St. John’s wort gets mixed reviews for treating depression

By Lucy Vernasco

What if there was a flower that could make you happy – not just as a thing of beauty but an object of healing? Some claim one such bloom actually exists.

Stocked with the supplements and gummy vitamins is St. John’s wort, capsulized from the blooms of a yellow-flowered shrub used to remedy snake bites, depression and other ailments since the ancient Greeks first tried it. In the form of branded and generic pills and capsules, St. John’s wort is sold as a mood lifter.

There’s even a Yogi Blues Away tea that relies on St. John’s wort to ease tension, fix mild emotional imbalance and assist with seasonal affective disorder.

Does it work? The supplement gets mixed reviews. But the actual herbal ingredient has to be used in pills or capsules for them to be effective.

According to an investigation by the New York State attorney general’s office, store-brand supplements are often mislabeled. Target, Walgreens and Walmart received cease and desist letters last week to stop selling a variety of supplements including Echinacea, garlic, gingko biloba, ginseng, saw palmetto, valerian root and St. John’s wort.  Officials reported that some supplements contained fillers such as wheat, not listed on ingredient labels, that can cause allergic reactions, according to the officials.

According to the cease and desist letter to Walgreens from the New York State attorney general’s office , “Eighteen percent of the tests yielded DNA matching the product label; 45 percent tested for botanical material other than what was on the label; and 37 percent yielded no plant DNA at all.”

Of the 15 tests performed on St. John’s wort purchased at Walgreens, only three of the supplements contained DNA of a substance: garlic, rice and tropical house plant. St. John’s wort could not be identified in any of the tests.

Walgreens provided a statement in response to the controversy and has removed the products from its shelves.

“We take these issues very seriously and as a precautionary measure, we are in the process of removing these products from our shelves as we review this matter further. We intend to cooperate and work with the Attorney General,” Walgreens Media Relations said in a statement.

Like many herbal remedies, the use of St. John’s wort traces back to ancient times.

The ancient Greeks and Romans relied on St. John’s wort, or Hypericum perforatum, to treat snake or reptile bites, gastrointestinal issues, menstrual cramping and depression. The common name stems from the growth of flowers that bloom around the birthday of St. John the Baptist, June 24, according to the American Cancer Society. St. John’s wort was also thought to have mystical powers that could ward off evil sprits.

Today, St. John’s wort is as accessible as iron tablets in the supplement aisle of stores. According to the University of Maryland Medical Center, it’s one of the most commonly purchased herbal supplements in the United States. It’s typically taken three times a day in the form of 300mg capsules or pills. In Germany, doctors prescribe it more than Prozac. The National Institutes of Health and The British Medical Journal have conducted studies to test its effectiveness for major depression of moderate severity.

Several chemicals make up St. John’s wort including hyperforin, hypericin and flavonoids, according to the University of Maryland Medical Center. Most studies have focused on hypericin, and supplements may contain about 0.3 percent hypericin. The part of the flower used for medicinal purposes is the flowering top of the plant, including the leaves, stem and flowers.

A study published in the British Medical Journal in 1996 by scientists from Munich, Germany and San Antonio, Texas, that used St. John’s wort (hypericum) extracts found that the extracts were significantly superior to placebo drugs for the treatment of mild to moderate depression.

“Interpretation of the evidence is still difficult. We believe there is good evidence that hypericum is better than placebo in treating some depressive disorders,” Dr. Klaus Linde of the Technical University of Munich said in the journal. “We do not yet know if hypericum is better in treating certain depressive disorders than others, and neither do we know if different preparations of hypericum are equally effective or the optimum dosages.”

A National Institute of Health trial conducted in 2002 by the National Center for Complementary and Alternative Medicine, the National Institute of Mental Health and the Office of Dietary Supplements found an extract of St. John’s wort was no more effective than a placebo drug. But the study looked at treating major depression as compared to milder forms that were the focus of the 1996 study. Major depression affects about 9.9 million Americans over the age of 18 each year. The double-blind and randomized trial involved 340 participants and the FDA-approved antidepressant Zoloft.

“Overall, we found that patients taking either St. John’s wort or placebo had similar rates of response according to scales commonly used for measuring depression,” said Dr. Jonathan R.T. Davidson professor of psychiatry and director of the Anxiety and Traumatic Stress Program at Duke University Medical Center in a press release. “And, although sertraline [Zoloft] produced no greater effect than placebo on the primary measures, it fared better than placebo on the Clinical Global Impressions-Improvement scale and produced results consistent with its known benefits.”

Jillian Bar-ar, a clinical herbalist and licensed nutritionalist, said the effectiveness of St. John’s wort varies from person to person.

“Sometimes it depends on the product and dosage,” Bar-ar said. “Everyone’s different.”

Bar-ar said that St. John’s wort also works as a powerful detoxifier to the liver and could assist with monthly depression related to menstruation. She said she’s not surprised by the investigation and findings of the New York attorney general.

“You should be working with a practitioner” when taking St. John’s wort, she said. Bar-ar said that it’s important to find an herbalist associated with the American Herbalist Guild to receive the best natural remedy information.

If you take herbal remedies on your own, “I would not exceed what’s listed on the product label,” she said.

Both Bar-ar and physicians associated with the clinical studies agreed that people who feel depressed, especially if it’s major depression with symptoms of fatigue, sleep disturbances and significant weight gain or loss, should seek professional help.

“Many Americans use dietary supplements like St. John’s wort for depression without consulting a physician,” Dr. Davidson stated.

Although there are mixed studies on St. John’s wort in treating depression, according to the University of Maryland Medical Center, the flower has shown promise treating the effects of menopause, menstruation and seasonal affective disorder.

Photo at top. According to an investigation by the New York State attorney general’s office, store-brand supplements are often mislabeled.  (Lucy Vernasco/Medill)