As an avid researcher of scientific literature on herbs (especially German research) since 1984, I knew about the St. John’s wort-depression connection early in the 1990s and subsequently wrote a book on the herb, as well as Stress and Natural Healing, which talks about the clinical use of herbs for depression.
After writing these books, more patients began to come into my clinic for mood disorders, which was an excellent opportunity for me to learn firsthand what did and didn’t work from the patients themselves. After working with patients diagnosed with depression, I learned that depression is more common than I knew. In a given one-year period, up to 9.5 percent of the U.S. population (nearly 19 million people) may suffer from depression. Women are twice as likely as men to have depression. It’s likely that some individuals are more susceptible to depression based on genetic predisposition, but teenagers, the elderly, women overall and people with chronic illnesses are most likely to suffer.
Depression is complex
Depression affects every facet of life—sleep, the enjoyment of activities, health, work, relationships, and it increases the chance of dying of a chronic or acute illness. The three most common types of depression include major depression, dysthymia (you simply don’t feel happy for extended periods of time) and bipolar disorder (mania alternating with periods of depression).
More than anything else, I learned that depression is a complex illness that involves personal, family, and societal issues, as well as the level of one’s overall state of health. In major clinical trials, depression is an illness that responds very well to placebos. This means that the simple act of participating in a research group and taking a pill that’s said to be effective for reducing depression—even if the pill contains simple sugar—can work as well as any medication or herb now available, including Prozac and St. John’s wort (Hypericum perforatum). Recent published analyses of all controlled studies on medications for depression have shown this to be true. A large, recent study supported by the National Institutes of Health showed that St. John’s wort, Zoloft, and a placebo pill had similar beneficial effects in groups of severely depressed patients. Many argue that these remedies would show higher effectiveness for people with mild to moderate depression, as a number of other clinical trials have shown.
Because depression involves the state of health of all the internal organs and is directly related to the health and vitality of the whole individual, I follow the guidance of my first health teacher, Paul Bragg, who said many times, “There are no specific medications for most diseases, rather a total program for health is the only sure way to cure disease.”
At our first meeting, Marcy told me that she had trouble getting out of bed in the morning, not only because she dreaded having to relate to others, but because she had a lot of trouble sleeping. Even when she managed to get up, she had trouble going out to shop and being out in the world. She had gone through a period of nearly two years where she could not sleep well, had no interest in sex or some of the foods she liked, and took little pleasure in her favorite activities. Her energy level was very low. As she put it, “I can barely do what I have to do in order to keep going.” Marcy had been to her doctor who referred a psychiatrist. After a one-hour interview, she received a prescription for a common antidepressant. At first, she was concerned about taking the drug, she told me, as if she had somehow failed to be the normal, happy person she envisioned herself to be. She didn’t discuss her concerns about the medication with anyone until she came into my office. During the last two years, Marcy had switched medications several times and found that they would provide some relief for three to six months, then stop working. She had settled on one that seemed to be helping, but it was nothing to “write home about,” she said. She could function, but did not relish her life. She found no joy, saw no mystery—the spice in life was simply gone. And she explained, “I can’t keep taking this forever, I know it makes me nervous sometimes and makes me more constipated. The cost, even with insurance, is more than I’d like to spend, and if I thought my sex drive was low before, now it doesn’t exist.”
Because depression can be worsened by an imbalance in any organ system, according to the principles of Traditional Chinese Medicine (TCM), a proper diagnosis is necessary in order to improve health and vitality. Marcy liked this approach more than the idea that specific chemical imbalances in her brain accounted for all of her symptoms. Marcy’s tongue had a thick white coating and was pale and swollen. Her pulse was very weak, especially in the digestive area. In TCM, low energy and depression can result from “Spleen Qi deficiency,” a term used to describe a condition in the body where the digestive organs and the chemicals they produce is moderately to severely out of balance. I reminded Marcy that the gut produces a number of neurotransmitters that might affect her mood directly or indirectly. Following is the program I wrote out and discussed with Marcy.
• Herbs to support healthy brain and mental functions: ginkgo (Ginkgo biloba), one 60-mg tablet or capsule after each meal, up to 3 per day; rhodiola extract (Rhodiola rosea), 100 to 200 mg per day of the extract in capsule or tablet form.
• Herbs to support vitality, immune function, and sexual energy: cordyceps (Cordyceps sinensis), 1 to 2 capsules of a mycelium extract or 3 to 7 g of a mycelium powder, twice daily; American ginseng (Panax quinquefolius), 1 to 2 droppersful of tincture or 1 to 2 capsules root extract, twice daily; ligustrum fruit (Ligustrum spp.), 1/2 teaspoon extract powder in a little water, twice daily.
• Liver-regulating herbs can also help people overcome mood swings associated with depression. I almost always recommend a good liver-regulating formula for my patients, especially when they have other symptoms of bile stagnation, such as poor digestion of fats.
• For Marcy, herbs to strengthen the digestive system were extremely important. In TCM, digestion is associated with immune function and daily energy. I recommended a formula that contained 50 percent dried ginger (Zingiber officinalis), 10 percent Asian ginseng (Panax ginseng), and 40 percent codonopsis (Codonopsis pilosula). The herbs are available in bulk (simmer 30 g or so of the blend for 30 minutes, steep for 15 minutes, and strain). One of my favorite Chinese ready-made formulas in tablet form is Liu Jun Zi. The tablets are not coated with sugar or dye, and they can be chewed and swallowed with a little water or tea for best results.
Diet and results
Because Marcy was already taking an antidepressant, I wanted to start with herbs that had no possibility of interacting with the medication. I do recommend St. John’s wort to some patients to help them slowly get off a pharmaceutical antidepressant or in some cases to improve its effects, but with Marcy my strategy involved working on her depression through enhancing her health and vitality, especially her digestive functions.
I talked with Marcy about her diet and we discussed the importance of getting enough protein (about 60 g daily from various high-quality sources like fresh fish, organic nuts, seeds, beans, and nutritional yeast) and sticking to whole fruit to satisfy her craving for sweets. Complete nutrition is essential. The nervous system needs all of the B vitamins, minerals, and essential fatty acids in order to function optimally. Recent studies emphasize the need for a good variety of essential fatty acids in the diet to maintain healthy nervous system function. These can be obtained through whole nuts, seeds (such as freshly ground flaxseed), fish and beans.
Marcy continued coming into my clinic for more than a year, and during that time she had her ups and downs, but the ups were longer and the downs were increasingly shorter. She felt that the digestive herbs were helping a great deal. She went on vacation for three weeks at one point and stopped taking the herbs, with seemingly dramatic results—she had a down week that was not fun, she later told me. Lately, Marcy has been talking about reducing the antidepressant and adding some St. John’s wort. She has a keen interest in experimenting with more natural remedies, based on the clear success she has had during the year.
Christopher Hobbs’s case studies are gleaned from his thirty years of studying and practicing herbalism. Hobbs, a fourth-generation botanist and herbalist, is the creator of the new correspondence course Foundations of Herbalism. Visit his website at
“Case Studies” is not intended to replace the advice of your health-care provider.