A review published online by Cochrane Systematic Reviews on October 8, 2008 concluded that extracts of the herb St John’s wort are as effective for treating major depression as standard drugs. A number of clinical trials since the 1980s have shown that the herb could be helpful for individuals with mild to moderate forms of this devastating condition, and several trials have recently evaluated the effect of St John’s wort in individuals with major depression.
For their review, Klaus Linde of the Centre for Complementary Medicine in Munich, and his colleagues at the University Medical Center in Freiburg, Germany analyzed 29 randomized, double-blinded trials which evaluated the effects of St John’s wort (Hypericum perforatum) on a total of 5,489 individuals with major depressive symptoms. The trials included 18 comparisons of the herb with a placebo, and 17 comparisons with standard antidepressant treatment (6 trials compared both placebo and antidepressant treatment to St John’s wort).
The review found that St John’s wort performed better than a placebo against major depression. In trials which compared St John’s wort extract to other treatments, the extract was found to be equally effective against depression, with significantly fewer people dropping out due to adverse effects compared to those who received selective serotonin uptake inhibitors or older antidepressants.
St John’s wort contains a number of substances that have antidepressant properties, including hypericins, flavonoids, biflavonoids, xanthons, and hyperforin. The authors emphasized that the quality of St John’s wort extracts can differ depending upon the plant material, extraction process, and solvents used.
"Overall, we found that the St. John's wort extracts tested in the trials were superior to placebos and as effective as standard antidepressants, with fewer side effects," Dr Linde stated. "Using a St. Johns wort extract might be justified, but products on the market vary considerably, so these results only apply to the preparations tested."
Depression is considered the most common cause of disability in the United States (Norman TR 2006). According to the National Institutes of Health, clinical depression will affect up to 25 percent of women in their lifetimes and up to 12 percent of men. People with depression suffer in many areas of their lives, including sleep, eating, relationships, school, work, and self-image.
Treatment for depression is usually multifaceted, and there is no doubt that nutrition plays an important role. Research has shown that the body chemistry of depressed people is altered in various ways and that deficiencies in neurotransmitters, hormonal imbalances, and other nutritional deficits can contribute to clinical depression. Also, many people with depression do not eat enough, overeat, or eat nonnutritious foods. New research has also connected depression to inflammation and oxidative stress, which are both appropriately managed with nutritional supplements.
St. John’s wort (Hypericum perforatum) is a medicinal herb used for the treatment of neurological and psychiatric disorders, including depression (Nangia M et al 2000). Compared to placebo, H. perforatum extract can effectively treat mild to moderate depression, reducing symptoms and recurrence rate (Lecrubier Y et al 2002).
The mechanism of action of St. John’s wort in depression is not entirely clear. One idea is that St. John’s wort affects presynaptic serotonin uptake and inhibits norepinephrine reuptake (Nangia M et al 2000). By affecting or inhibiting reuptake mechanisms of presynaptic neurons, St. John’s wort may increase availability of serotonin and norephinephrine. Clinical trials show positive response rates to treatment with St. John’s wort (Kim HL et al 1999; Linde K et al 1996).
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