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I have been following the discussions of St. John's wort for depression for about 20 years. It has been hailed as a miracle antidepressant. It isn't. Debunkers have tried to say it doesn't work at all. It actually does work in many cases. The thing that is important to understand about the herb is that it doesn't work for everyone in the same way, although neither do all the prescription antidepressants.

Most people who use St. John's wort (sometimes known by its botanical name, Hypericum) for depression or anxiety describe it as "less like a drug" than their other medications. It works, apparently, through a different mechanism than SSRIs selective serotonin reuptake inhibitors) and SNRIs (selective serotonin-norepineprhine reuptake inhibitors). St. John's wort seems to reduce inflammation in the brain rather than changing the brain's responses to serotonin and norepinephrine. It also has anti-inflammatory effects elsewhere in the body, notably in fat cells.

To be scientifically accurate, there is a compound in St. John's wort that affect the brain's use of dopamine, norepinephrine, and serotonin, but this compound, called adhyperforin, isn't the compound that over the counter St. John's wort is standardized for. The herbal supplements you can buy are standardized for hypericin, which is anti-inflammatory.

Doctors understably are very cautious about treatments they don't understand, or at least about treatments that aren't recognized by most of their peers. There have been 750 studies of St. John's wort in the medical literature, but there have not been, and there never will be, clinical trials of the herb of the same scope as those for far more profitable pharmaceutical preparations. Usually the doctor's attitude is "OK, if you are mildly depressed, you can try it, but if there's any danger of suicide, you must take a stronger drug."

This doesn't mean that you shouldn't tell your doctor you are suicidal if you are, and you want to use St. John's wort. It means that any time you are severely depressed, you need to be in a doctor's care. No herb and no drug is ever all that you need to get well. However, if you are going to take St. John's wort, you need to follow a few basic rules for success:

  1. Don't take St. John's wort until you have been off SSRIs and SNRIs for at least six weeks. It is theoretically possible that the adhyperforin or some other chemical in the herb could interact with the prescription drug and cause a condition called "serotonin syndrome." This syndrome manifests itself as high blood pressure, headache, and severe mood swings. There's only one possible case in millions of St. John's wort users, but you don't want to be the second.
  2. Don't take St. John's wort if you work outdoors or spend a lot of time in the sun. It can make your skin much more sensitive to sunburn. This side effect doesn't happen all the time, but if you have red hair and blue eyes, it's a real risk.
  3. Give St. John's wort about a month to work. It won't help to take more than the recommended three doses of 300 mg per day. If what's going on in your brain isn't inflammation, or it isn't a problem with all three of the neurotransmitters serotonin, dopamine, and norepinephrine, then you may need something else. However, the herb also won't work if you don't take at least 300 mg three times a day. One of the studies "debunking" St. John's wort used just 200 mg once a day.

The drug you take or the herb you take is always just part of getting over depression. It's not unusual to need more than one kind of drug along the way. Keep in close contact with people who can help you in case depression becomes overwhelming, and give any treatment time to work.

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