Millions of Americans suffer from depression
One Saturday last June, a stream of customers filed through Larry Schaefer’s health-food store in Sun City, Arizona, seeking St.-John’s-wort, the herb rapidly becoming known for its ability to combat depression.
“I sold every single bottle I had,” says Schaefer, owner of The Almond Tree, where St.-John’s-wort products normally sell at a rate of thirty bottles a week. On this June Saturday alone, he sold sixty bottles, the result, he says, of a national television broadcast about the herb. The following week he sold a total of 125 bottles—more than four times the weekly average. “People didn’t really care what form I had it in,” Schaefer says. “They just wanted it.”
Schaefer wasn’t the only one whose supplies of St.-John’s-wort were scooped up. Shop owners and manufacturers across the country reported phenomenal increases in sales of St.-John’s-wort products last summer—as much as 700 percent in some cases. Richo Cech of HerbPharm, a botanicals supplier based in Williams, Oregon, estimates that his company pressed 10,000 pounds of fresh St.-John’s-wort flowers into extracts this year, five times the company’s annual average of 2,000 pounds.
The St.-John’s-wort fervor was fanned by the ABC television news program 20/20, which in June described, for millions of viewers, the herb’s ability to fight mild depression as effectively as and more safely than synthetic antidepressants.
Until that broadcast, most Americans knew St.-John’s-wort (Hypericum perforatum) only as a noxious weed. But convincing news of the herb’s ability to beat depression had reached the U.S. medical establishment in 1996, when the British Medical Journal published a scientific analysis of twenty-three clinical trials of the herb as a depression treatment. The authors concluded that St.-John’s-wort extracts were as effective as standard antidepressants and caused fewer side effects, including nausea and dizziness. Patients who took St.-John’s-wort felt less sad, less anxious, and more hopeful, among other improvements.
The National Institute of Health’s Office of Alternative Medicine, the National Institute of Mental Health, and the Office of Dietary Supplements are collaborating to fund research on St.-John’s-wort and issued a request for proposals last June. But substantial research already exists in Europe, and German doctors commonly prescribe preparations made from the flowering tops of St.-John’s-wort to treat anxiety, mild depression, and sleep disorders. In 1994, German physicians wrote prescriptions for nearly sixty-six million St.-John’s-wort products worth about $35 million, according to the British Medical Journal.
The fervent interest in St.-John’s-wort is undoubtedly linked to the way many Americans feel. According to a National Institute of Mental Health estimate, 10.6 million Americans suffer mild cases of depression and 9.9 million suffer mild to severe cases of depression each year; many of these people are drawn to drugs such as Prozac or Nardil to relieve their symptoms.
Health researchers believe that depression can result from deficiencies of serotonin and norepenephrine, mood-regulating chemicals that send signals to the brain. Some antidepressants work by correcting these deficiencies. In the case of St.-John’s-wort, however, science hasn’t yet demonstrated exactly how it works, but it is believed that the herb’s therapeutic components perform in a few different ways. One of the herb’s constituents, hypericin, has been shown to increase the concentration of serotonin and norepinephrine in storage sites in the central nervous system. Other constituents appear to inhibit an enzyme called COMT (catechol-O-methyltransferase), which also can reduce the brain’s two “feel-good” chemicals. Yet another mechanism appears to suppress the release of interleukin-6, which affects mood through neurohormonal pathways.
Because St.-John’s-wort causes no serious side effects, says Hyla Cass, M.D., a California psychiatrist specializing in nutritional medicine, people generally find it more pleasant than synthetic remedies, which can cause dry mouth, headaches, nausea, reduced sexual drive, anxiety, insomnia, drowsiness, diarrhea, loss of appetite, and a dulling of emotional response.
“I don’t notice that happening with St.-John’s-wort,” says Cass, adding that her patients notice, too. “It seems to bring out their own natural energy and vibrancy.”
However, some health-care providers warn that St.-John’s-wort is not a panacea for depression. For one thing, it takes three to six weeks of use before it begins to work. And, adds Donald Brown, a naturopathic physician who has prescribed St.-John’s-wort since the 1980s, the most effective way to treat depression is not by taking a pill, natural or otherwise, but by following a holistic approach that includes lifestyle changes and the guidance of a qualified health-care provider. Brown says he tends to prescribe St.-John’s-wort primarily for patients who want to wean themselves off synthetic antidepressants.
With the increased demand for St.-John’s-wort, some members of the herbal supplement industry worry about poor-quality products entering the market or products that claim to contain St.-John’s-wort but don’t. That could lead to St.-John’s-wort users experiencing unexpected reactions or no results at all.
“While it [the increased demand] was great, a lot of product got dumped on the market,” says Grace Lyn Rich of Nature’s Herbs, an herbal supplement manufacturer. “People who never had a St.-John’s product all of a sudden did.”
Rich and others advise consumers and retailers to buy wisely. Sounds simple enough. But that can be tricky because herbal products are sold as dietary supplements, so they aren’t as strictly regulated as medicine. Rich suggests that those who have used herbal supplements stick with brand names they trust and that new users check with their health-food retailer for guidance.
Hypericin, a constituent found in St.-John’s-wort, is often used in commercial St.-John’s-wort preparations as a “marker” of quality assurance. Product labels will often state that the content is standardized to 0.2 to 0.3 percent hypericin. Identifying chemical markers is common in the effort to achieve consistency; the product is then said to be “standardized” to ensure that the product will give more-or-less guaranteed results.
In the case of St.-John’s-wort, as is true for many botanicals, more than one constituent may be responsible for the herb’s therapeutic action. So, until more is known about what makes St.-John’s-wort an effective depression remedy, going by its hypericin content may be the best way to assure product consistency. But if hypericin is preferentially extracted from the herb, then other components—which may also be contributing to the herb’s ability to combat depression—may be present only in lower amounts, or not at all.
• Bombardelli, E., and P. Morazzoni. “Hypericum perforatum.” Fitoterapia 1995, 66,1:43–68.
• Ernst, E. “St. John’s wort, an anti-depressant? A systematic, criteria-based review.” Phytomedicine 1995, 2:67–71.
• Hobbs, C. “St. John’s wort, Hypericum perforatum.” Herbalgram 1989, 18/19:24– 33.
• Linde, K., et al. “St. John’s Wort for depression—an overview and meta-analysis of randomized clinical trials.” British Medical Journal 1996, 313:253-257
This article is based on information supplied by Marilyn Barrett, who holds a doctorate in pharmacognosy from the University of London. She operates a consulting service in Redwood City, California.