Karin Taylor, 58, a tax accountant in Toronto, was stumped. She had a good  marriage, two "wonderful kids," and a job she loved. 

“I had no reason whatsoever to feel depressed," she says. "Yet there it  was."

Sure, she was aware in the back of her mind of her family history of  depression, including three relatives who committed suicide. But she had  always felt fine, until a year ago, when, for no obvious reason, life just  lost its zest.

She tried every self-help trick in the book - meditation, positive  thinking, creative visualization. Nothing worked.

Desperate, she finally saw a doctor and, putting aside her fear of side  effects, agreed to a prescription for Paxil, an antidepressant drug. But  she never took it.

Just as she was about to, a longtime woman friend,  came to visit, bringing along an herbal  antidepressant called St. John's wort, or Hypericum perforatum, which is  sold as a dietary supplement.

Taylor tried it - three 300 milligram tablets a day - and now says she  feels "wonderful. I just feel completely natural - no highs, no lows. I  just feel the way I always recall feeling."

Taylor's woman friend swears by it, too, saying the herb "took away the underlying total  gray cloud" that had always been with her, despite 10 years of therapy,  12-step programs, exercise and a prescription antidepressant, Effexor,  which she still takes.

St. John's Wort, or Johanniskraut, has become the antidepressant of choice  in Germany, where it outsells Prozac 7-to-1; in fact, it outsells all  other antidepressants combined.

It's taking off here, too, says industry analyst Patricia Negron of Adams,  Harkness & Hill in Boston. Sales began to grow last fall, she says, and  have "been building ever since."

The herb "is probably going to be one of the biggest herbs of 1997," says  Mark Blumenthal, executive director of the American Botanical Council, a  Texas research and educational group. "It's driven not by market hype but  by clinical data. 

Many people with depression, of course, are successfully treated with  "talk therapy," prescription antidepressants or both. But as alternative  medicine grows in popularity, it is perhaps no surprise that people are  turning to herbal remedies for psychiatric as well as physical ills.

Often, mainstream American doctors scorn or ignore herbal remedies because  they can't find studies on the products' safety or efficacy in medical  journals. With St. John's wort, they can.

Last August, the British Medical Journal published a compilation of 23  randomized trials of the herb involving 1,757 patients with mild or  moderate depression. In 15 of the trials, some people were given the  medication and others a dummy drug; in eight, people were given either the  herb or standard antidepressants.

Some of the studies were flawed - definitions of depression were not  always consistent with American definitions, for instance - but the  results were encouraging. They showed that the herb was "significantly  superior to placebo" and "similarly effective as standard  antidepressants."

Furthermore, side effects like upset stomach occurred in less than 20  percent of people taking the herbal remedy, compared to more than half of  those on standard antidepressants.

The October, 1994 issue of Geriatric Psychiatry and Neurology was devoted  to data on the herbal antidepressant as well.

Promising as all this seems, there is a major problem: Nobody really  understands quite how it works.

One theory that it acts like a type of prescription antidepressant called  a monoamine oxidase inhibitor, or MAOI, has been discredited, easing  concerns that St. John's wort users would have to avoid foods that react  badly with MAOIs.

But these findings leave wide open the question of how the herb does work.

For years, researchers assumed that the key ingredients are hypericin and  pseudohypericin, but these chemicals do not seem to cross the blood-brain  barrier, a membrane that protects the brain. That raises the question of  how they can affect brain chemistry.

One possibility is that the chemicals may act on immune cells that then  secrete chemicals that do cross the blood-brain barrier.

Others think the herb may increase brain levels of the neurotransmitter  serotonin, as many prescription antidepressants do. If so, the key  ingredient may be turn out to be a third constituent, hyperforin.

Other theories are that the herb lowers levels of the stress hormone  cortisol or that it acts on receptors called GABA on brain cells.

However it works, St. John's wort is cheap - about $ 10 for a month's  supply in health food stores, compared to about $ 80 for a  two-to-four-week supply of Prozac.

It also seems to have little toxicity, unlike some prescription  antidepressants that can cause agitation, inhibition of sex drive, dry  mouth, urinary retention and, in rare cases, abnormal bleeding.

The herb seems to help "with no side effects, really, for mild  depression," says Dr. Michael Jenike, associate chief of psychiatry at  Massachusetts General Hospital. "I'm sure Prozac would come out ahead for  any kind of moderate to severe depression. But for mild depression, St. John's wort may be just as good."

Dr. Harold H. Bloomfield, a psychiatrist in Del Mar, Calif., agrees,  noting that the herb "is used by well over 20 million people" in Europe.

Because it is not clear how well, if at all, St. John's wort works in more  severe depression, most researchers warn that you should not even consider  it - or any do-it-yourself approach - if you are seriously depressed or  suicidal.

Instead, get to a psychiatrist or other licensed mental health  professional who can assess your situation and offer treatment that's  already well-tested in this country.

And never take St. John's wort along with any other psychoactive  medication, warns Varro Tyler, a plant medicine specialist emeritus from  Purdue University.

Jenike agrees. "Absolutely, you should not mix" this with other  medications, "and I would be very careful with alcohol, too." Mixing  antidepressants, even mainstream prescription forms, can be fatal.

St. John's wort has also been associated with sun sensitivity in animals,  which means users might be more sensitive to sunburn.

Despite such caveats, if you're one of the millions of Americans like Taylor's woman friend who have been slogging through life in a gray cloud, the herbal  antidepressant might help.

In fact, the National Institute of Mental Health and the Office of  Alternative Medicine are are excited enough about it that they are  planning to seek proposals from psychiatrists willing to study it.

"Everyone wants to apply," says Jerry Cott, chief of the pharmacological  treatment research program at NIMH.

Taylor's woman friend is already a convert. She used to think antidepressants of any  kind were "unnatural." Now, she says, "it was the gray cloud I lived under  that was unnatural."

Judy Foreman’s column appears every other week. Past columns are available on www.myhealthsense.com.
 

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