The Hottest Alternative in Town! Beat Depression with St. John's Wort

The Hottest Alternative in Town! Beat Depression with St. John's Wort

What's all the buzz? Since early in 1997 when glowing reports started showing up in magazines such as Newsweek and on 20/20, St. John's wort has become everybody's favorite herbal. Dr. Bratman says it's because of its exemplary record of safety and effectiveness, that has made it the primary treatment for depression in Germany and elsewhere, and apparently, American physicians are paying attention. Why now, I wonder? And why St. John's wort? Why not Echinacea, or Ginkgo biloba, equally safe and effective herbal medicines used widely in Europe? We may never know the answers -- in a pop culture such as ours, anything (or anyone) can be made famous (or infamous) overnight with nothing more than media exposure. But let's not "look a gift horse in the mouth," as the saying goes. Psychiatry is a field of medicine, like oncology, which is badly in need of some new approaches.

The causes of depression are understood to be either temporary normal responses to the very real difficulties of life, or if chronic, depression is now seen as being biochemical, and a variety of pharmaceutical drugs have been developed to interfere in different ways with the assumed "biochemical imbalance." In the same way that alcoholism and other addictions have been de-demonized by being designated a biochemical problem i.e. physical rather than psychologically based -- so has depression lost its negative association with mental illness. It has also blurred the psychiatric definition of clinical depression; if it's caused by a biochemical imbalance -- it's a physical illness, not a mental illness and therefore in the domain of the family physician, being easily treated with a prescription for the latest pharmaceutical antidepressant.

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What was once dispensed in the psychiatrist's office or hospital setting for refractive, chronic "clinical" depression, is now being served up to young and old, rich and poor, depressed a little or a lot, anxious, angry, and UNHAPPY people. Not to worry -- Prozac is here. Patients with concomitant, obviously temporary depression secondary to PMS are now being prescribed Prozac; kids who are antsy in school now progress from Ritalin to Prozac; elderly people in pain are given Prozac; migraine sufferers are encouraged to try it; almost anyone can be prescribed Prozac (or another of the many antidepressants) today for almost any complaint.

Dr. Bratman is cautious about "alternative" medicine; he's obviously sold on St. John's wort for depression, but is by no means an alternative physician. His careful extensive evaluation of Prozac, however, could be made for almost any pharmaceutical drug today. He lists the serious side-effects, including insomnia, restlessness, agitation, irritability, erratic behavior, anorgasmia, and obviously differing effects in individuals, as well as the addictive potential. The effects are strikingly similar to those produced by classic stimulent drugs, such as caffeine, cocaine, and amphetamines, and according to Peter Breggin, author of Talking Back to Prozac, it is not a true antidepressant, and should be classed as a stimulant and regulated as a dangerous, potentially addictive drug. The most obvious effect of Prozac is its stimulating property, and that is what often leads to problems for its users.

Insomnia, for instance, is a common occurrence with depression, for many people. One of the most problematical sides to Prozac is that its effects vary greatly among users. Why would so many doctors be prescribing this drug to so many patients if it has all these serious side-effects? The official statistics show Prozac to be almost side-effect-free-the Physicians' Desk Reference (PDR) lists an incidence of sexual side effects, for example, that is under 2%, despite the fact that most women who quit Prozac (and it is probably prescribed to more women than men) do so because of anorgasmia. The reason for this discrepancy lies in the fact that, according to Dr. Bratman, the studies done lasted for only 4 to 6 weeks, and although an original pool of 1,730 patients were involved in clinical trials, only 286 actually completed the trials. The fact that the FDA approves such drugs today on the basis of so little scientific data for safety, is an outrage. Patients have to learn the har d way, as guinea pigs do.

Dr. Bratman does a nice job Of clearly explaining the symptoms of depression, the history of treatment with drugs, the different kinds of antidepressants and their differing mechanisms of action, and as indicated above, he takes an in-depth look at Prozac. Besides the considerable risks of serious side-effects, the author of Beating Depression with St. John's Wort says Prozac really isn't very effective, either; it often fails to improve patients' depression, and in early studies the drug did not surpass placebo. Could it be that hype and energy-boosting qualities of this drug have distorted the true effects?

After the thorough discussions of antidepressant drags, especially Prozac, the author presents some anecdotal stories of patients' experience with St. John's wort, how it works, and what scientific studies have been done. According to the British Medical Journal (August 1996), there have now been 23 randomized double-blind clinical trials of St. John's wort in the treatment of depression. The total number of studies and patients involved in these studies far outnumber the FDA-approved studies on Prozac! No wonder Dr. Bratman is enthusiastic about this herb -- it's being validated scientifically and irrefutably. St. John's wort has shown itself to be remarkably safe and effective, for mild to moderate depression, and even effective for major depression, with the important benefit of no side-effects. Many studies are presented and they are impressive, especially when one considers that a plant extract is being tested, not a pharmaceutical drug, for which these trials were constru cted. But scientific data aside, it's the fact that it works, that patients feel better with no trade-offs to side-effects, that should be the basis for doctors trying this alternative herb for their depressed patients. The one thing that consumers are still confused about when it comes to alternative medicine, is that their doctors tell them "it's not scientifically proven." With Dr. Bratman's book in hand, patients may now ask their doctor why they should not use a scientifically proven, safer, more effective, and less expensive medicine for their depression.

Dr. Bratman offers a few other noteworthy herbs for depression and an excellent Appendix summarizing all the research on St. John's Wort. Unfortunately, he is a proponent of taming herbs into drugs as a way of mainstreaming them. Safety and effectiveness can be proven in a scientific manner without changing the herb into an expensive pharmaceutical drug.

This is an excellent introduction to St. John's wort for depression, as well as good information on the antidepressant pharmaceutical drugs. People with depression will find a well-balanced view of treatments, and doctors treating patients with depression will hopefully, be open to a new approach.

Could all this buzz about an herb for treating depression lead to acceptance of other herbs for treating other illnesses? Hmm....

Townsend Letter for Doctors & Patients.


By Irene Alleger

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