Ease the Blues with St. John’s Wort

As the holiday season approaches, people with depression sometimes experience a worsening of their symptoms. For those interested in trying St. John’s wort, an herbal remedy that has been used for centuries to treat mood disorders, new research review confirms that for people with mild to moderate depression it may be as effective as standard antidepressants, and cause fewer side effects.

Dealing with depression

Depression is a common condition, marked by feelings of sadness, hopelessness, lack of pleasure, suicidal thoughts, sleep disruptions, and changes in appetite. A person may be diagnosed with depression when they experience a depressed mood and loss of interest or a lack of pleasure in daily activities for more than two weeks. Fortunately, there are many effective treatments, including talk therapy, lifestyle changes, medications, and complementary therapies such as St. John’s wort.

In a recent Cochrane Systematic Review on St. John’s wort (Hypericum perforatum) extracts, researchers compared its antidepressant effects with standard antidepressants or placebo. The review included 29 trials and 5,489 men and women, in studies that lasted between 4 and 12 weeks. The Hamilton Depression Scale and other rating scales were used to assess the severity of participants’ depression before and after treatment.

In the majority of studies, St. John’s wort extracts were better than placebo for the treatment of mild to moderate depression and as effective as standard antidepressants but with fewer side effects. People who were taking St. John’s wort extracts were less likely to drop out of a study due to side effects compared with people on standard antidepressants. The study authors note that results were more favorable in German studies where use of the herb is very common and often prescribed by doctors.

Always take precautions

The study authors warn that people who are interested in taking St. John’s wort should first consult a knowledgeable doctor. Herb-drug and herb-supplement interactions are a potentially significant problem, as certain combinations can interfere with medications or supplements, making them less effective or increasing side effects.

Donna Mehregany, MD, a psychiatrist and clinical instructor at Case Western Reserve University School of Medicine adds, “One concern with patients who self-medicate with St. John’s wort is that they often neglect necessary psychotherapy or lifestyle changes that are needed in order to treat a mood disorder such as depression. If a person chooses to use St. John’s wort they should place their treatment in the hands of a qualified physician who can recommend complementary treatments and monitor dosage, length of treatment, interactions with other medications, and possible side effects.”

Other tips for easing the blues

• Seek help. If you think you are depressed see your primary care doctor or a counselor. If you feel suicidal, contact your doctor or a suicide hotline immediately.

• Use a variety of tools. A combination of counseling and medications is important for easing depression symptoms, but a healthy diet, regular exercise, and finding ways to reduce stress are just as important for improving your mood.

• Stay connected with others. Reach out to supportive friends and family and get involved with social activities. Withdrawing or being socially isolated only makes things worse.

• Plan for the holidays. Find healthy and supportive environments and activities that offer comfort. This may be a good time to get creative and sign up for a new class that stimulates your mind, revisit an old hobby, or call a friend for a lunch date.

• Soothe negative thoughts with mind-body therapies. Activities such as yoga, meditation, and guided imagery may help relieve depression and focus the mind on positive, hopeful, and peaceful thoughts.

Jane Hart, MD

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