Fact Sheet: St. John's Wort

Depression is a serious medical illness affecting 17 million Americans. But with recent advances in both medications and psychotherapy techniques, individuals with depression have over an 80% chance of being successfully treated. Unfortunately, a stigma still surrounds mental illnesses that prevents many who may suffer from depression from seeking treatment. This stigma can encourage people to enthusiastically embrace self-help remedies before sufficient evidence has pronounced them effective or even safe.

The herbal extract Hypericum perforatum, commonly known as St. John's wort, has been promoted as an alternative treatment for depression. Anecdotal evidence, particularly from Germany (where nearly 3 million prescriptions are written for the herbal extract each year), points to the effectiveness of St. John's wort in the treatment of mild to moderately severe depression. But before St. John's wort gains formal acceptance in this country as an "alternative" antidepressant, it needs to be subjected to testing that follows rigorous clinical guidelines.

Investigating a Promising Alternative

Without question, there is cause for some excitement that St. John's wort could be an effective remedy. Preliminary findings indicate that it is of some benefit in the treatment of mild to moderately severe depression and is associated with only a few mild side effects. However, it is not known exactly why this herbal remedy is an effective antidepressant or what is the proper amount to take. Also, it is important to note that these early studies compared the effectiveness of St. John's wort against that of placebo and older antidepressant medications, often given at what would be considered subtherapeutic doses. In general, these reports also did not study the effectiveness of St. John's wort in individuals with the formal diagnosis of major depressive disorder, but rather included subjects with depression of lesser severity. Comparisons of St. John's wort against the newer and highly effective class of antidepressants, the selective serotonin reuptake inhibitors (or SSRIs, of which Prozac is but one) in patients with major depressive disorder have yet to be performed.

But one is underway. The National Institute of Mental Health has begun a large-scale rigorous study to definitively answer whether St. John's wort is superior to placebo. Individuals formally diagnosed with major depressive disorder will undergo an 8-week trial and receive either placebo, St. John's wort, or an SSRI. After the initial phase of the investigation is completed, the subjects will be followed for months afterward to study the long-term effects of taking St. John's wort, which have not yet been examined.

Know the Whole Story

For many, the belief that St. John's wort is a safe all-natural remedy for depression stems from what they have learned from the media. Unfortunately, most of the stories that have advocated St. John's wort as a natural remedy for depression only cited the positive aspects of this treatment approach. Only a very few presented the possible side effects or acknowledged that the early studies of St. John's wort did not follow the same strict criteria required in America to gain approval from the Food and Drug Administration (FDA). These early stories also rarely included warnings advising against the use of the herbal remedy while taking other medications or during pregnancy.

People may tend to believe that if something is found in nature, no harm can result from its use. But no real distinction can be made between "natural" remedies and other drugs, since the origin of many medications can also be traced to plants and other naturally occurring elements. The plant itself does not have medicinal properties; it is the chemicals within the plant that have the curative effect. And a chemical is a chemical, whether it occurs naturally (as in plants) or not.

St. John's wort is marketed in this country as a dietary supplement, so it is outside the regulatory jurisdiction of the FDA, according to a law passed by Congress in 1994. Because the FDA has limited authority to challenge companies that produce herbal supplements, manufacturers can claim that their products enhance normal body functions without submitting scientific evidence to support these claims. However, these manufacturers are not allowed to state that dietary supplements can be used to treat medical illnesses, such as depression.

The Dangers of Self-Diagnosing and Self-Medicating

No one who thinks he or she may be depressed should self-medicate with St. John's wort or any other "alternative" remedy. Many suitable, clinically approved, and highly effective therapies are already available for the treatment of depression. If you think you may be suffering from depression, it is important to consult with a physician. Symptoms of depression could be caused by other illnesses or result from other causes, such as substance abuse. Never self-medicate. The risk of self-harm far outweighs the potential benefits of self-help.

 

The American Psychiatric Association is a cosponsor of the National Public Education Campaign on Clinical Depression in cooperation with the National Mental Health Association, National Alliance for the Mentally Ill, National Depressive and Manic Depressive Association and the DEPRESSION/Awareness, Recognition, and Treatment (D/ART) Program, National Institute of Mental Health.

Produced by the APA Joint Commission on Public Affairs and the Division of Public Affairs. This pamphlet was developed for educational purposes and does not necessarily reflect opinion or policy of the American Psychiatric Association.

One in a series of pamphlets designed to reduce the stigma surrounding mental illnesses by promoting informed factual discussion of the disorders and their psychiatric treatments.

Copyright 1999 American Psychiatric Association

This article is provided by Medem, Inc. All rights reserved.

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