the past few years, much interest has risen in the use of herbs
in the treatment of both depression and anxiety. St. John's
wort (Hypericum perforatum), an herb used extensively in the
treatment of mild to moderate depression in Europe, has recently
aroused interest in the United States. St. John's wort, an attractive
bushy, low-growing plant covered with yellow flowers in summer,
has been used for centuries in many folk and herbal remedies.
Today in Germany, Hypericum is used in the treatment of depression
more than any other antidepressant. However, the scientific
studies that have been conducted on its use have been short-term
and have used several different doses.
Because of the widespread interest in St. John's wort, the National
Institutes of Health (NIH) conducted a 3-year study, sponsored
by three NIH components-the National Institute of Mental Health,
the National Center for Complementary and Alternative Medicine,
and the Office of Dietary Supplements. The study was designed
to include 336 patients with major depression of moderate severity,
randomly assigned to an 8-week trial with one-third of patients
receiving a uniform dose of St. John's wort, another third sertraline,
a selective serotonin reuptake inhibitor (SSRI) commonly prescribed
for depression, and the final third a placebo (a pill that looks
exactly like the SSRI and the St. John's wort, but has no active
ingredients). The study participants who responded positively
were followed for an additional 18 weeks.
At the end of the first phase of the study, participants were
measured on two scales, one for depression and one for overall
functioning. There was no significant difference in rate of
response for depression, but the scale for overall functioning
was better for the antidepressant than for either St. John's
wort or placebo. While this study did not support the use of
St. John's wort in the treatment of major depression, ongoing
NIH-supported research is examining a possible role for St.
John's wort in the treatment of milder forms of depression.
The Food and Drug Administration issued a Public Health Advisory
on February 10, 2000. It stated that St. John's wort appears
to affect an important metabolic pathway that is used by many
drugs prescribed to treat conditions such as AIDS, heart disease,
depression, seizures, certain cancers, and rejection of transplants.
Therefore, health care providers should alert their patients
about these potential drug interactions.
Some other herbal supplements frequently used that have not
been evaluated in large-scale clinical trials are ephedra, gingko
biloba, echinacea, and ginseng. Any herbal supplement should
be taken only after consultation with the doctor or other health