Investigating a Natural Remedy for Depression

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HOST: Dawna Friesen

GUEST: Dr. Jacques Bradwejn, Psychiatrist

FRIESEN: It's called St. John's Wort and it's received a lot of attention lately as an alternative medicine used to treat depression. European studies seem to support the claim that the herbal remedy can relieve mild depression. But now a US health agency is launching a study to find out if the herb will treat moderate to severe depression and if it will stand up to modern prescriptions like Prozac. To talk about the study we're joined by Dr. Jacques Bradwejn. He is in Ottawa and he will have a hand in this new study.

Dr. Bradwejn, good morning.

BRADWEJN: Good morning.

FRIESEN: Can you tell me about St. John's Wort? I know it's been around for about 2,000 years but what do we know about its active ingredients and how it works?

BRADWEJN: Well, it's a plant that, as you say, has been around for many years and was used traditionally to help mood or anxiety problems. And more recently there has been studies in Europe looking at extracts of the plant. And it has shown in several studies -- some of them are small studies -- but in several studies that it can help mild to moderate depression.

FRIESEN: It's widely used in Europe, I guess. Especially Germany, is that right?

BRADWEJN: That's right. In Germany it's used a lot. It's used as a prescription medicine and it's often prescribed by family physicians. It is the first-line medication, we could say, for the treatment of depression, especially mild depression.

FRIESEN: Now, North Americans are just sort of latching onto it, though. Why is it becoming so popular here?

BRADWEJN: Well, first, there's a lot of interest for alternative medicines and there's a public perception which sometimes is actually wrong that natural products may be better for your health. So this is one very important reason.

But also because there has been European studies and because it's used in Europe quite a bit there's been an interest here to test it further and to answer very important questions. One of them is that we don't know if St. John's Wort works as well in mild [sic] to severe depression as well as it works in mild to moderate depression.

FRIESEN: So is that what this study is trying to answer: how well it works for more severe cases?

BRADWEJN: Exactly. That's one of the questions. The other question is whether it could work in a sustained way because many people who suffer from depression need to take treatment and take medication for several months or even years, so we would like to know whether it works not only on a short-term basis but also on a long-term basis. And that's the second question that the large study sponsored by the NIMH will be looking at.

FRIESEN: From what we know about it now, how does it compare to something like Prozac? I've read that people that take St. John's Wort say they don't feel like they're medicated, that it feels sort of like taking a vitamin. Is it as benign as taking vitamins?

BRADWEJN: Well, it's benign in the sense that it causes very few side effects but the study precisely would like to answer the question of how well it works in comparison to a medication like Prozac. So it will be comparing it to another medication which is very similar to Prozac called sertraline, or Zoloft. And during the study we might be able to answer this question of how well it does and how it compares even in terms of side effects.

FRIESEN: When can we expect to see the results?

BRADWEJN: In about three years. It's a fairly large study and it will be done, as I said, in an acute phase, and also in a more prolonged phase over several months. It will take at least three years to complete.

FRIESEN: Now, if the herb is found to be useful in more severe cases of depression and is found to be safe what's the next step?

BRADWEJN: Well, the next step is to be integrated in the type of treatments that are already given. Depending on the results we might be using the herb for more milder forms of depression or more moderate forms but we would use it in an integrated fashion and use it as one of the tools that we already have for the treatment of depression. It's very important also to realize that many patients don't do as well with every medication so it may be another tool that we could use and therefore we could have more means of treating different types of depression.

FRIESEN: Okay. Thank you very much, Dr. Bradwejn.

BRADWEJN: Thank you.

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