This ancient herbal medicinal is just now being recognized as a reliable treatment for depression.
A friend of mine called me the other day and made me laugh. That's not unusual for me, but is a marked change in personality for my friend, who is usually depressed and worried about something in his life. For most of his life, Kevin has been "moody" and lacked a smile. Curious, I called him back to let him know how much more pleasant he seemed - and why? I learned that Kevin had been taking an over-the-counter herb with a strange name: Saint John's Wort. He was pleased that I had noticed a change he had been aware of after taking the herb for just a few weeks.
The name of this herb gives some indication of its reverence among traditional, native and folk healers all over the world. St. John of God is the patron saint of nurses. "Wort" is simply Old English for "plant", rendering "nurses plant" or "herb for nurses", given through the beneficence of Saint John of God. Today, the attention that this plant is receiving all over the world, and especially in Europe, is due to two reasons. First, the ailments that it treats have not been addressed to popular satisfaction using "traditional" corporate pharmaceutical agents, and, most recently, modern methods of scientific inquiry have yielded promising results in the treatment of certain ailments using St. John's Wort.
WHAT IT TREATS
Like acupuncture, the remedy is known to work without a logical and scientific explanation. Saint John's Wort has long been used to treat nervous conditions including anxiety, depression and many other psychiatric ailments. It's current use has aroused the public's interest. Prozac, the most common drug prescribed for depression, is also in the top three of all prescription pharmaceuticals sold in the U.S. A monthly supply of Prozac can run from $60 to $150, making happiness quite expensive. In Germany, where Saint John's Wort is currently the leading treatment for depression, physicians write some 3 million prescriptions a year for the herb - 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 Saint John's Wort is still their best seller.
Other traditional uses for this amazing herb are in the treatment of neuralgia, wound management, kidney conditions, sleep disorders, and mild obesity.
Getting to the source of depression: Stress
If you're depressed, you are not alone. Depression afflicts nearly 17% of all Americans in the U.S. for the length of their lives. However depression is nothing to be embarrassed about since those afflicted tend to be more gifted and higher acheiving than their non-depressed peers. Indeed, stress (i.e., the stress commonly associated with achieving people) is a consistent cofactor in depressed people. It is in relieving this stress that St. John's Wort, and nearly every prescribed pharmaceutical anti-depressant, achieves its anti-depressant qualities.
A monthly supply of Prozac can run from $60 to $150, making happiness quite expensive.
It is important to note that stress is the same no matter how it manifests itself. It is because of this that anxiolytic drugs and herbs are able to relieve so many disorders, ranging from depression to gastric upset and weight control agents. Remove the stress and the related symptoms vanish.
Depressed patients' environmental stresses play a major role in their disease. Most of these influences are better addressed with a licensed psychologist, however a few obvious factors bear note. Low light levels, poor sleep habits, and poor diet can, in combination or singly, provide the necessary factors for inducing depression. This is thought to be due to a reduction in a neurochemical called melatonin, manufactured in a part of the brain that is stimulated by bright light and our eyes. A good first line of treatment that you don't need a prescription for is as follows: increased exposure to bright light (the brighter the better), good sleep habits (depressed people's sleep schedules tend to rotate clockwise; staying up later and sleeping in longer - don't fall into this pattern! You should also be sleeping in a dark room and waking up under bright lights). The seasonal "blues" often associated with the declining sunlight of fall and winter months is sometimes treated with special full-spectrum lights which stimulate the brain's production of melatonin. Melatonin, meanwhile, is manufactured in the brain from another neurotransmitter, serotonin, that may be involved in the therapeutic action of Saint John's Wort.
Stress seems to deplete the brain of serotonin. The lowered levels of serotonin (and its by-product, melatonin), have been clearly associated with depression. So it may be possible to conclude that raising the level of serotonin will similarly raise one's mood.
THREE TYPES OF ANTI-DEPRESSANT AGENTS
The traditional prescription drug remedy for treating depression has been in three major catagories:
- Mono-amine-oxydase Inhibitors (MAOI's)
- Selective Serotonin Reuptake Inhibitors (SSRI's - we will also include the MSRI's, or Mixed Serotonin Reuptake Inhibitors in this category, since it was through the same mode of inquiry as the SSRI's that they were developed)
A little on brain chemistry will help to understand the action of these drugs. The human brain is teeming with chemicals. In fact, if you look closely enough, it's all chemicals! Without getting into philosophical discussions, suffice it to say that it would appear to some that all thoughts and all emotions have their chemical counterparts that can be studied under the microscope. If you're not comfortable with this sort of reductionistic view of the psyche - relax. There is plenty we don't know and plenty of room for alternative or supplemental models of understanding. It is only that the method of inquiry currently being pursued by medical science is that of "isolate and tweak", which, so far has had its rewards.
Two of the major chemical players in the brain when it comes to depression, are neurotransmitters known as serotonin and norepinephrine.
Stress seems to deplete the brain of serotonin.
The brain's nerve cells communicate with each other by way of long, wire-like structures that branch out from one nerve cell to touch many other neighboring cells. The point where these projections "touch" the neighboring cell is called the "synapse." It is in this space between the two nerve cells where the chemical messages are sent and where one will find neurotransmitters like serotonin.
Neurotransmitters, like serotonin, work something like the way keys fit into locks. On the one side of the synapse there's the neurotransmitter, or the key, and on the other side of the synapse there is the lock, known as the receptor site. Every neurotransmitter has a specific receptor site that only it, or chemicals with similar structures "fit" into. When a neurotransmitter is received at its' receptor site, information is transmitted, whether it's a feeling of well being (serotonin, norepinephrine, et. al.), euphoria (opiates, for example), pain (acetaldehyde - i.e., the chemical metabolite of alcohol that yields the infamous "hangover"), a rush of excitement (epinephrine, also known as adrenaline), or some other chemical information. Once a chemical is received it is eaten up by another chemical called an enzyme. It's nature's way of "re-setting" the switch.
Mono-amine-oxydase (MAO) is one of these enzymes. Imagine enzymes as performing a janitorial chore in your brain. If it didn't "clean up" the chemicals in the synapse, the next "message" would be confused by the residual neurotransmitters.
One by one, let's look at how these agents work:
UNDESIRED SIDE EFFECTS
- Trycyclics are wide ranging in their action on the brain's neurotransmitters and for this reason are termed "dirty". This is not "dirty' as in "bad" or containing dirt, but unselective in the brain chemicals that they affect. They affect the re-uptake of both serotonin and norepinephrine, allowing these two chemicals to hang around longer and do their thing before they are eaten up by the enzymes. There is also evidence that they amplify the chemical reactions of these neurotransmitters. Tricyclics also affect other brain chemicals, but for simplicities' sake, we will ony address serotonin and norepinephrine. Again, the higher the level of serotonin you maintain, the less depressed you will be.
- MAOI's (Monoamineoxydase Inhibitors), as their name implies, work on the "lock" side of the reaction by blocking the action of the monoamine oxidase, the enzyme that eats serotonin and norepinephrine. By blocking their reuptake, they are left to work their action for longer periods of time (MAOI's vary in their ability to block MAO, there is usually enough left to eventually degrade the neurotransmitters, it only takes longer). The problem with MAOI's is that they leave the brain open to the action of other chemicals (amines) as well, not just serotonin and norepinephrine. This means that a person taking an MAOI has to avoid certain sources of otherwise harmless chemicals. These sources unfortunately include chocolate, aged cheeses, red wines, fava beans and many other commonly enjoyed foods. The repercussions of an accidental ingestion of these foods (actually, the tyramines they contain) while under the influences of an MAOI is staggering, and can range from hypertensive or hypotensive crisis to stroke and, possibly, death.
- SSRI's (Serotonin Re-uptake Inhibitors), also, as their name implies, affect only the reuptake of serotonin, and are thus considered "clean" in their action. They have proven quite effective in treating depression and are the current drugs of choice (Prozac, Zoloft etc.). Saint John's Wort appears to be in this category.
The main complaint with modern anti-depressant therapy is that of undesired side effects. The tricyclics are antihistiminic, which leads to dry mouth, hypostatic blood pressure (dizziness on standing from a relaxed position), constipation, urinary retention, carbohydrate cravings, excessive drowsiness, blurred vision and others. In short, the tricyclics are hard to tolerate, owing to these side effects.
The MAOI's - well, if you can consider stroke a "side effect"... These aren't used often anymore. The best, the "clean", or specific drugs, the SSRI's, have a whole host of their own side effects as well: agitation, insomnia, loss of libido, and impotence are among them.
IF YOU ARE ALREADY ON ONE OF THESE DRUGS...
you should know that these side effects are not always present, and will almost always subside upon stopping the drug. Do not, under any circumstance stop your medication abruptly, or without contacting your attending physician! Do not under any circumstance mix drugs - and St. John's Wort is a drug.
What Saint John's Wort offers...
- Studies have shown St. John's Wort helps the body alleviate depression and supports the viral-inhibiting function of the immune system. In Europe and especially Germany, St. John's Wort is prescribed twice as often as standard antidepressants.
- There is evidence that extracts of hypericum (St. John's Wort) are more effective than placebo for the treatment of mild to moderately severe depressive disorders. (Linde, K. et al. St. John's Wort for depression-an overview and meta-analysis of randomised clinical trials. BMJ 1996: no 7052, vol.313).
- A commercial extract of St. John's Wort has been reported to improve symptoms such as anxiety, anorexia, and depression in a study of 15 women. (Muldner VH. Zoller M. Antidepressive effect of a hypericum extract standardized to the active hypericine complex/biochemistry and clinical studies. Arzenimittelforschung 1984;34:918).
- A double-blind trial of 100 patients treated with St. John's Wort and valerian was compared to diazepam; following two weeks of therapy the herbal remedy was deemed more effective than diazepam. (Panijel M. Die behandlung mittelschwerer angstuzustande. Therapieworch 1985;41:4659-68).
- Flavonoids (produced from Saint John's Wort) have inhibited the influenza virus by more than 83 percent as compared to not using it. (Mishenkova IL et al., Antiviral Properties of St. John's Wort and preparations produced from it. Tr S'ezda Mikrobiol Ukr 1975:222-3).
The specific action of St John's Wort is currently unknown, as is the active agent.
The May 5, 1997 issue of Newsweek magazine reports: "Is Saint John's Wort 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 specific action of Saint John's Wort is currently unknown, as is the active agent. The commonly accepted "marker" agent is called hypericin. What this means is that when hypericin is present, the anti-depressant effects are present, but we don't yet know how it works, or if it is indeed the responsible agent - only that it is very, very likely the effective substance. It is believed by many researchers that the active properties of this herb inhibit the reabsorbtion of serotonin, much like the "clean" drugs (Prozac, for example). St. John's Wort contains a number of chemicals (hyperforin, for example, which is the substance used to help heal wounds), like many plants, and is considered very safe. Most importantly, users of St. John's Wort enjoy the same or better level of relief from depression when compared to traditional pharmaceutical agents (in double-blind studies, no less!), but without the annoying side effects!
IF YOU PLAN TO TAKE ST JOHN'S WORT...
you should know that it contains a number of photo-sensitive chemical agents and that it's properties are enhanced by exposure to light (exposure of the taker), but that a sensitivity of the skin to light could develop in some people. The remedy to this is to wear long sleeved clothing, long pants, a hat, lighten up on the dose, or just get out of the light for a while! For the most part, though, they effects coming from exposure to light are desirable. Most importantly, if you decide to take St. John's Wort, YOU DO SO AT YOUR OWN RISK. PLEASE DISCUSS IT WITH A QUALIFIED PHYSICIAN. You'll be surprised at how receptive many physicians are to this remarkable herb. The optimum dosage, based on the majority of medical studies, is 300 milligrams of Hypercum extract containing .3 percent of the active ingredient hypercin three times a day. Give the herb at least a few weeks to start working.
Further research is clearly needed. U.S. researchers from the NIMH and 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 John's Wort will continue to flourish.