St. John's Wort Helps Beat the Blues, Study Says
Dec. 9, 1999 (Urbana, Ill.) -- Extracts of the herb St. John's wort can
safely help mildly depressed people beat the blues, according to research to be
published in the Dec. 11 issue of the British Medical Journal. But while
the herb extract was more effective than placebo, it fared no better than
imipramine, a tricyclic antidepressant used widely in Europe that is available
only by prescription.
Depression affects nearly one in ten Americans each year, costing the nation
up to $44 billion in treatment costs and lost productivity. The American
Psychiatric Association estimates that depressed individuals have a greater
than 80% chance of being successfully treated.
But some people don't seek medical help because of the stigma involved, and
seek to self-medicate with St. John's wort and other remedies. In addition,
extracts of the herb are widely prescribed in Europe, and in Germany they are
prescribed more than any other antidepressant. But clinical trials that have
purported to demonstrate the effectiveness of St. John's wort remain disputed
because some researchers say they were not properly designed.
To settle the question, Karl-O Hiller of the Steiner Arznelmeitel in Berlin
and his colleagues compared the effects of St. John's wort extracts,
imipramine, and a placebo on 263 moderately depressed people.
The patients took three capsules a day of the herb extract, the prescription
drug, or a sugar pill, and all pills were adjusted to look and taste the same.
After eight weeks, the doctors judged the extent of the patient's depression
using a questionnaire called the Hamilton depression rating scale that measures
St. John's wort extract eased depressive symptoms significantly more than
placebo pills and to about the same extent as imipramine, the authors write.
And both the herbal remedy and the drug improved the patients' scores on a
questionnaire that gauged quality of life. According to the researchers, St.
John's wort extract "may thus be considered as an alternative first choice
treatment in most cases of mild to moderate depression without psychotic
Other experts called the study encouraging, but in some ways inconclusive.
"What's important is the fact that St. John's wort is better than placebo
after eight weeks, and that certainly is encouraging for concluding that St.
John's wort extract is effective in [treating] depression, at least for the
short term," says Benedetto Vitiello, MD, of the National Institute for
Mental Health, who is coordinating a study comparing St. John's wort with the
antidepressant Zoloft (sertraline hydrochloride).
Vitiello also notes that the St. John's wort used in the study may not even
be available in the U.S. In Germany, St. John's wort extracts and other herbal
remedies are carefully regulated by government agencies. But no such controls
exist in the U.S. because of a 1994 law that forbade the FDA regulating
so-called natural products like St. John's wort.
"It's like tea or coffee -- there is a different concentration of
ingredients," Vitiello says. "That is the major risk for the consumer
-- they don't know what they're buying."
- In a European study, extracts of the herb St. John's wort worked just as
well as a tricyclic antidepressant in treating mild depression.
- Current trials in the U.S. are examining how St. John's wort fares against
the widely prescribed antidepressant, Zoloft.