St. John's Wort

After suffering from depression for years, Kelly Martin finally decided enough was enough. He dragged himself to his doctor’s office, and 10 minutes later the Calgary business manager walked away with a prescription for antidepressants.

But from there things went from bad to worse: Paxil caused terrible side effects, so after seven weeks Martin stopped taking the drug. Little did he know that quitting abruptly can exacerbate depressive symptoms.

“I felt worse than I have ever felt,” Martin tells alive of that emotional crash he endured in 1996. He went on to search for alternatives. He stumbled upon information about St. John’s wort–which at the time wasn’t nearly as well known as it is today–and tracked down a store that carried it.

“It started to work very quickly,” says Martin, 37. “After a few weeks, there was a huge difference ... I felt normal for the first time in a long time.”

New research into St. John’s wort validates Martin’s experience.

As Effective as Antidepressants

According to a study published in the Cochrane Database of Systematic Reviews in October 2008, St. John’s wort is just as effective as common antidepressants and has fewer side effects.

Headed by Klaus Linde, a doctor at the Centre for Complementary Medicine Research in Munich, Germany, the review examined 29 randomized, double-blind studies involving 5,489 patients with mild to moderately severe major depression. The studies all lasted at least four weeks and compared St. John’s wort to tri- and tetracyclic antidepressants as well as selective serotonin reuptake inhibitors (SSRIs).

“Overall, the St. John’s wort extracts tested in the trials were superior to placebo, similarly effective as standard antidepressants, and had fewer side effects than standard antidepressants,” the authors wrote.

Researchers also found that people taking St. John’s wort, or Hypericum perforatum, were less likely than patients taking antidepressants to stop treatment because of adverse effects.

Comparing Side Effects

Side effects of St. John’s wort are “usually minor and uncommon,” the Cochrane review notes. They include dry mouth, dizziness, diarrhea, fatigue, nausea, and sensitivity to sunlight, according to the Bethesda, Maryland-based National Center on Complementary and Alternative Medicine, a division of the US National Institutes of Health.

Potential health risks of antidepressants, by contrast, are many. Among the side effects of Paxil (paroxetine hydrochloride) and Prozac (fluoxetine hydrochloride), for instance, are nervousness, anxiety, abnormal ejaculation, abnormal vision, constipation, decreased libido, diarrhea, dizziness, female genital disorders, nausea, sleepiness, sweating, decreased appetite, dry mouth, impotence, tremors, weakness, and infection.

Furthermore, all antidepressants carry the increased risk of suicidal thinking and behaviour in children, adolescents, and young adults. Among the signs of suicidality are new or worsening depression, anxiety, or irritability; feelings of agitation, aggression, or restlessness; panic attacks; being angry or violent, or acting on dangerous impulses; and mania, which is marked by an extreme increase in activity and speech.

Check with Health Practitioner

Linde’s findings on St. John’s wort aren’t without caveats. The authors urge anyone considering taking the herb to consult a health professional first. “Using a St. John’s wort extract might be justified, but important issues should be taken into account,” they wrote.

For one, products vary considerably in terms of potency and quality from brand to brand and even from batch to batch. St. John’s wort is available in capsule and liquid extract forms, as well as in teas. In their review, researchers used preparations ranging in dosages from 500 mg to 1,200 mg.

For another, the herb can interact with prescription medications and significantly compromise their effect.

Health Canada warned people not to use St. John’s wort with any retroviral drugs after a 2000 study found that it greatly reduced the presence of indinavir, a protease inhibitor used to treat HIV infections, in the bloodstream.

At the time Health Canada cautioned that St. John’s wort might also negatively interact with anti-epilepsy drugs, oral contraceptives, and immunosuppressant and anticoagulant medications.

People taking St. John’s wort in conjunction with conventional antidepressants have experienced “serotonin syndrome,” which is marked by headaches, tremors, and restlessness.

Geographical Differences

The Cochrane review found that study findings were more favourable in Germany, Austria, and Switzerland, which all have a long history of using the herb, than in other nations.

“This 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 overoptimistic results,” the researchers noted.

Calgary’s Kelly Martin, meanwhile, had such a positive experience with the herb that in 1997 he started a website to tell the world all about it: sjwinfo.org. He still updates the site regularly and says millions of people have visited.

“Part of the healing process is wanting to help people,” Martin says, emphasizing that everyone should do their own research before taking anything for depression. “I found something that works for me, and if it [the] helps one person, then it will have all been worth it.”

Martin says findings like those from Linde’s research boost his confidence in St. John’s wort.

“No drug or herb is perfect,” Martin says. “Everything has some kind of side effect ... Without information, a lot of people say, ‘Oh, it’s just that herbal stuff.’ But reputable organizations have done studies that say, ‘Yes, it’s really effective.’

“Studies like this one only support what I and thousands of other people already know.”

Depression: The Stats

About 8 percent of Canadian adults will experience major depression at some time in their lives, according to the Public Health Agency of Canada.

Major depression is also the fourth leading cause of disability and premature death in the world.

Symptoms include

• Persistent sad, hopeless, or empty feelings
• Feelings of hopelessness, worthlessness, helplessness, pessimism, or guilt
• Loss of interest in activities
• Difficulty concentrating or making decisions
• Restlessness
• Irritability
• Sleep problems
• Overeating or loss of appetite

With a major depression, symptoms last at least two weeks and prevent people from working, studying, sleeping, or eating.