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St. John’s Wort for Major Depression?

German Study Shows Herb as Effective as Antidepressants for Major Depression
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St. John's Wort and Major Depression continued...

Would he advise patients to take it?

"I don't know," says Raison. He'd prefer to use traditional antidepressants as a first line of treatment for severe depression.

But if a patient insisted on trying it, Raison says he might "give it a whirl" if it's appropriate for the patient. St. John's wort can interact with other medications in the blood and can make them less effective.

Raison adds that there have been "a few cases" where St. John's wort has triggered liver failure in people who were taking medication for a liver condition.

Raison notes that an important thing he's learned from medical training is "anything that has good effects, also has side effects."

Quality of St. John's Wort Varies

Scientists are still not sure how St. John's wort works for depression. The authors of this study write that at least seven ingredients may be involved.

According to the researchers, studies from German-speaking countries appear to have better results from taking St. John's wort for depression. They note that St. John's wort has a long tradition of use in these countries, and the "difference could be due to the inclusion of patients with slightly different types of depression, but it cannot be ruled out that some smaller studies from German-speaking countries were flawed and reported over-optimistic results."

The authors write that the quality of St. John's wort "can differ considerably."

They note that a recent study of what is available on German store shelves found that a number of brands contain only a tiny amount of the main active ingredients thought to be key for treating depression.

Power of Placebo

Linde says in a news release that those products with very low concentrations may only work by a placebo effect.

Raison says a placebo can be a "very powerful antidepressant."

"There's a whole body of literature now that shows placebo can have a direct effect on the pathways of the brain and work like an antidepressant."

Timing of Antidepressants

How long do traditional antidepressants take to kick in?

The old thinking was that you wanted to see depression lift within four to six weeks, but Raison says that is changing. "You want to see within a week or two that patients are getting better."

Why?

According to Raison, one reason is that the "longer it takes [a traditional antidepressant] to work, the more vulnerable people are to have a relapse."

The review and findings are published in The Cochrane Library.

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