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St. John's Wort and the Treatment of Depression

According to the National Institute for Mental Health (NIMH), depressive disorders affect nearly 19 million American adults each year. Onset of depression usually stems from a combination of genetic, psychological, and environmental factors. While NIMH's estimate is concerned with people who have sustainable depressive symptoms as opposed to people who simply have a "blue day" now and again, my very unscientific guess is that the number is too low. We operate under too much day to day stress (for example, by the time this HerbClip bin is received most U.S. citizens will have filed tax returns), more and more people experience physical illness which can lead to depression, and the substances, both food and medications we consume, can affect our serotonin levels as well as our "mood". And these circumstances do not even include those people who are predisposed to depressive disorders due to genetics.

In Bin 278, we have included three HerbClips dealing with St. John's wort (SJW) in relation to treatment for depression. SJW has the potential to interact with various pharmaceutical drugs and the adenosine triphosphate transporter P-glycoprotein (Pgp) has been identified as a contributor to reduce bioavailability of the drugs affected by SJW. HC 010455 is based on an article that investigates the interaction between SJW and Pgp. An SJW extract from Lichtwer Pharma (LI 160) was tested on two cell patterns that express Pgp. While the SJW extract was found to inhibit Pgp at high doses, the authors stated that a therapeutic dose of SJW would not alter the brain availability of drugs that interact with Pgp.

HC 010458 critiques an article that examines possible mechanisms of action of SJW. While the author states that hyperforin is postulated as SJW's primary active ingredient, it is actually no longer considered to be the major mechanism of action of SJW in relieving depression. The author concludes that the studies conducted so far support the hypothesis that SJW's antidepressant effects may come from "a combination of various actions involving numerous pathways and neurotransmitters" which points to the possibility that SJW may have a mechanism of action that has yet to be determined.

HC 030155, the FasTrak HC for this issue, concerns a clinical trial which found that the SJW extract WS 5570 (Dr. Willmar Schwabe GmbH, Karlsruhe, Germany) is more effective in treating moderate to severe depression than the conventional antidepressant Paxil®.

So whether SJW endures a myriad of clinical trials (which invariably it will) to prove its efficacy, find its mechanism of action, and discover its herb-drug interactions or we simply accept that our Greek ancestors knew something intrinsically when they stated the belief that SJW was so obnoxious to evil spirits that one whiff would make them disappear, the use of SJW will continue to provide benefits to those who seek alternative ways of dealing with depression.

Lori Glenn, Coordinator