Its symptoms can include chronic fatigue, digestive disorders, headaches, backaches, irritability, restlessness, and loss of interest in life. A person with depression may be chronically angry or sad—or may display little or no emotion at all.
The causes are not fully understood, but researchers have identified a number of triggers.
It’s clear that we still have a lot to learn about depression and safe, effective treatments. While conventional medicine continues to develop safer drugs, people with mild to moderate depression may benefit from a botanical with a long history of efficacy: St. John’s wort.
Depression: Just the Facts
One of the most common medical problems in the US, depression affects more women than men. It can be triggered by stress, nutritional deficiencies, a traumatic event, chemical imbalances in the brain, or even food allergies.
Whatever the cause, it begins with a disturbance in the part of the brain that controls mood.
Dopamine, serotonin, and norepinephrine are the neurotransmitters (chemicals that regulate behavior) most commonly associated with mood. The drugs used to treat depression—selective serotonin reuptake inhibitors (SSRIs), tricyclic drugs, and monoamine oxidase inhibitors (MAOIs)—typically affect these neurotransmitters.
Problems with Pharmaceuticals
The US Food and Drug Administration (FDA) has issued its strongest warning—a black box warning—to antidepressant drugs, stating that their use can increase suicidal thoughts and behaviors in teenagers and young adults.
Depending on the drug and the person, antidepressants can cause less serious side effects ranging from constipation, bladder problems, dizziness, sexual dysfunction, and blurred vision to headaches, nausea, insomnia, agitation, and nervousness.
Since some individuals who take antidepressant drugs don’t experience any relief at all, it may be worthwhile to look into a natural alternative.
St. John’s Wort
Used in ancient Greece and Rome, St. John’s wort (Hypericum perforatum) has a long history for treating depression. It was used during the Middle Ages to ease a troubled mind and in the nineteenth and twentieth centuries to treat “nervous affections with depression.”
Today, research supports its use for mild to moderate depression, anxiety, insomnia, and seasonal affective disorder (SAD). In Germany, this herb is approved by Commission E (similar to FDA) as a prescription medicine for mild to moderate depression.
“In many controlled, clinical studies involving thousands of people, [its] preparations produced significant improvement in depression and symptoms, such as inability to sleep and concentrate, without the side effects of conventional antidepressants,” says herbalist Steven Foster. While its method of action is still under investigation, some researchers believe this herb blocks neurotransmitter reuptake in the brain.
In one randomized, double-blind, placebo-controlled trial seeking to evaluate the safety and efficacy of this herb, people with mild to moderate depression were given either 600 mg or 1,200 mg per day of a St. John’s wort (SJW) extract or a placebo for six weeks.
Both doses of SJW were significantly superior to the placebo based on a rating scale for depression. In addition, 73 percent of participants receiving SJW went into remission, compared to 15 percent in the placebo group. Although the 1,200 mg dose was no more effective than the 600 mg dose, both were well tolerated and equally safe.
Many studies show that SJW is as effective as pharmaceutical antidepressants and, in some cases, safer. Five randomized, double-blind, multicenter trials involving more than 1,000 participants found SJW as effective as and better tolerated than tricyclic drugs—it was also determined safer for the heart than tricyclic antidepressants.
Other Uses of St. John's Wort
In addition to its use for depression, St. John’s wort shows promise for relieving menopausal symptoms. A combination therapy of black cohosh (known for its efficacy in treating physical symptoms) and St. John’s wort (for psychological symptoms) was tested in German women experiencing physical and psychological symptoms for at least three months.
In the randomized, double-blind, placebo-controlled trial, patients received Remifemin black cohosh plus SJW or a placebo for 16 weeks. After weeks 8 and 16, treatment with the herbal combination produced significant improvement in physical and psychological symptoms, compared to the placebo.
The herbal combo was well tolerated, and adverse effects didn’t differ from the placebo. One reviewer concludes that the combination had a much better effect on psychological symptoms than black cohosh alone, and this study “provides good evidence that two herbs that work well independently can be even better in combination for certain medical conditions.”
Adverse Effects of St. John's Wort
Avoid St. John’s wort during pregnancy since its effects on the unborn child are unknown. Its use during lactation appears to be safe, but discuss this and any other herb with your healthcare practitioner if you’re breastfeeding.
Be sure to discuss St. John’s wort with your practitioner before taking it. It may cause mania in people with bipolar disorder. SJW may interact with a variety of pharmaceuticals, including antidepressant drugs, HIV treatment drugs, and oral contraceptives.