April 20, 2001

St. John’s Wort doesn’t help depression: study

Featured Image

St. John’s Wort doesn’t help depression: study

The first large-scale, multi-center trial in the United States of the effectiveness of St. John’s Wort in treating moderately to severely depressed individuals has shown that the herbal remedy is not effective.

Results of the double-blind, placebo-controlled study, led by Dr. Richard C. Shelton, professor of Psychiatry at Vanderbilt University Medical Center, were published in this week’s Journal of the American Medical Association.

The study looked at 200 patients at 11 academic medical centers across the country who had been diagnosed with a depression of at least moderate severity.

The participants in the study were given either 900 to 1,200 milligrams of St. John’s Wort per day or a placebo for eight weeks. Then, the study was unblinded and patients doing well with St. John’s Wort received the herb for another six months. Those not responding were given an anti-depressant.

The results showed that the herbal remedy was no more effective than a placebo for the treatment of major depression of at least moderate severity.

“This study seriously calls into question the effectiveness of St. John’s Wort in the treatment of the typical depressed patient with a moderate to severe depressive condition,” Shelton said. “People have been attracted to St. John’s Wort because it comes from a natural source, but our study shows that it’s a treatment that may not work.”

“As in most significant illnesses, the most dangerous treatment is the treatment that doesn’t work. Depression is a life-threatening disease and represents the number one most common cause of disability in industrialized countries,” he added. “About 5 to 10 percent of people who suffer from depression, and who go untreated, will die of suicide. For those reasons alone, we recommend that patients suffering from depression take established treatments.”

The study also questioned the validity of 23 previous randomized trials of St. John’s Wort in 1,757 outpatients with mild to moderately severe depressive disorders. In these studies, SJW appeared to be comparably effective to standard antidepressants while producing fewer side effects. The results indicated that SJW might be a safe and effective alternative to antidepressant medications.

But all of the previous studies, none of which was conducted at Vanderbilt, had at least one major flaw, Shelton said. The JAMA study did not include very mildly depressed patients.

“If someone is depressed enough to be treated, the answer is ‘no’ for treatment with St. John’s Wort for now, based on what we found in this study,” Shelton said.

The Food and Drug Administration does not regulate herbs, so health food stores and companies on the Internet can make unsubstantiated claims as to their effectiveness, Shelton said.

St. John’s Wort is a bushy perennial that contains a variety of chemicals, the most significant of which is hypericin, named after the botanical name for the plant, Hypericum Perforatum.

Recent estimates show that nearly two million people in the United States use St. John’s Wort. Shelton said about half of those people suffer from significant depression, which has about a 0.15 percent annual mortality rate, untreated.

Therefore, assuming that approximately half of these people don’t seek treatment if St. John’s Wort fails, it is conservatively estimated that more than 1,500 people could die annually, since it is not an effective treatment.

The JAMA study also showed that St. John’s Wort appears safe and causes no major side effects, although patients in the study receiving the herbal remedy suffered from headaches at a higher rate than in patients taking the placebo.

Shelton said there is another current trial, funded by the National Institute of Mental Health, looking at the effectiveness of St. John’s Wort. It should be completed by the end of the year. Another study, looking at the effectiveness of the herbal remedy in treating mildly depressed patients, has also been proposed.

“The danger is that if people are taking St. John’s Wort and it’s not working, they may get discouraged and not proceed on to another type of treatment,” Shelton said. “What we have here is a piece of information, which probably will become widely known to the public through newspaper articles and TV reports. But most importantly, health professionals ought to know. It’s only one study, but it’s a large study and a very well done study.”