St. John's Wort - Ease the Blues – Studies are Showing

By Bruce Brightman - founder, LifeSource Vitamins

It is estimated that one in six Americans will have some form of depression in their lifetime1. Depression afflicts nearly 10 million Americans and is the leading cause of disability worldwide2. Research has put the cost of depression in the U.S. along to be $53 billion with reduction in work productivity due to depression accounting for $33 billion, direct treatment costs to be $12 billion, increased mortality at $8 billion due to suicide3.

While the primary methods of treating depression are two classes of prescription medications: SSRI's (selective serotonin reuptake inhibitors) like prozac and celexa and SNRI's (selective norepinephrine reuptake inhibitors) like Effexor and Cymbalta⁴, a 2005 study in the British Medical Journal ⁵ found St. John's Wort (SJW) to be "effective.in [patients] with moderate or severe unipolar depression."

Now a new study⁶ out of the Cochrane Database of Systematic Reviews has found SJW to indeed be beneficial for mental health. Self-proclaimed as "the best single source of reliable evidence about the effects of healthcare", the Cochrane Database Systemic Reviews "explores the evidence for and against the effectiveness and appropriateness of treatments (medications, surgery, education, etc) in specific circumstances"⁷.

In the review, the researchers looked at 37 trials, including 26 comparisons with placebo and 14 comparisons with synthetic standard antidepressants. Rating the overall quality of the trials as "reasonably good" and with doses ranging from 300 to 1500 mg per day, the researchers found that SJW "improved symptoms more than placebo, and similarly to synthetic antidepressants in adults with mild to moderate depression". However, they warned that results from six of the larger and most recent trials looking at patients only with major depression "showed only minimal benefits" of SJW compared to placebo.

To measure the benefits of SJW, the researchers looked at the response rate ratio (RR) which is the ratio of the number of patients in the treatment group with improved symptoms divided by the patients in the placebo group with improved symptoms. Statistical significance was not reached in SJW in the six larger recent trials restricted to major depression (RR = 1.15). However, the six smaller trials did have a significant RR (2.06), and six large trials and five smaller trials not restricted to major depression also reached significance at 1.71 and 6.13, respectively. SJW did cause fewer side effects than older antidepressants "and may have caused slightly fewer adverse effects than SSRI's."

The researchers also cited the possible wide-ranging supplement quality to explain the results. "It has to be emphasized that the quality of [SJW] preparations can differ considerably. The composition of a product depends on the raw plant material used, the extraction process, and the solvents" and "the amounts of bioactive constituents in different products can vary enormously. They went on to cite a 2003 study⁸ showing that "a number of products available on the German market contain only minor amounts of bioactive constituents."

Nevertheless, extracts of St. John's Wort "seem more effective than placebo and similarly effective as standard antidepressants for treating mild to moderate depressive symptoms."

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Reference:

¹ Kessler RC, et al. The epidemiology ofmajor depressive disorder. Results from the national comorbidity survey replication (NCS-R). JAMA 2003;289: 3095-105

² Wang PS. The economic burden of depression and the cost-effectiveness of treatment. Int J Methods Psychiatr Res 2003;12(1):22-33

³ Szegedi A. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine. British Medical Journal Online February 11, 2005

⁴ "Depression" posted on the National Mental Health Institute Website www.nimh.nih.gov/health/publications/depression/complete-publication.shtml#pub10

⁵ Szegedi A. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine. BMJ 2005 Mar 5;330(7490):503. Epub 2005 Feb 11

⁶ Mulrow LK. St John's wort for depression. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD000448. Review

⁷ "An introduction to Cochrane Reviews and The Cochrane Library" posted on www.cochrane.org/reviews/clibintro.htm

⁸ Wurglics M, Schulte-L?bbert S, Dingermann T, Schubert-Zsilavecs M. Rational and traditional hypericum preparations [Rationale und traditionelle Johanniskraut-Pr?parate]. Deutsche Apotheker Zeitung 2003;143:1454-8

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