Newsweek 5/5/97 Lifestyle/Health: A Natural Mood Booster

More and more therapists are recommending an herb called Saint Johns Wort to
treat mild depression. Does it work?
   By Sue Miller

Karin Taylor's black moods were often accompanied by inexplicable bouts
of insomnia, crying and lethargy. By last summer she'd sunk so low she
didn't care if she lived or died. But Taylor balked when her physician
suggested a common antidepressant: she didn't feel comfortable taking
drugs. Fortunately, she says, a friend visiting from California suggested a
natural herb called Saint Johnswort. Within three weeks, Taylor's
depression had lifted. "I feel restored," says the 58-year-old Toronto
accountant, who continues to take two herb capsules daily. "I'm my normal
self again."
   People have been ingesting Saint Johnswort, a yellow-flowered plant with
the Latin name of Hypericum perforatum, for some 2,000 years. Some believe
it was initially used in ancient Greece to drive away evil spirits. It's
been popular for about 15 years in Europe as a natural remedy for
depression. In Germany, where it's currently the leading treatment,
physicians write some 3 million prescriptions a year--25 times the number
they write for Prozac. Now, thanks to a spate of books and articles touting
the herb's properties, its popularity is quickly spreading on this side of
the Atlantic. American health-food stores now peddle a panoply of
mood-boosting supplements, including kava root, the hormone pregnenolone
and the amino acids 5hydroxy-tryptophan and L-tyrosine. But Rob McCaleb of
the Herb Research Foundation calls Saint Johnswort "the premier herb for
treating moderate depression."
   What's the evidence for this claim? The respected Journal of Geriatric
Psychiatry and Neurology aroused a good deal of interest in 1994, when it
devoted an entire issue--17 research papers in all--to "Hypericum: A Novel
Antidepressant." One compelling study tracked the herb's effects on 3,250
patients battling mostly mild and moderate depression and found that about
80 percent either felt better or became completely free of symptoms after
four weeks. Then last August, the British Medical Journal published a
review of 23 controlled studies involving 1,757 depressed patients. In that
analysis, researchers from the United States and Germany found that Saint
Johnswort worked nearly three times better than a placebo. The herb shows
"definite promise," says Dr. Cynthia Mulrow, a University of Texas
internist who coauthored the study. "It's a reasonable alternative to
consider."
   Despite the promising studies, researchers still know very little about
the herb's active ingredients or how it works. They also aren't sure
whether Saint Johnswort can help the severely depressed or if it's safe and
effective for long-term use. Experts note that many of the products in the
health-food stores contain overly diluted concentrations that render the
herb impotent. The optimum dosage, based on the majority of medical
studies, is 300 milligrams of Hypericum extract containing .3 percent of
the active ingredient hypericin three times a day. Give the herb at least a
few weeks to start working.
   Though most psychiatrists favor drugs over herbs, some are incorporating
Saint Johnswort into their practice. Dr. Harold Bloomfield, a Yale-trained
psychiatrist and coauthor of a new book called "Hypericum & Depression,''
heard about the herb while researching his 1994 book, "How to Heal
Depression." After reading the literature, nearly all of it from Germany,
he started giving it to patients, and he claims the results have been
excellent. Ever since Bloomfield's book was published last fall, he has
been inundated with calls from curious psychiatrists and psychologists and
clinical social workers, who can recommend it as a remedy for depression
because it's simply a dietary supplement. Bloomfield estimates that the
number of therapists treating patients with the herb has grown from a few
dozen six months ago to several hundred today.
   Janet Lawson is one of the patients. An improvisational jazz singer once
nominated for a Grammy, Lawson lives in East Stroudsburg, Pa., when she's
not touring the world. For years, she suffered from severe mood swings but
refused to take prescription antidepressants. Now she spends about $40 for
four fluid ounces of Phyto Proz Supreme at her local health-food store and
takes a dropperful each day. The herbal concoction contains not only Saint
Johnswort but a variety of other plant extracts, including the mildly
calming extract of kava root. In Laguna Hills, Calif., 48-year-old
Elizabeth Dante tried to overcome her depression with the drug Paxil but
didn't like the slightly medicated way it made her feel. So she switched to
500 milligrams of Saint Johnswort three times a day. "I don't feel at all
medicated now," she says. "It's like taking a vitamin."
   Is Saint Johnswort as benign as a vitamin? Enthusiasts note that
millions of Germans have used the herb extensively without any reported
deaths. In the study of 3,250 depressed patients, only 2.4 percent
experienced side effects. Those included restlessness, gastrointestinal
irritations and mild allergic reactions. Purdue University herb expert
Varro Tyler notes that prescription antidepressants, such as Prozac, cause
more common and more serious side effects, such as insomnia, weight loss
and sexual dysfunction. "The absence of serious side effects is one of
Hypericum's biggest selling points," he says.
   The biggest concern is that the herb might make some people dangerously
sensitive to the sun. Certain animals, such as sheep, have grown sick and
even died from exposure to the sun after ingesting large quantities of
Saint Johnswort. No one has ever reported phototoxicity in people using the
herb for depression, but Bloomfield says the potential "should be kept in
mind... if one has a prior hypersensitivity to sunlight or if one is taking
photosensitizing drugs" such as tetracycline. In light of the potential
risks, most experts suggest consulting a physician before taking Saint
Johnswort. They also recommend that patients avoid combining it with
prescribed antidepressants or altering the dosages of those antidepressants
by themselves.
   Further research is clearly needed. "The studies in Germany were not
done with the same kind of rigor as those generally done in this country,"
says Jerry Cott, a pharmacology expert at the National Institute of Mental
Health. "I think mainstream psychiatry would say, 'I'm still unconvinced'."
The doubts should soon be put to rest. U.S. researchers from the NIMH and
the NIH's Office of Alternative Medicine are now planning a large
multicenter trial of the herb. Meanwhile, America's penchant for self-care
ensures that remedies like Saint Johnswort will continue to flourish.

 
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