Naturopathic Health: St. John's Wort and Depression Treatments

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Dr. Jaclyn Chasse, N.D. is a licensed naturopathic doctor and the Medical Educator for Emerson Ecologics, a distributor of dietary supplements to medical professionals.  Dr. Chasse’s clinical practice focuses on women’s health, pediatrics and infertility, with an emphasis on botanical medicine.  Dr. Chasse is also a master gardener and spends her free time cooking, playing in the woods with her family and taming her small yard into an urban permaculture oasis.

Many people assume that herbs are not well researched for medical uses, but this is not the case! St. John’s wort has a large body of research supporting its use.    

This last week, I was conducting a review of the published research on St. John’s wort, especially focusing on research on its use for depression. From just a simple search on Pubmed, our free public database of published scientific research studies, there were literally hundreds of clinical trials of St John’s wort in humans.

St. John’s wort can be used to treat depression and sever anxiety.
Photo by Pauline Rosenberg/ Courtesy

I remember a number of years back, just after I had started naturopathic medical school, seeing a study on St John’s wort published in the Journal of the American Medical Association (April 2002). It was widely publicized in the media. The study concluded that St John’s wort was not effective for the treatment of depression.  I remember that media blitz, if you can call it that, because I was so disappointed. I had known that for many friends, St. John’s wort was very effective. Was it really placebo effect? 

When conducting my research review this week, I was absolutely astounded by the quantity of research out there on St. John’s wort! Hundreds of research studies! And study after study showed that St John’s wort was very effective for treatment of depression, from mild through severe depression!! Head to head studies against many pharmaceutical antidepressants (sertraline, fluoxteine, citalopram, paroxetine, and more) showed that St. John’s wort was equally (or in many cases, more) effective than the pharmaceutical being tested. In addition, St. John’s wort was better tolerated than most drugs and had fewer side effects. This may not be enough data to be conclusive, but the research is extremely positive!

This got me thinking back to that JAMA study published back in 2002. I had never actually read that entire study. So, I pulled the study and read it. There were some important pieces that were not mentioned in the media. First, the study did not use a standardized dose of St. John’s wort–there could be a 4 fold difference in the dose the patients were taking! econd, the study also demonstrated that the drug tested by its side (sertraline) also had no therapeutic effect! Third, the authors state that the lack of results seen is probably “due to low assay sensitivity of the trial”, which may be a fancy way of saying that the study really wasn’t designed to be able to draw an accurate conclusion.

To put the icing on the cake, I looked at the financial disclosures section of the study. The financial affiliations section was longer than the references. And the lead author, Jonathan Davidson, M.D from Duke University, had a large number of financial affiliations to pharmaceutical companies, such as Pfizer, Wyeth and GlaxoSmithKline. The list goes on, but you get the point.

This begs the question–was this study designed to fail? Were they looking for a way to downplay all of the positive studies that had been published on St. John’s wort? It’s certainly a possibility!

So, what’s the point of all of this? First, one study published (or publicized) should not sway the tide of your decision-making. Do the research to see how that falls into the grand scheme of the totality of research. Second, St. John’s wort has LOTS of evidence supporting its use, so don’t be afraid to consider it! Third, don’t believe everything you hear. A good word of advice in general, but definitely the case when considering research and herbal medicine! 

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