People have been ingesting Saint Johnswort, a yellow-flowered plant with the Latin name of Hypericum perforatum, for some 2,000 years. Some believe it was initially used in ancient Greece to drive away evil spirits. It’s been popular for about 15 years in Europe as a natural remedy for depression. In Germany, where it’s currently the leading treatment, physicians write some 3 million prescriptions a year–25 times the number they write for Prozac. Now, thanks to a spate of books and articles touting the herb’s properties, its popularity is quickly spreading on this side of the Atlantic. American health-food stores now peddle a panoply of mood-boosting supplements, including kava root, the hormone pregnenolone and the amino acids 5-hydroxy-tryptophan and L-tyrosine. But Rob McCaleb of the Herb Research Foundation calls Saint Johnswort “the premier herb for treating moderate depression.”
What’s the evidence for this claim? The respected Journal of Geriatric Psychiatry and Neurology aroused a good deal of interest in 1994, when it devoted an entire issue–17 research papers in all–to “Hypericum: A Novel Antidepressant.” One compelling study tracked the herb’s effects on 3,250 patients battling mostly mild and moderate depression and found that about 80 percent either felt better or became completely free of symptoms after four weeks. Then last August, the British Medical Journal published a review of 23 controlled studies involving 1,757 depressed patients. In that analysis, researchers from the United States and Germany found that Saint Johnswort worked nearly three times better than a placebo. The herb shows “definite promise,” says Dr. Cynthia Mulrow, a University of Texas internist who coauthored the study. “It’s a reasonable alternative to consider.”
Despite the promising studies, researchers still know very little about the herb’s active ingredients or how it works. They also aren’t sure whether Saint Johnswort can help the severely depressed or if it’s safe and effective for long-term use. Experts note that many of the products in the health-food stores contain overly diluted concentrations that render the herb impotent. The optimum dosage, based on the majority of medical studies, is 300 milligrams of Hypericum extract containing .3 percent of the active ingredient hypericin three times a day. Give the herb at least a few weeks to start working.
Though most psychiatrists favor drugs over herbs, some are incorporating Saint Johnswort into their practice. Dr. Harold Bloomfield, a Yale-trained psychiatrist and coauthor of a new book called “Hypericum & Depression,” heard about the herb while researching his 1994 book, “How to Heal Depression.” After reading the literature, nearly all of it from Germany, he started giving it to patients, and he claims the results have been excellent. Ever since Bloomfield’s book was published last fall, he has been inundated with calls from curious psychiatrists and psychologists and clinical social workers, who can recommend it as a remedy for depression because it’s simply a dietary supplement. Bloomfield estimates that the number of therapists treating patients with the herb has grown from a few dozen six months ago to several hundred today.
Janet Lawson is one of the patients. An improvisational jazz singer once nominated for a Grammy, Lawson lives in East Stroudsburg, Pa., when she’s not touring the world. For years, she suffered from severe mood swings but refused to take prescription antidepressants. Now she spends about $40 for four fluid ounces of Phyto Proz Supreme at her local health-food store and takes a dropperful each day. The herbal concoction contains not only Saint Johnswort but a variety of other plant extracts, including the mildly calming extract of kava root. In Laguna Hills, Calif., 48-year-old Elizabeth Dante tried to overcome her depression with the drug Paxil but didn’t like the slightly medicated way it made her feel. So she switched to 500 milligrams of Saint Johnswort three times a day. “I don’t feel at all medicated now,” she says. “It’s like taking a vitamin.”
Is Saint Johnswort as benign as a vitamin? Enthusiasts note that millions of Germans have used the herb extensively without any reported deaths. In the study of 3,250 depressed patients, only 2.4 percent experienced side effects. Those included restlessness, gastrointestinal irritations and mild allergic reactions. Purdue University herb expert Varro Tyler notes that prescription antidepressants, such as Prozac, cause more common and more serious side effects, such as insomnia, weight loss and sexual dysfunction. “The absence of serious side effects is one of Hypericum’s biggest selling points,” he says.
The biggest concern is that the herb might make some people dangerously sensitive to the sun. Certain animals, such as sheep, have grown sick and even died from exposure to the sun after ingesting large quantities of Saint Johnswort. No one has ever reported phototoxicity in people using the herb for depression, but Bloomfield says the potential “should be kept in mind… if one has a prior hypersensitivity to sunlight or if one is taking photosensitizing drugs” such as tetracycline. In light of the potential risks, most experts suggest consulting a physician before taking Saint Johnswort. They also recommend that patients avoid combining it with prescribed antidepressants or altering the dosages of those antidepressants by themselves.
Further research is clearly needed. “The studies in Germany were not done with the same kind of rigor as those generally done in this country,” says Jerry Cott, a pharmacology expert at the National Institute of Mental Health. “I think mainstream psychiatry would say, “I’m still unconvinced’.” The doubts should soon be put to rest. U.S. researchers from the NIMH and the NIH’s Office of Alternative Medicine are now planning a large multicenter trial of the herb. Meanwhile, America’s penchant for self-care ensures that remedies like Saint Johnswort will continue to flourish.
