Dr. Pressman

St. John’s Wort: The Miracle Medicine by Dr. Alan H. Pressman

Note: The information on this website is  not a substitute  for the advice of  & treatment by a qualified professional.

Chapter Five
Part 1: Diagnosis

Treating Depression with St. John’s Wort (Hypericum Perforatum)

In a 4-week treatment study, 900 mg. of hypericum [daily] was associated with a significant reduction in the total score of the Hamilton Depression Rating Scale. Overall, hypericum was well tolerated and therefore the data suggest that pharmacological treatment with hypericum may be an efficient therapy in patients with SAD [seasonal affective disorder].

Pharmacopsychiatry Journal
September 30, 1997

The American Psychiatric Association estimates that about one in four women and one in 10 men will experience a significant depression in their lifetime. In fact, in any given year in the United States, an estimated 18 million people suffer from depression and over half of them never receive treatment. Among those people who are most seriously depressed, more than 30,000 will take their own lives. Depression the most common of mental illnesses and a serious medical condition that takes an enormous toll on personal and professional lives is notoriously underdiagnosed and undertreated. One reason for this is the social stigma still attached to mental illness. Another equally insidious reason is the fact that depression simply goes unrecognized. In an increasingly chaotic, fragmented, and high-stress world, many of the symptoms of depression masquerade as “normal” conditions. Recognizing depression, therefore, is the first step toward treatment.

Recognizing Depression

All of us have times in our lives when we feel sad, confused, anxious, angry, lonely, and lost. These are normal reactions to the grief and madness contemporary life throws our way. Death, illness, loss, betrayal, separation, poverty, aging, violence  are just some of the things that suddenly can turn our lives upside down. Faced with any of these challenges, it is natural for us to turn away from the world for a while, take time to regather our strength and our spirit, and then learn how to carry on for another day. Slowly we begin to enjoy life anew, to take pleasure in our families and friends, and to look forward to the future.

When we cannot shake off life’s indignities, when day after day rolls by wrapped in a dark cloud, when seemingly nothing brings us pleasure or solace, we have moved from simple sadness and grief to the state of depression. And we need help.

Defining Depression

Depression is a serious medical illness. Most medical practitioners define it as a mental state characterized by an inability to derive any pleasure or happiness from the simple things in life; like spouses and lovers, children, friends, sex, food, work, music, nature. And while it’s normal to have a day or two when nothing makes us happy, the inability to enjoy life for a prolonged period of time is not normal. It is a red flag that something has gone terribly wrong inside us.

Still, we often excuse or ignore this key marker for depression because it may masquerade as one or more of a constellation of symptoms, many of which we accept as normal in our hectic world: no appetite, no energy, no interest in anyone or anything; sadness, sleep difficulties, confused and foggy thinking, anger and irritability; vague aches and pains that never go away; seeking solace in drugs, alcohol, and sex; and at the darkest end of the spectrum, recurrent thoughts of death and suicide. These are all recognized medical symptoms of depression.

As for what causes depression to begin with, most research seems to indicate that the causes are a complex blend of psychosocial influences (what happens to us and what we learn as children and adults), biochemical responses (how our bodies and brains respond to what happens in our lives), and genetic predisposition (whether depression runs in our families). The fact that there may not be any one cause or reason for depression can make diagnosis and treatment difficult and long-term.

For some of us, the symptoms of depression begin as natural reactions to a life-changing event or unpleasant incident. But instead of going away with time, they become ingrained in the very fabric of who we are and how we view the world. For others of us, living with these symptoms is a lifelong challenge that may start as early as childhood. The number of symptoms we have, how intensely we experience them, and how long they have lasted all determine a diagnosis of depression.

Diagnosing Depression

The American Psychiatric Association (APA) and the National Institutes of Health (NIH) have issued guidelines for diagnosing depression also called mood disorder or clinical depression and among the major symptoms they list are:

• feeling sad or depressed for most of the day
• loss of appetite, overeating, or other eating disorders, including sudden weight loss or weight gain
• feelings of guilt, worthlessness, or hopelessness
• sleep difficulties, including insomnia, inability to stay asleep through the night, or oversleeping
• inability to concentrate, slowness in thought, loss of energy, general fatigue
• loss of interest or pleasure in everyday activities
• vague or chronic body aches and pains that appear to have no physical origin and don’t respond to standard treatment
• irritability and agitation
• recurrent thoughts of death or suicide, or attempted suicide

Furthermore, there are four basic types of depression, each one distinguished from the other by the nature and number of the above symptoms that are present, the severity or intensity of those symptoms, and how long they have been present.

The four major types of depression are: major depressive disorder, dysthymic disorder, bipolar disorder (manic-depression), and cyclothymic disorder. Let’s look briefly at each one.

Major Depressive Disorder. According to the APA and NIH diagnostic guidelines, a diagnosis of major depressive disorder (major depression) should be considered and a thorough medical evaluation conducted if a person has four or more of the above symptoms nearly every day for more than two weeks, or to such a degree that they significantly affect family, work, and other areas of the person’s life. Additionally, one of the symptoms experienced must be either sadness or depression for most of the day, or loss of interest/pleasure in everyday activities.

Major depressive disorder is the most commonly diagnosed depression and is characterized as either mild, moderate, or severe, depending on the number and intensity of the symptoms. The majority of major depressive disorders fall into the mild-to-moderate range and 80 percent of these are fully treatable.

There are also several subgroups of major depressions, including the postpartum depression experienced by many women during the first weeks or months after childbirth, and seasonal affective disorder (SAD), the depression seasonally-triggered during autumn/winter that appears to be related to diminishing sunlight.

Dysthymic Disorder. With dysthymic depression, a person experiences a number of the classic symptoms of depression but at a much lower intensity than in a major depressive disorder. However, this “low-level” functioning form of depression is present almost all the time, every day, over a very long period of time a minimum of two years at least. In fact, many dysthymic depressions begin in childhood and continue throughout a person’s life. Later in life, they often progress to a major depression, and when that happens, a person is diagnosed with having “double depression.”

Bipolar Disorder. Also known as manic-depression, bipolar disorder is chiefly characterized by alternating periods of extreme emotional highs (mania) and severe emotional lows (major depression). Bipolar depression appears to have a clearly biochemical and/or genetic basis. It is a far less common type of depression, affecting only about one percent of the population, and it often requires lifelong medication lithium is usually the drug of choice as well as careful medical supervision.

Cyclothymic Disorder. Similar to dysthymic depression’s relationship to major depression, cyclothymic disorder is a milder form of bipolar disorder. A person with cyclothymic disorder also experiences alternating periods of emotional highs and lows, but at a far less intense level than in classic manic-depression. Also like dysthmymia, cyclothymic depressions may begin in childhood or young adulthood and frequently progress to bipolar disorders.

It’s important to note here that the extensive body of research confirming the effectiveness of St. John’s wort in treating depression has focused exclusively on treating mild-to-moderate forms of major depression, dysthmymic depression, and seasonal affective disorder (SAD). Before we discuss the use of St. John’s wort as an alternative treatment for those types of depression, we need to look at some of the conventional forms of treating depression.

Part 2: Treatment

Conventional Treatments for Depression

Conventional medicine traditionally has treated depression with psychotherapy, antidepressant drugs, or a combination of both. For many mild-to-moderate forms of depression, particularly those which are “reactive” in nature that is, those which arise in response to a life-changing event psychotherapy alone may be sufficient. When psychotherapy alone isn’t enough, a treatment plan combining therapy and antidepressant drugs is often the next best course. Far too frequently, however, antidepressant drugs are prescribed alone, often by a family physician, without the crucial backup of at least some initial psychotherapy. Since all depressions have both a psychosocial and a biochemical component, both modes of treatment are usually needed.

Let’s take a look at the psychotherapeutic approach first.

Using Psychotherapy to Treat Depression

Psychotherapy, or what is commonly called “talk” therapy, focuses on the verbal and emotional interaction between a trained therapist and a patient. Through mutual talking and listening, the patient and the therapist work together to help reframe the patient’s view of, and response to, the world. Patients are guided toward creating better coping mechanisms, finding workable solutions to their specific problems, and repairing or strengthening their personal relationships.

Three basic forms of psychotherapy are used to treat depression: cognitive therapy, behavioral therapy, and interpersonal therapy.

Cognitive therapy focuses on helping patients change their negative or depressive views and thoughts about the world and about specific social situations.

Behavioral therapy focuses on helping patients transform negative or self-defeating behaviors into positive and self-affirming behaviors.

Interpersonal therapy focuses on helping patients improve their personal relationships.

Most psychotherapy for depression is short-term, lasting usually no more than 20 visits of one hour each, and improvement is usually felt in two to three months. When therapy sessions aren’t enough to ease the symptoms of depression, or when symptoms are more severe, antidepressant drugs are frequently prescribed as an adjunct to psychotherapy.

Using Antidepressant Drugs to Treat Depression

Antidepressant drugs have revolutionized the treatment of depression because they so effectively and dramatically relieve or stabilize many of the physical and emotional symptoms of depression. And when a depressed person is feeling better physically and emotionally, they are also better equipped to make the psychosocial changes necessary to alleviate their depression.

The symptoms of depression are in part caused by complex biochemical changes or imbalances in the brain’s chemistry. Biochemicals called neurotransmitters are responsible for harmoniously processing the billions of chemical “messages” that the brain transmits throughout the body from moment to moment. Many of these chemical messages concern emotions, memories, stress responses, general well-being, pleasure, and pain.

Three key neurotransmitters have been associated with the symptoms of depression. They are serotonin, which is associated with a general sense of well-being; dopamine, which is directly responsible for pleasurable feelings; and norepinephrine, which affects mental alertness and physical energy.

When these neurotransmitters are functioning well and are at optimal levels in the brain, we experience a sense of happiness, well-being, security, balance, clear-thinking, and boundless energy. But when the neurotransmitters malfunction, or their levels significantly drop or rise, our thoughts, emotions, sense of well-being, and even physical health are affected in turn.

Antidepressants are designed both to restore equilibrium to the neurotransmitter system and to act directly on the biochemicals responsible for feelings of depression, pleasure, and well-being.

Three major groups of antidepressants have been used over the last thirty years. They are the monoamine oxidase inhibitors (MAOIs), the tricyclic antidepressants (TCAs), and the selective serotonin reuptake inhibitors (SSRIs). All the antidepressants are slow-acting drugs and must be taken for several weeks before their effect is appreciably felt. Let’s take a look at how each class of antidepressant works in the brain.

MAOIs. This group of antidepressant drugs increases the levels of serotonin in the brain by suppressing (inhibiting) an enzyme called monoamine oxidase. Monoamine oxidase breaks down serotonin and thus decreases the quantity of serotonin available in the brain. Serotonin is a powerful neurotransmitter responsible for general feelings of physical and mental well-being and emotional stability. Normal levels of serotonin contribute to our feeling good, but low levels can cause anxiousness, anger and irritability, and a generally depressed feeling. By inhibiting the action of monoamine oxidase on serotonin, the MAOIs in effect raise serotonin levels and the pleasurable feelings that go along with them.

Examples of popular MAOIs are Nardil (phenelzine) and Parnate (tranylcypromine), both of which are quite effective in treating depression. But the MAOIs, like all prescription antidepressants, have bothersome and sometimes serious side effects and aren’t tolerated well by some individuals. The major drawback of the MAOIs, however, is how they interact with certain foods, beverages, and prescription and over-the-counter drugs that contain the enzyme tyramine. Examples of tyramine-containing substances include aged cheeses, red wines, soy sauce, salami, some cold medications and some antibiotics. When combined with any of the tyramine-containing substances, MAOIs can produce dangerous and potentially life-threatening reactions. These include a sudden rise in blood pressure, chest pain, nausea, and possible stroke. Because people taking MAOIs must avoid a significant number of foods, drinks, and medications, these antidepressants are now less frequently prescribed.

TCAs. The tricyclic antidepressants, named for the unique three-ring structure of their chemical composition, are a first-generation group of antidepressants that date back to the 1950s and which were very popular in the ’70s and ’80s. The TCAs work directly to increase the levels of the neurotransmitters epinephrine, norepinephrine, and dopamine also called catecholamines. Norepinephrine and dopamine are critically involved in regulating both the central nervous system and the cardiovascular system.

Some well-known TCAs include Elavil (amitriptyline), Sinequan (doxepin), and imipramine (Tofranil, SK-Pramine) considered the “gold standard” of antidepressants and the one against which the effectiveness of other antidepressants, including St. John’s wort, have been tested. The TCAs are remarkably effective in treating depressions, particularly those that involve weight loss, depressed moods, and the inability to experience pleasure. But the TCAs also have been associated with some serious side effects, including sexual dysfunction, confusion, blurred vision, sluggishness, low blood pressure, rapid heart beat, and very rarely, seizures. Further, they are not recommended for people with cardiac and urinary tract problems, and this proviso excludes many older patients.

SSRIs. The selective serotonin reuptake inhibitors are the newest and most popular class of antidepressants. They block the natural reuptake (absorption) of serotonin into brain cells and thus keep the levels of circulating serotonin high. The SSRIs appear to be better tolerated than the other groups of antidepressants, though they can cause insomnia, jitteriness, impotence, dry mouth, and diarrhea. The SSRIs also must be used cautiously with older people or those with kidney or liver problems.

Two popular SSRIs are Prozac (fluoxetine) and Zoloft (sertraline), with Prozac by far the most popular and most prescribed of the two. It is also prescribed for obsessive-compulsive disorder and bulimia, particularly when they are associated with symptoms of depression.

Prozac appears to have somewhat less intense side effects than the other antidepressants, but it remains in the body for a long time after a person stops using it. Therefore, caution must be used when switching from Prozac to another serotonin-based antidepressant. And many people do in fact stop taking Prozac. It doesn’t work for all depressions, and some of its side effects are disturbing, including possible rapid weight loss and insomnia. These same people are often subsequently prescribed an MAOI, but the combination of the two antidepressants can cause a potentially fatal condition called serotonin syndrome. With serotonin syndrome, too much serotonin floods the body, causing agitation, tremors, muscle spasms, abrupt changes in blood pressure, and sometimes coma.

Drug manufacturers caution physicans and patients alike to wait at least five weeks after stopping Prozac before taking another serotonin-based antidepressant such as an MAOI. Alternatively, people stopping an MAOI should wait at least two weeks before taking Prozac.

All antidepressants were originally formulated to be taken on a short-term basis one year at the most and as an adjunct to psychotherapy. Many people, however, take antidepressants for much longer periods of time, even over the course of a lifetime. This is often not necessary for mild-to-moderate depressions. And as with all prescribed medications, long-term use of synthetic drugs also raises the spectre of increased and more serious side effects as people get older. Antidepressant drugs are expensive too, some costing from two to three hundred dollars a month for a daily regimen.

That’s why the news of a natural antidepressant like St. John’s wort has met with such enthusiasm and generated a wealth of research. It is comparable in effect to Prozac, perhaps more effective than imipramine, is far less expensive than prescription antidepressants, and has fewer and milder side effects. And as we will soon see, St. John’s wort has even more to offer in the treatment of depression. It may combine the best of all three classes of antidepressant drugs, while also targeting some of the physical causes of depression that prescription antidepressants do not.

Using St. John’s Wort to Treat Depression

As we mentioned in chapter one, St. John’s wort has been used medicinally in traditional Western herbal medicine for almost two thousand years. One of its primary uses for centuries has been as a nervine. In herbal medicine, the nervines are plant herbs that nourish and strengthen the nervous system and are used to treat sadness, stress, tension, insomnia, and anxiety, all of which are known symptoms of depression. The nervines also act as “tonics” in the body. That is, they not only treat specific conditions anxiety, for example but they simultaneously strengthen (”tone”) the body overall by nurturing and supporting the immune system.

While the use of St. John’s wort for all its applications fell out of favor for a time in English-speaking countries, it was frequently prescribed for its nervine properties in non-English-speaking countries, most notably Germany. There it soon became the most widely used medication for mild-to-moderate depression (prescribed by both conventional and alternative practitioners), outselling Prozac, for example, by nearly fifty percent.

With more than twenty million German people taking over sixty million doses of St. John’s wort daily, Germany led the way in pioneering research on the herb’s effectiveness compared to standard antidepressants, its safety and side effects during use, and the possible biochemical mechanisms by which it worked. Their conclusions indicated that compared to conventional antidepressants, St. John’s wort was equally effective in treating mild-to-moderate depression, remarkably safe, and significantly less costly. In other parts of the world, researchers, medical practitioners, and people living with depression (not to mention pharmaceutical manufacturers) began to take notice.

During the last twenty years, a wealth of research has been conducted investigating the antidepressant effects of hypericum (St. John’s wort) and many of its constituents both in vitro and in numerous animal studies and patient trials. To date, hypericum’s effectiveness has been studied in over 5,000 patients in more than 25 clinical trials, half of which were double-blind studies. That is, the patients and researchers both did not know which medication was being taken by either study group hypericum or a conventional antidepressant. The results of all these studies indicate that hypericum is an effective antidepressant for mild-to-moderate depression and is well tolerated by patients.

Based on these initial results, the National Institutes of Health and their Office of Alternative Medicine will soon conduct a multimillion dollar study of hypericum’s antidepressant action in multiple clinical trials throughout the United States. In the meantime, new research findings on hypericum’s therapeutic properties are published every few months. We have already highlighted some of those findings in Chapter Two. The balance of this chapter focuses exclusively on the use of hypericum to treat depression.

How Hypericum Treats Depression

While recent research has categorically shown that hypericum is a very effective antidepressant, what still isn’t clear is just how it treats depression. But researchers are getting closer to that answer every day.

The scientific approach to deciphering how hypericum works has typically been a conventional one. Researchers have isolated and tested single chemical constituents of hypericum for their specific therapeutic properties, hoping to find the one or two chemical agents uniquely responsible for its antidepressant actions. We detailed this conventional approach to studying plants in Chapter Two and pointed out why it’s not the best approach to understanding how plant herbs work. Practitioners of traditional herbal medicine believe the therapeutic properties of most plants are dependent on the synergistic interaction of all the chemical constituents in the plant.

The most recent research into hypericum’s antidepressant properties tends to confirm the traditionalists’ point of view. Numerous biochemical studies of the plant’s constituents have yielded increasingly diverse information about all of hypericum’s therapeutic properties, but particularly about its antidepressant actions. What’s particularly interesting about those actions and unique to hypericum is the fact that it seems to treat depression on two fronts. It targets biochemical imbalances in the brain just as standard antidepressants do. But hypericum also treats the physical symptoms of depression by boosting the body’s immune system. Let’s take a brief look at both those actions.

Treating The Brain: The MAOI vs. SSRI Controversy

In early studies of hypericum, scientists focused on two of the plant’s primary chemical constituents, hypericin and pseudohypericin, with hypericin being studied the most frequently. Researchers isolated these constituents from other chemical compounds in the plant and studied them singly either in natural form or in synthetic variations.

Hypericum as an MAOI. The results of these preliminary studies, which used high doses of the chemical constituents, indicated that both hypericin and pseudohypericin were MAOIs that is, agents that raised serotonin levels by inhibiting the action of the enzyme monoamine oxidase (which breaks down serotonin). The hypericum plant (along with its primary consituents) was therefore initially labeled an MAOI, similar to Nardil and Parnate. This was mostly good news. The MAOIs are excellent antidepressants, and hypericum has far fewer side effects than prescription MAOIs.

Unfortunately, as we talked about earlier in this chapter, the MAOIs are also associated with additional and potentially fatal side effects when combined with certain foods and other drugs. Hypericum, as an MAOI-like plant herb, inherited the same negative associations with potentially serious side effects.

Subsequent research pointed out, however, that the earlier research had been erroneous, largely because it used such high doses of hypericin isolated from other constituents in the plant. Nevertheless, much of the hypericum literature, including several books, warn people to avoid the same substances that individuals taking prescription MAOIs do. It’s important to note here, that there is no evidence, scientific or anecdotic, to support this warning when hypericum is taken at normal doses of 900 milligrams daily. The MAO-inhibiting effect in hypericum is very mild and just one component of the plant’s antidepressant action. Indeed, other constituents in the plant subsequently exhibited stronger MAO-inhibiting effects than hypericin did but still at mild levels among them, pseudohypericin, quericitin, and the xanthones plus they were demonstrating other antidepressant properties as well.

Hypericum as an SSRI. In fact, a second wave of research studies in the late 1980s and early to mid-1990s strongly indicated that the antidepressant action of hypericum, in its fully extracted form (with all its plant constituents), was most like Prozac and the other SSRIs, but with milder side effects. This was even better news than the first round of information, because the SSRIs are the most well tolerated of the antidepressant drugs. Like Prozac and the other SSRIs, hypericum helps to prevent the reuptake (absorption) of serotonin by brain cells and to keep levels of serotonin high. Hypericum’s flavonoids, specifically amentoflavone, the xanthones, and GABA-binding receptors were all believed to be partly responsibile for hypericum’s serotonin effect.

Hypericum as an SNDRI? Then a third wave of research studies, some just completed in late 1997, produced even more startling information about hypericum’s antidepressant properties. Not only did whole hypericum extracts inhibit serotonin reuptake, they also appeared to directly affect the levels of norephinephrine and dopamine in the brain, and these powerful neurotransmitters are crucial to a healthy central nervous system. Now hypericum was looking more like the classic tricyclic antidepressants (TCAs) which we discussed above! In fact, in at least one study of over 200 patients, it outperformed and was safer than imipramine, the “gold standard” of all antidepressants.

If these latest research results are validated by other studies, hypericum will become the only commercially available antidepressant that acts as a serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI) and one of the few, if any, therapeutic agents that specifically treats dopamine deficiencies.

Treating The Body: Hypericum as an Immune-Modulator

Russian and German research has confirmed that hypericum is a significant immune-modulator: it both stimulates the immune system when infection and inflammation are present, and it suppresses an overstimulated immune system that has been stretched to its maximum capacity by physical and emotional stress. (This is one of the primary reasons why hypericum is also an excellent antiviral and antibacterial agent.)

As is increasingly evident from studies of stress-induced illness, there is a significant link between emotional well-being and physical well-being. As it turns out, the immune system is just as seriously taxed by depression as it is by viral or bacterial infections which threaten the body. In depression, unfortunately, the communication between the brain and the body is often a question of mixed signals that do neither the brain nor the body any good.

The biochemical imbalances in the brain that typify major depression trigger neurotransmitters there to send a message to the immune system that something is wrong throughout the organism. The immune system responds by producing interleukins, the chemical messengers of the immune system that go into alert mode whenever infection threatens healthy cells.

But in depression, the interleukins are really responding to distress signals from the brain, not from the body, and when they cannot find a physical infection to mediate, they send a message back to the immune system center that they need more help. Interleukin production goes into overload, and the body is flooded with confused and misdirected chemical messengers who have nowhere to go and nothing to do but sit there. The integrity of the immune system is compromised and the system effectively shuts down. The body, in turn, is now ripe for opportunistic infections. That is one of the primary reasons why people with major depression are besieged by chronic infections and nonspecific aches and pains.

Hypericum, as a powerful immune-modulator, both decreases the excessive quantities of interleukins throughout the body and strengthens and supports the beleaguered immune system. As interleukin production decreases and the immune system as a whole is restored to balance, many of the physical symptoms associated with a person’s depression are relieved. In fact, with hypericum, the physical symptoms of depression are often the first to go. This is another aspect of the plant’s antidepressant action that is, like it’s SNDRI-effect, totally unique to hypericum.

Much of this new research is extraordinary news indeed for the millions of people who live with depression, even when further studies are definitely called for. What is important to repeat here is, that based on all these research studies, there is absolutely no doubt about hypericum’s effectiveness in treating mild-to-moderate depression for a significant number of people. And it will treat such depressions safely, inexpensively, and with far fewer and milder side effects than prescription antidepressants. So let’s move on to the who, what, when and how of treating depression with hypericum.

Part 3: Using Hypericum

Using Hypericum to Treat Your Depression

Depression is a serious disease, and hypericum is potent medicine. These two facts cannot be repeated often enough.

Too much of recent mainstream literature about St. John’s wort has a “jump-on-the-bandwagon” mentality. Some writers and alternative medicine advocates seem to suggest that just because hypericum is a natural herb with mild side effects it can be used by most anyone who is experiencing some depressive symptoms. This simply isn’t true.

In the most scientifically rigorous of the clinical trials involving patients, hypericum was effective in 75 percent of cases at the most. And these were patients who had been thoroughly evaluated by medical doctors beforehand, who had received a clinical diagnosis of major depression, and who were closely monitored throughout the trials. Depression is difficult to treat, and finding the optimal antidepressant for a person unique set of symptoms is often the most difficult part of that treatment. Like the synthetic antidepressants, hypericum is not always effective in treating some mild-to-moderate depressions.

With those warnings, please bear the following in mind . . .

If You Are Already Taking A Prescription Antidepressant

Don’t stop taking it! If you are interested in using hypericum as an alternative antidepressant, talk to your medical practitioner first. All the pro-and-con scientific evidence about mixing hypericum with other antidepressants isn’t in yet. Some research implies that hypericum can be used as adjunctive (supportive) therapy with a serotonin reuptake inhibitor, such as Prozac. Other research strongly suggests that it is best to gradually withdraw from a prescription antidepressant before beginning a treatment regimen with hypericum. Again, working with a qualified medical practitioner conventional or alternative is the best and safest course of action when switching from a conventional drug to hypericum.

If You Suspect You Have A Depressive Disorder

Don’t self-medicate with hypericum! Review the guidelines for major depression, then talk to a qualified medical practitioner and get a thorough evaluation of your symptoms. Remember, hypericum has been tested only in patients with mild-to-moderate depressions. Also, many milder forms of depression don’t require an antidepressant at all; psychotherapy alone can produce wonderful results in some cases. The bottom line here is that hypericum is medicine, and you shouldn’t take medicine you don’t need.

If You Have Mild-to-Moderate Depression And You Are Working With A Qualified Medical Practitioner

Do try hypericum after reviewing all your treatment options and after discussing with your practitioner other medications you may be taking or other medical conditions you may have, such as high blood pressure. Also review our descriptions of the possible side effects of hypericum in Chapter Two and our guidelines for buying and using research-grade hypericum in Chapter Three.

The most up-to-date research on hypericum and depression recommends the following as optimal daily doses for treating mild-to-moderate depression:

Tablet or Capsule Forms: 300 mg. of hypericum extract standardized to 0.3 percent hypericin, three times a day with meals, for a total of 900 mg. daily.

Liquid Extract Form: one-quarter teaspoon (approximately 20 drops) of hypericum extract standarized to 0.3 percent hypericin, three times a day in distilled water, with meals, for a total of three-quarters of a teaspoon daily.

Like the other antidepressants, hypericum is a slow-acting therapeutic agent. You should wait at least four to six weeks for its full antidepressant effects to be felt. However, you may notice some physical effects sooner than that.

Improved sleep patterns may occur as early as seven days after beginning treatment. Furthermore, hypericum does not interfere with normal dream patterns, as do synthetic antidepressants, nor does it produce the intense and vivid dreams associated with prescription antidepressants.

Eating disorders, including both poor appetite and overeating, may improve as early as two weeks after beginning treatment. Fatigue, exhaustion, and low energy levels may also improve as early as two weeks after beginning treatment. The “blues” or depressed mood may improve as early as three weeks after beginning treatment. A general sense of well-being may also occur as early as three weeks after beginning treatment.

After you have been on hypericum for a while, you will probably also notice that you feel physically stronger and healthier. And in fact, you may well be both. Hypericum’s potent immune-modulating properties, as well as its antiviral and antibacterial action may make you more resistant to run-of-the-mill colds and viruses and help you recover quickly when they do occur. This is another “bonus” of hypericum treatment that other antidepressants don’t offer!

Length of Treatment: Current research strongly suggests that hypericum be taken for no more than a year. This recommended duration of treatment is actually standard for all the antidepressants.

What to Do if Side Effects Occur: If bothersome side effects occur while you are taking hypericum, you do not have to taper off the herb, as with some other antidepressants. It can be stopped immediately. If you are going to try another antidepressant, however, you and your practitioner should wait the recommended two to four weeks before beginning a new treatment regimen, particularly if you are planning to use one of the serotonin-based drugs.

Using Hypericum To Treat Seasonal Affective Disorder

Seasonal affective disorder (SAD) also known as major depression with seasonal pattern, seasonal depression, or simply the “winter’s blues” is a subtype of major depression that generally occurs in the late fall or winter and completely disappears in the spring. It appears to be related to decreasing sunlight as the winter days grows shorter.

The symptoms of SAD are the same as those for mild-to-moderate depression, and include mood swings, depressed mood, sadness, fatigue, general physical debilitation, sleep disorders (especially oversleeping), eating disorders (especially overeating and craving sweets and starches), weight gain, and listlessness.

Conventional Treatments of SAD

Conventional treatments of SAD include a number of the same antidepressant medicines described earlier for use in treating mild-to-moderate depression, phototherapy, or a combination of medication and phototherapy.

Phototherapy, also called light therapy, has become the preferred treatment option. It is a fairly new therapeutic approach which was devised because SAD occurs primarily during the winter months and is believed to be related to diminishing sunlight. Phototherapy treatment involves exposing people with SAD to a very bright and broad-spectrum artificial light which contains all the wavelengths of sunlight. The light is dispersed by means of a special box or by a visor that attaches to the individual’s head.

Phototherapy treatment is usually monitored by a specialist in that field, although portable home devices are also available. Treatment sessions are generally administered on a daily basis for 30 minutes to two hours per session, depending on the severity of symptoms. Phototherapy, on its own, is quite effective for some people, though other individuals may need a combination of antidepressants and light therapy to fully relieve their symptoms.

One of the drawbacks of phototherapy is that it can be quite time consuming and intrusive. Another concern is that its long-term side effects are not known since it is a relatively new treatment form, and there is some concern that permanent eye damage may be a problem. Short-term side effects of phototherapy may include headache, irritability, strained eyes, and sleep disturbances.

Treating SAD With Hypericum

Hypericum’s effectiveness in treating SAD was documented in a 1994 single-blind study conducted in Germany, where hypericum has long been used to treat the symptoms of seasonal affective disorder.

Two groups of outpatients who had been diagnosed with SAD were each prescribed hypericum (300 mg., three times a day). One group also received broad-spectrum phototherapy for two hours each day. The other group didn’t. Instead, they received a non-therapeutic “dim” light treatment that mimicked phototherapy.

At the end of four weeks, both groups of patients showed a significant improvement in their depressive symptoms, based on the Hamilton Depression Scale, and they experienced minimal side effects. Furthermore, there was no significant difference in improvement rates between the two groups. In other words, the patients who received hypericum only improved just as much as did those patients who received hypericum and phototherapy!

Based on the results of this specific study, as well as the larger body of research on hypericum and major depression, you may want to try using hypericum alone for your SAD symptoms under a practitioner’s care, of course. We recommend that the following daily doses be taken for a six-month period, from September through March.

Tablet or Capsule Forms: 300 mg. of hypericum extract standardized to 0.3 percent hypericin, three times a day with meals, for a total of 900 mg. daily.

Liquid Extract Form: one-quarter teaspoon (approximately 20 drops) of hypericum extract standarized to 0.3 percent hypericin, three times a day in distilled water, with meals, for a total of three-quarters of a teaspoon daily.

Since the full effects of hypericum may not be felt for four to six weeks, we recommend you starting taking it in early September. That way, by the time the days begin to significantly shorten, you will be receiving the full therapeutic effects of the herb.

Depression is a daunting and insidious disease for those who live with it, who live around it, and who treat it. Not only is it difficult to diagnose and treat, it may also go unrecognized for years on end, effectively placing a stranglehold on millions of human lives during their most formative and productive years.

But this is one serious medical condition that is highly treatable and often curable. Their are many treatment options available to those who live with depression, not the least of which, now, is hypericum. The appearance of St. John’s wort on the therapeutic landscape, as an effective, natural, safe, and inexpensive antidepressant, may be the most heartening medical development to occur in the field of depression for years.

Remember, too, that depression is a quintessentially body-mind-spirit disease, with physical, mental, and emotional components. Alternative medicine, therefore, with its emphasis on holistic treatment and total health, has much to offer in the support of depression, besides the benefits of hypericum.

For one, many other herbs combine well with hypericum in teas and tonics which can provide additional short-term support during treatment for depression. Some of the herbs that share hypericum’s calming properties are valerian (Valeriana officinalis), lobelia (Lobelia inflata), hops (Humulus lupulus), rosehips (Rosa canina), and balm (Melissa officinalis). Herbs that share hypericum’s immune-strengthening and energy-enhancing actions are echinacea (Echinacea augustifolia), ginseng (Panax ginseng), ginger (Zingiber officinale), and cinnamon (Cinnamomum zeylandicum). Check your local health food stores for teas and tonics containing these herbs, or try one of the recipes we share at the end of this chapter.

Good nutrition, nutritional supplements, gentle body-mind exercises such as t’ai chi, chiropractic manipulation, massage, and meditation techniques all can add immeasurably to physical and emotional well-being. Many of the reference books we list in the back of the book, particularly those under Chapter One, provide wonderful instruction in using the therapeutic tools of alternative medicine to help treat depression.

St. John’s Wort Calming Tea

This is a soothing tea for body and soul during particularly stressful times, or when you are feeling especially anxious. Use dried herb for the ingredients.

• 2 teaspoons St. John’s wort
• 1 teaspoon rosehips
• 1 teaspoon balm
• 1 teaspoon valerian
• 4-5 cups pure spring water, boiled

Place all the dried herb ingredients in a large glass or enameled teapot that you have prewarmed with hot water. (Discard the hot water before adding herbs.) Pour boiling spring water over the herbs, cover the pot, and allow tea to steep for 15 minutes. Strain into a cup or mug and season to taste with honey.

Drink three to four cups of this tea evenly spaced throughout the day, between meals. You may leave the pot out on your kitchen counter and drink the tea at room temperature. If you prefer your tea hot, gently warm (not boil) the tea in a glass or enameled pot on top of the stove, or add 1-2 teaspoons boiling water to a cup of lukewarm tea. Never microwave herbal tea. Discard any leftover teas and grounds at the end of the day.

St. John’s Wort Restorative Tea

This tea is a true tonic. It has both a balancing effect on the emotions and an energizing effect on the body and brain. It’s especially good for those days when you are feeling physically low and mentally fuzzy, but still need to get things done! Use dried herb for the ingredients.

• 2 teaspoons St. John’s wort
• 1 teaspoon lavender
• 1 teaspoon peppermint
• 1 teaspoon rosemary
• 4-5 cups pure spring water, boiled

Place all the dried herb ingredients in a large glass or enameled teapot that you have prewarmed with hot water. (Discard the hot water before adding herbs.) Pour boiling spring water over the herbs, cover the pot, and allow tea to steep for 15 minutes. Strain into a cup or mug and season to taste with honey.

Drink three to four cups of this tea evenly spaced throughout the day, between meals. You may leave the pot out on your kitchen counter and drink the tea at room temperature. If you prefer your tea hot, gently warm (not boil) the tea in a glass or enameled pot on top of the stove, or add 1-2 teaspoons boiling water to a cup of lukewarm tea. Never microwave herbal tea. Discard any leftover teas and grounds at the end of the day.