So, you’re depressed. Given that the Globe’s analysis showed that, at least in lab tests, there is considerable variation among St. John’s wort brands, should you take it at all?
Buying any herbal remedy is basically a crapshoot. But the short answer is that if you try a brand of St. John’s wort and it helps within about three weeks, stick with it. Your improved mood might be due to the placebo effect – you feel better because you expect to feel better. In studies in which neither depressed patients nor doctors know who is getting a real drug and who is getting a harmless substitute, 55 to 65 percent of patients feel better on a placebo, at least for a limited time.
And in a sense, who cares? Feeling better is what counts.
If, on the other hand, you take St. John’s wort for a few weeks and still feel depressed, stop fooling around with self-medication, get to a doctor and ask about a prescription drug such as Zoloft or Prozac and/or psychotherapy.
Whatever you do, don’t take St. John’s wort and a prescription antidepressant without checking with a doctor. There are now reports of three cases of “serotonin syndrome,” a potentially fatal excess of serotonin, in people who combined St. John’s wort with a prescription antidepressant.
In a year or so, there should be more definitive answers on how well St. John’s wort works, when a $3.6 million study sponsored by the National Institute of Mental Health is completed. Led by researchers from Duke University, this study involves scientists at 12 centers nationwide, including McLean Hospital in Belmont, Mass., and will involve 336 patients who are taking St. John’s wort, Zoloft, or a placebo.
The Duke study is using a brand of St. John’s wort called Kira, made by Lichtwer Pharma AG. This is the brand that has been studied the most in Germany, where St. John’s wort is widely used.
Kira was not one of the products we tested. It contains an extract of St. John’s wort called LI 160. This extract contains hypericin and hyperforin, a compound many researchers now believe is essential to St. John’s wort efficacy.
Through its corporate ties to another German pharmaceutical company, Dr. Willmar Schwabe GmbH & Co., Lichtwer allows its LI 160 extract to be used as the basis for another St. John’s wort product, Quanterra, whose label states that it contains a variant of the extract called LI 160 WS, which means vitamin C has been added to stabilize hyperforin.
Even without the Duke study, this is already some evidence for the potential benefits of St. John’s wort for depression.
In 1996, German researchers pooled data from 23 short-term studies (using different brands of St. John’s wort) and found that it helps with mild to moderate depression; it was more effective than placebo and equivalent to standard prescription drugs.
“What is impressive is that the vast majority of studies do suggest that St. John’s wort has real antidepressant effects. If, in fact, this was nothing more than placebo, we would not expect to see such consistent results,” says Dr. Scott Ewing, director of the depression and anxiety disorders clinic and a St. John’s wort researcher at McLean. “Having said that,” he warns, “virtually all of the studies have been methodologically flawed in one respect or another.” In fact, that’s one reason why NIMH decided to sponsor the Duke study.
Anecdotally, there’s lots of support for St. John’s wort. “I’ve talked to 25 or 30 people who’ve tried it,” says Dr. Jonathan Cole, a McLean psychiatrist who is participating in the Duke study. About 15 thought it helped, he said.
“One of my informants had gotten very depressed after her pet died. She kept crying and crying. She took St. John’s wort and stopped crying. After a month, she figured she was over it and stopped taking it. She started crying again. She stopped crying again” when she resumed St. John’s wort, he said.
On the other hand, Ewing says that in his clinical experience, results “have been somewhat disappointing. Very often, people may be doing little more than giving themselves a rather expensive placebo because the substance may have lost its potency” because it’s sensitive to temperature and other factors. (St. John’s wort prices vary, but run about $1.00 a day, compared to Prozac, which can cost $5 and up a day.)
In addition to the Duke study, other research on St. John’s wort is underway or has been recently completed.
In a Massachusetts General Hospital study funded by Lichtwer, Dr. Jerry Rosenbaum, a psychiatrist, is comparing Kira to Prozac and placebo, with neither patients nor doctors knowing which patients are getting which substance.
At McLean, Ewing has just completed a study in which patients and doctors did know that all the patients were getting St. John’s wort, a brand called Alterra. “We haven’t analyzed all the data yet,” he says, but 70 to 80 percent of the 40 patients responded to the herb. He is now starting a double-blind study of 80 patients in which some will get St. John’s wort and some a placebo.
So the data aren’t all in. But at the moment, the bottom line remains: If you take St. John’s wort and it helps, great. If you try it and it doesn’t, get to a doctor for more proven remedies.