St. John’s Wort for Depression: More Evidence
By Alan R. Gaby, MD
Healthnotes Newswire (February 17, 2005)—St. John’s wort, a popular herbal remedy for depression, is at least as effective as the antidepressant drug paroxetine (Paxil®) and causes fewer side effects, reports the British Medical Journal’s online edition (http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38356.655266.82v1; accessed 02/2005). The results of this study add to the large body of research showing that St. John’s wort is a safe and effective treatment for mild to moderate depression.
In the new study, 251 people suffering from acute depression were randomly assigned to receive 300 mg of a St. John’s wort extract three times a day or 20 mg of paroxetine once a day for six weeks. If after two weeks the depression had not improved by at least 20%, the dose of St. John’s wort or paroxetine was doubled for the remainder of the study. After six weeks of treatment, the depression had resolved in 50% of the participants taking St. John’s wort and in 35% of those taking paroxetine, a statistically significant difference. A dosage increase was necessary at the two-week point in 57% of the people taking St. John’s wort and in 48% of those taking paroxetine. The incidence of side effects (mainly gastrointestinal symptoms, fatigue, dizziness, headache, dry mouth, or increased sweating) was 72% higher in the group receiving paroxetine than in the St. John’s wort group.
Many other studies have shown that St. John’s wort is significantly more effective than a placebo and at least as effective as certain antidepressant drugs, including fluoxetine (Prozac®) and imipramine. Furthermore, in most of these studies, the herbal remedy was better tolerated than the prescription medication. Despite the strong evidence demonstrating St. John’s wort’s effectiveness, its use as a treatment for depression remains controversial.
The controversy stems mainly from a widely publicized negative report published in 2001 in the Journal of the American Medical Association (2001;285:198–86). In that study, although the remission rate was significantly greater with St. John’s wort than with a placebo, only 14.3% of those who received the herb went into remission, causing the authors of the report to question its efficacy. However, the 4.9% remission rate in the placebo group was far below the placebo response rate seen in other studies of depression, which suggests that many of the participants recruited for this study would have been unlikely to respond to any treatment.
The bulk of the evidence at this time indicates that St. John’s wort is a safe and effective alternative to antidepressant medications for the treatment of mild or moderate depression, although severe depression does not seem to respond to the herb. As it can interact with a fairly large number of medications, people interested in taking St. John’s wort should be monitored by a qualified healthcare practitioner.
Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Three Rivers Press, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Three Rivers Press, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.
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