Alternative Treatments: The Curious Case of St. John's Wort
In a world where synthetic medicines are preached as cure-alls, a 5-petaled face of yellow flower power may sit modestly in your garden. St. John's Wort, Hypericum perforatum, is a curious herbal supplement thought to be equipped with antidepressant and anti-anxiety medicinal properties. But does it qualify as a reliable picker-upper?
St. John's Wort Quick 101
SJW's underlying mechanism of action remains more or less unclear, but there are three floating theories:
- By inhibiting monoamine oxidase (MAO), an enzyme responsible for the breakdown of mood brain chemicals, SJW may thus increases quantities of happy chemicals like norepinephrine, epinephrine, and dopamine. This upsurge makes us more cheery.
- SJW may work as a SSRI and increases levels of serotonin, another happy brain chemical.
- Hypericum extract may activate GABA, benzodiazepine, or glutaminergic receptors, which can also pump us full of bliss.
The gist: St. John's Wort works very similarly to the best antidepressant treatment today's mental health field can offer.
But Does SJW Actually Work?
The National Institute of Health (NIH) conducted a funny drug trial in 2002 that compared St. John's Wort to Zoloft (chemical name Sertraline) and a placebo. If you believe in drug conspiracy theories, this study was allegedly intended to show off Zoloft's undeniable prowess and beat down our friend SJW. The results:
- 24% of St. John's Wort users exhibited a "full response"
- 25% of Zoloft takers exhibited a "full response"
- 32% of placebo poppers exhibited a "full response" (Sound high? A common placebo response rate is around 20% to 35%)
What NIH scientists said: St. John's Wort is clearly ineffective.
What you should take note of: Zoloft was inferior to a placebo, and insignificantly better than a common houseplant.
The reality: This aesthetic little bud can pack a punch, and possesses real potential to help you as much as your neighborhood SSRI (Selective Serotonin Reuptake Inhibitor, the most commonly prescribed antidepressant). Results from many fancy clinical trials have found what researchers believe to be "unsatisfying" results, yet drug response rates from St. John's wort actually mimic the efficacy of similar drugs like Lexapro, Zoloft, etc. But don't get too excited - drug response rates from these "official" drugs often barely breach placebo response rates. What does this mean to you? St. John's Wort is a fair alternative to harsh, manufactured antidepressant products.
St. John's Wort Complications
With any drug, natural or synthetic, there are difficult complications of which to be aware.
- Side Effects: Due to the strength of active ingredient of hypericin, St. John's Wort can present very real side effects: photosensitivity, hypomania (excessive overexcitement and energy), sedation, lethargy, and gastrointestinal upset (tummy related issues).
- Drug Interactions: SJW contains ingredients that conflict with several metabolism enzymes, resulting in some serious tummy processing complications. SJW may reduce the effectiveness of codeine (a strong cough medicine) and thus morphine (a serious pain-management drug). Our yellow friend can also raise caffeine blood levels, causing the uncomfortable effects of caffeinism (the anxious feeling of too much coffee). Additionally, SJW can interfere with antidepressants, antipsychotics, certain cardiac and anti-inflammatory medicines, oxycodone, birth control hormones, and anticoagulants such as warfarin and coumadin. Take with caution!
- St. John's Wort Withdrawal: SJW can become an angry beast after abrupt discontinuation, similar to many modern antidepressants. Be aware of the following rebound symptoms: Digestive upset, nausea, tiredness, dysphoria (negative feelings about the world), headaches, body shaking, high blood pressure. Be strong - withdrawal symptoms will pass with time.
Did You Know?
As if we need more cynical statistics, another recent study found concerning discrepancies between advertised levels of hypericin (the active ingredient in St. John's Wort) and actual concentrations. It was discovered that most supplemental products flaunting SJW had labels that overstated active ingredient amounts by 50%. This means that our expectations for therapeutic preparation will be double the amount of what we really get. Not cool, Big Pharma.
Be aware that the herbal supplement industry is not as strictly regulated as FDA-approved medicines, meaning that you should always proceed with caution when experimenting with off-mainstream pills.
Be an informed remedy shopper,
and always discuss trying new things with a medical professional. St. John's Wort is an interesting blonde blossom and is worth investigating for those managing depression or anxiety. Although literature may knock it for being "less superior" than a placebo, keep in mind that many certified medications perform at a similar level. And if you must choose between a manufactured med and some yellow flower power, the natural path always seems to shine a bit brighter.