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Old myth or flower power?

An herb named for a contemporary of Jesus has been used for centuries to treat depression and other ailments. But most research on St. John’s wort suggests the yellow-flowered plant is not quite a miracle cure.

While St. John’s wort (Hypericum perforatum) has proved useful for mild cases of depression, its benefit to sufferers of moderate to severe depression is limited, if not nonexistent.

St. John’s wort, which was named after famed biblical figure John the Baptist, has been used not just as an antidepressant but also to soothe nerve pain and help speed the healing of wounds.

“The properties are like a bittersweet, cooling herb,” said Maryon Marsh, owner of the Misting Shed, a herb nursery in Brandon that grows St. John’s wort. “That is, it calms the nerves, reduces inflammation, promotes healing as a local anesthetic and analgesic.”

But sufferers of severe depression should look elsewhere for a treatment.

“If St. John’s wort works at all, it is intended for minor depressive symptoms, not major, life-threatening, incapacitating depressions,” said Dr. Paul Doering, distinguished service professor of pharmacy practice at the University of Florida.

A four-year, $6-million study involving 340 adults suffering from depression, wrapped up in 2001 with no conclusive evidence that the herb works for severe depression. The study, which was sponsored by the National Center for Complementary and Alternative Medicine (NCCAM), the National Institute of Mental Health (NIMH), and the National Institutes of Health Office of Dietary Supplements (ODS) was conducted at 12 research centers nationwide, including USF.

The study involved varying doses of St. John’s wort, sertraline or Zoloft, a prescription antidepressant, as well as a placebo. The trial was double-blind, which means neither the participants nor the clinic staff knew whether a participant was getting a St. John’s wort or placebo pill. After compiling their data, the researchers found no significant statistical difference between placebo and St. John’s wort effects on severe depression sufferers.

But, because sertraline was also found to be no more effective than the placebo, one of the researchers on the project said the findings have been interpreted differently.

“The trial results were not as clean as we had hoped for, and so, the resultscan be interpreted differently by different people,” said Dr. P. Murali Doraiswamy, chief of biological psychiatry at Duke University. “So, it depends on who you ask, and even within members of any study group, you will see different opinions. People more closely associated with big (pharmaceutical companies) are going to say St. John’s wort is useless and that the NIH study proves it. People who are associated with herbal manufacturers are going to say neither Zoloft nor St. John’s wort proved effective, and so you cannot conclude St. John’s wort was worse than Zoloft.”

Joseph de Raismes, city attorney for Boulder, Co., has authored two pamphlets describing the benefits of St. John’s wort and other alternative treatments for mental illnesses. In his pamphlets, available at , de Raismes cites from the research of Drs. Adriane Fugh-Berman and Jerry M. Cott of George Washington University, though he also limits his observations to sufferers of mild to moderate depression.

“I do know people who have used it and claimed that it helped them,” said de Raismes, who said two of his siblings have suffered from serious mental illnesses. “But for me, there’s so much in this area of herbal treatments which is anecdotal, you need to really put that aside and figure out whether there are double-blind, placebo-controlled studies. Those are the ones that I cite in my pamphlet.”

Doraiswamy said the short-term efficacy of St. John’s wort is comparable to newer prescription antidepressants.

“But I also think that St. John’s wort is less well-studied in terms of its long-term efficacy and its effectiveness for treating anxious states — e.g. post-traumatic stress disorder, phobias, panic attacks — that often accompany depression,” Doraiswamy said.

Like all medications, however, St. John’s wort and other alternative treatments have side effects. Besides dizziness, fatigue and increased sensitivity to sunlight, the herb inhibits indinavir, a drug used to treat HIV, and also might affect the functioning of cyclosporine, which helps prevent organ transplant rejection, according to the National Institutes of Health.

Side effects can occur just as frequently with synthetic medicines as with so-called natural remedies, which include, according to de Raismes’ pamphlet on evidence-based herbal therapies, Ginkgo biloba for mild dementia, kava for anxiety and stress and valerian for insomnia and stress.

“People need to remember that even “natural” substances can interact with prescription medications, and some of these interactions can be quite serious,” said Doering. “The more research that is done, the more we realize that these things are not without risks.”

Doraiswamy agreed.

“Patients often view that something that is herbal must be safer than a prescription drug, and that is not necessarily the case. Anything that is well-studied in large trials is always safer than something that is supported only by anecdotal hearsay.”

Marsh said she refers depression-sufferers to more experienced medical outlets when they seek her St. John’s wort as treatment.

“I say go to a reputable health food store and get it encapsulated,” she said. “Then you know exactly what you’re getting, as long as it’s a reputable manufacturer. If it says there’s 250 milligrams, then there is 250 milligrams.”

Future research on St. John’s wort, according to the NIH study, will focus on the efficacy and safety of the herb for treating minor depression.

“We’re just at the beginning of understanding how psychotropic medications work,” de Raismes said. “So, by definition, more research would be helpful.”

For the NIH-NCCAM St. John’s wort trial:

Contact Khari Williamsat