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August 1, 1999
Wort 101
Wondering about the wonder drug?
By Meredith Phillips

From his post across the room in his red leather chair, my therapist uttered the words I dreaded hearing: "A prescription for an antidepressant would probably make you feel much better." Suffering from a moderate depression, I would have done anything to feel like myself again, but I feared the side effects. What if antidepressants turned me into a glassy-eyed, dry-mouthed zombie with no sex-drive and a weight problem? I implored him to recommend something else -- yoga, maybe, or St. John's wort, an herbal supplement available in most drugstores and natural groceries. Recently hyped as a "wonder-drug," St. John's wort's pretty yellow star-shaped flowers -- hypericum perforatum -- seem to be effective in the treatment of some depressions.

Since I was under his regular care, my therapist agreed to let me try St. John's wort as long as I took advantage of the herb's full effects as a mood enhancer by taking the "research dose" of a reputable brand. Like the prescription antidepressants Prozac and Zoloft, St. John's wort may increase the body's level of serotonin, a brain chemical that gives a person a sense of well-being. It also seems to affect levels of neurotransmitters norepinephrine and dopamine and has few known side effects, which makes St. John's wort -- government regulated or not -- a popular alternative with the public.

The National Institutes of Health (NIH) is launching a three-year study on St. John's wort's effectiveness that they hope will satisfy U.S. doctors in length and scope, but because the herb is not yet regulated by the Food and Drug Administration (FDA), it remains classified as an over-the-counter remedy. St. John's wort is also being touted as an immune booster, so we've seen it cropping up in teas, commercial herbal drinks, vitamin formulas, tinctures, and pills. But if you're planning to use St. John's wort to help alleviate the symptoms of depression, you should understand a few things first. The effectiveness of the plant depends upon the form in which it's taken, the duration it's taken for, the dosage and ultimately, the chemistry of the person taking it, meaning that it is not effective in every case. Also, be sure to read up on the cautions: St. John's wort should not be used in conjunction with other antidepressants, and recent studies show that it may significantly reduce the effectiveness of certain prescription drugs, including birth-control pills and HIV medication.

Form: Currently St. John's wort is available in tablet, capsule, and liquid form. Most conventional research has focused on just two constituents of hypericum as the primary antidepressant agents: hypericin and pseudohypericin.

Dosage: The effective research dose for mild to moderate depression is 300 mg of 0.3 percent hypericin, 3 times a day for a total of 900 mg daily, if taken in tablet or capsule form. For a liquid extract, it's 1/4 teaspoon of 0.3 percent hypericin for a total of 3/4 teaspoon daily.

  • Because the dosage is not strong or consistent enough, teas are not recommended for the treatment of depression.
  • Even though vast quantities of St. John's wort have not shown short-term side effects, don't exceed this standard dosage if it doesn't seem to be working -- it may be that St. John's wort is not effective in your case.
  • Since hypericum preparations are not standardized, their strength can vary with each batch and each manufacturer.

Duration: St. John's wort, like many prescription antidepressants, is a slow-acting drug that takes time to build up in your system and become effective.

  • Though mild sedative effects may be recognizable sooner, the herb may not be effective as an antidepressant for four to six weeks.
  • n Research suggests that St. John's wort should not be taken for more than a year.

Cautions: Certain health conditions become more dangerous in the presence of the herb. In addition, St. John's wort can react negatively with certain other medications, including prescription antidepressants, and may significantly decrease the effectiveness of birth-control pills, a protease inhibitor used to treat HIV, and other medications. Be sure to discuss any possible interactions with your doctor before trying St. John's wort.

  • Do not take St John's wort along with other antidepressants, such as like Zoloft, Paxil, or Prozac. If you have recently been on other medications, consult a doctor to avoid a dangerous or unpleasant reaction. Other reactions can occur with decongestants, diet pills, narcotics, and amino acid supplements.
  • The medical journal the Lancet cited a groundbreaking study in which St. John's wort caused the early metabolization of prescription medications, including a protease inhibitor used to treat HIV, and the birth control pill. The early metabolization of the birth control pill resulted in an effectiveness drop-off of 50 percent, according to the study. The FDA issued an advisory in February 2000 warning doctors and patients to use caution with St. John's wort, noting that its use may influence the effectiveness of other important prescription drugs as well, including those used to treat heart disease, cancer, depression, asthma, emphysema, and seizures.
  • Some literature advises people taking St. John's wort to avoid beer and wine, coffee, chocolate, preserved meats, bouillon, yeast, fava beans, soy products, yogurt, sour cream, avocados, eggplant, tomatoes, raisins, and bananas because these foods include the enzyme tyramine that in the past was believed to react with St. John's wort. That belief is changing, but doctors advise avoiding large quantities of these foods to be on the safe side.
  • Reported side effects can include increased photosensitivity, dry mouth, dizziness, and minor stomach problems.

Though the right patient on the right dosage of St. John's wort may feel less depressed, it isn't effective in every case. When larger and more comprehensive medical studies are completed like the one being conducted by NIH, perhaps we'll know why it works for some people and not others, and how it really rates compared to prescription antidepressants. St. John's wort is not recommended for the treatment of serious depression, and the real risk of taking St. John's wort lies in the practice of self-medication. Depression has many causes -- including some physiological ones like anemia, diabetes and migraine -- that need to be diagnosed by a doctor before it can be treated effectively. Depression can also be caused by certain medications. Other problems, such as alcohol or drug abuse, exacerbate depression and should be treated in conjunction with it. St. John's wort is a promising herbal remedy that will be a reasonable treatment for some people suffering from depression, but it should not be used as a replacement for professional help; always consult a medical or health professional before self-medicating.