amount of the St. John’s wort with imipramine in severely depressed patients. The overall improvement of both groups was virtually the same with far fewer side effects for the St. John’s wort group.

Hyperforin: The Power Behind St. John's Wort

Hyperforin is a natural compound extracted from the St. John's wort plant that is the primary compound responsible for its antidepressant effects. Biochemical studies have demonstrated that hyperforin works similarly to many prescription antidepressants by inhibiting the reuptake of the neurotransmitters norepinephrine, serotonin, and dopamine. All three of these neurotransmitters are chemical messengers that transmit information between nerve cells. An imbalance of serotonin, norepinephrine, and/or dopamine can cause depression. By acting as a "reuptake inhibitor" in the same manner that an antidepressant would, hyperforin increases the levels of these neurotransmitters in the brain, which can reduce the symptoms of depression.

An extensive body of research, consisting of over 30 controlled clinical trials, has proven the effectiveness of hyperforin-rich St. John's wort extract for elevating mood and relieving depression. A 2005 German study established that hyperforin was superior to the prescription drug paroxetine (Paxil) as a treatment for severe depression. Additionally, adverse side effects occur less frequently with hyperforin than prescription antidepressants.

St. John’s Wort in Germany

The German Commission E recognized Hypericum Perforatum (the dried parts from above the ground) as an herb approved for use in 1984. Since then, St. John's wort has been so commonly used as an antidepressant in Germany that it is estimated to be prescribed as much as four times more often than fluoxetine (Paxil).

St. John’s wort has been popular in the U.S. as well, with 1997 sales topping $45 million. In response, the United States Pharmacopoeia/ National Formulary published both a monograph and compendial standard for St. John’s wort in an attempt to create quality standards.

While studies worldwide point to St. John’s wort as effective for depression, treatment should be done under the guidance of a healthcare professional. One of the problems with trying to determine the efficacy of any supplement, herb, or antidepressant is that they all react differently in each person. This variable can be pronounced in people with depressive disorders, further enforcing the need for a qualified medical evaluation.

References
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Randi Fredricks is a Naturopathic Psychotherapist with a Doctorate in Naturopathy and a Masters in Psychology. She sees clients at her office in San Jose, California. She can be reached at 408-315-0645 or you can contact her online. This article is an excerpt from Randi Fredricks' book Depression-Free Naturally: Complementary and Alternative Therapies for Mood Disorders. Copyright © 2010. All rights reserved. No part of this article may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems.






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