By: Jean Johnson for Medtech1
“I think ‘Nature's Prozac’ is a fun way of referring to St. John's wort,” said psychiatrist and clinical researcher affiliated with Georgetown Medical Center, Norman Rosenthal, M.D., “And not that out of line.”
Opinions on the yellow-flowered plant that grows wild in disturbed areas like roadsides and blooms around June 24 on St. John's Day, however, are all over the map.
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| There are actually several types of depression:|
Major Depression - This is the most serious type of depression, in terms of number of symptoms and severity of symptoms, but there are significant individual differences in the symptoms and severity.
Dysthymic Disorder - This refers to a low to moderate level of depression that persists for at least two years, and often longer. While the symptoms are not as severe as a major depression, they are more enduring and resistant to treatment.
Bipolar disorder – This used to be called manic-depression. A person with bipolar disorder can swing from extreme mood states of invincible elation to paralyzing despair and back again. This psychiatric illness can be mild, moderate or severe.
Cyclothymic disorder – This is characterized by mild and alternating mood swings of elation and depression that are not debilitating enough to motivate the person to seek medical help. The periods of elation and depression can each last for lengthy periods, such as a few months.
Adjustment Disorder, with Depression - This category describes depression that occurs in response to a major life stressor or crisis.
Postnatal depression (PND) – Around one in eight new mothers experience serious PND. Usually, the depression begins during the first year of motherhood, and ranges in severity from mild to severe.
Seasonal affective disorder (SAD) – Depression is more common in the winter months and in the northern hemisphere, which suggests to some researchers that brain chemistry is affected by sunlight exposure causing seasonal depression in some people.
Germans tend to swear by the herb and have done so for decades. On the other hand, the National Center for Complementary and Alternative Medicine – located within the U.S. National Institutes of Health – is quite skeptical and includes all the usual cautionary statements about how it’s important to consult with an official M.D. or D.O. (doctor of osteopathy) before embarking on herbal therapies.
Vanderbilt University psychology department takes a more neutral, investigative stance. Writing for the Web site, Lindsay Franklin points out that St. John’s wort (wort means plant in Old English) has been used for over 2,400 years. While in the modern era, the herb has been associated with relief from depression and anxiety, historically St. John’s wort was used as a nerve tonic and painkiller particularly to help with arthritis, menstrual cramping and gastrointestinal problems. The Roman emperor Nero is said to have treated himself for depression with plant.
Symptoms and History of Depression
Symptoms of mild to severe depression affect 1 in every 15 Americans. Roughly 18 million experience the problem with females suffering at higher rates than males. Characteristics of this debilitating disease include a sad or low feeling that persists beyond two weeks. It is generally accompanied by some of the following: Feelings of hopelessness, worthlessness, and guilt; suicidal thoughts; fluctuations in appetite, weight, sexual activity, and sleep; and little energy for or interest in normal activities.
While depression and anxiety have deep roots in human history, these conditions have been greatly exacerbated by the rise of industrialized, urban society and its accompanying forfeiture of community and individual autonomy. Thus, when Prozac was discovered in the 1980s – a drug that increases levels of serotonin which is a neurotransmitter in the body that influences sleep, appetite, aggression, and mood – the pill was met with wild acclaim and crowds flocked into their physicians to fill the hole in their souls.
Prozac and its sister designer drugs including Zoloft and Paxil did not work for everyone, of course, and they are costly. So, it did not take long for word to spread across the Atlantic. In 1997 news of Germany’s use of St. John’s wort as a remedy for depression hit U.S. newspapers.
A New York Times headline ran “In Germany, Humble Herb Is a Rival to Prozac,” and the paper observed that after falling into disuse during the rise of modern pharmaceuticals, St. John’s wort had been rediscovered as a potion able to “sooth nerves and relieve melancholy.” Sales of the herb tripled in the U.S. as people flocked to the herbal sections of their groceries to load up.
Ross Sacharoff , manager of Urban Roots, a natural foods store in the East Village of New York City, said in 1997, 'St. John's wort has been out forever, and now suddenly everyone wants it. I’ve never seen anything like this before.”
Studies Differ in Their Findings
A number of studies largely completed in Germany in the mid to late-1990s concluded that St. John’s wort did improve mild and moderate depression. Many experts, though, pointed to numerous flaws in the research, and by 2001 a study at Vanderbilt University that focused on using the herb to treat major depression accumulated data that counteracted the German results. Conclusions of the Vanderbilt study were published in the Journal of the American Medical Association.
Professor of psychiatry at Vanderbilt and director of the study, Richard Shelton, M.D., noted that research data provided “remarkably negative” results, and that “since we know there are treatments out there that do work, I would recommend that folks choose an active treatment rather than St. John’s wort.”
While Shelton underscored that his was just a single study, director for psychiatry clinical trials at Duke University Medical Center, Murali Doraiswamy, M.D., who was not involved in the research said, “This is a very important study. It’s the first scientifically rigorous test, and St. John’s wort didn’t succeed. We have to face reality and give it the same scrutiny as a prescription drug. It’s a serious condition we’re treating.”
Even Norman Rosenthal who wrote a book on the herb agreed in a PBS interview in 2001. “If you've been depressed for a month or more, if you're not sleeping properly, you're not eating, you're losing weight, you can't get out of bed in the morning, your job is suffering, your relationships are suffering, that is the cluster of symptoms you see in depression,” said Rosenthal. “Sometimes people feel hopeless and despairing, see no future or actually consider suicide. If you have those features, don't mess around. Get to a doctor. Get the best treatment by a professional for that condition. Don't self-medicate.”
Norman Rosenthal, M.D. and St. John’s Wort
Rosenthal has long championed the idea that emotional pain needs to be taken as seriously as physical ailments. His pioneering psychiatric work in seasonal affective disorders (SAD), for example, led to a book called “Winter Blues.” Rosenthal also wrote “St. John’s Wort: The Herbal Way of Feeling Good.” (1998)
Thus, while Rosenthal is quick to send those with major depression for professional treatment, he does support the idea that St. John’s work is effective in some situations where minor and moderate depression interferes with quality of life.
In his PBS interview this practitioner who has been listed among The Best Doctors in America and in the Guide to America’s Top Psychiatrists spoke of one patient “who had job difficulties, felt irritable and angry with the people at work. It bothered her sleep a little bit; she didn't feel like going to work in the morning’ and she developed a negative attitude around work,” Rosenthal reported. “She decided to take St. John's wort, and within two or three weeks her whole attitude had improved. She wasn't seriously disturbed in any way, but it turned her around.”