St. John's Wort Extract: Safe Solution for Depression & Anxiety?

Saint-John's-Wort is one of many herbs that are rapidly growing in popularity because of the notion that they're "natural" and so safer than drugs, What isn't often recognized, however, is that 25 percent of prescription drugs are either made from plant-derived substances or are synthetic derivatives of plants. The latter occurs because you can't patent an herb, and drug companies are in business to make a profit. Consequently, they often manipulate natural plant molecular structures, something you can get a patent for. Statistics reveal that 80 percent of the world's population relies on plant-derived drugs such as herbal preparations.

The treatment of mental depression, which affects about 17 million adults, has evolved. For instance, famed psychiatrist Sigmund Freud considered depression to be a behavioral problem characterized by anger or rage directed inward. In 1955 researchers found that a drug called reserpine, which was usually used to treat high blood pressure, also appeared to positively affect mood. Subsequent studies showed that reserpine affected the release of seratonin, a brain neurotransmitter.

Most scientists today recognize that depression is caused by an imbalance in brain neurotransmitters. Antidepressant drugs work by increasing the level of deficient neurotransmitters. The three types of antidepressant drugs currently prescribed by doctors include the following:

1) Monomine oxidase inhibitors work by inhibiting the activity of a brain enzyme called MAO, which breaks down neurotransmitters. MAO inhibitors were the original antidepressant drugs, but there was a problem involving food-and-drug interactions, specifically with an amino acid derivative called tyramine. Tyramine is found in aged cheeses, aged and cured meats, sauerkraut, soy sauce, yeast extracts, red wine and beer. Consuming any of those foods while taking an MAO inhibitor may lead to dangerous rises in blood pressure and even strokes or heart failure.

2) Tricyclic antidepressants are so-named because of their structures. They work by inhibiting the reuptake of the brain neurotransmitters serotonin and norepinephrine. Normally, serotonin and norepinephrine are rapidly degraded by enzymes, but taking tri-cyclic drugs blunts that rapid breakdown, thereby elevating brain levels and easing depression in people who are deficient in the neurotransmitters. Tricyclic antidepressants, too, have the potential to produce a number of serious side effects, including adverse effects on heart function.

3) Selective serotonin reuptake inhibitors are the most popular antidepressant drugs due drugs due to their lower rates of side effects in comparison to both MAO inhibitors and tricyclics. One drug in this class, Prozac (fluoxetine), is used to treat 12 million people worldwide and 6 million in the United States alone. As their name implies, SSRIs work by preventing the excessive breakdown of serotonin in the brain. They're not side-effect free, however. Among other problems, they cause sexual dysfunction in both sexes and can have dangerous interactions if taken with other antidepressants.

These considerable side effects as well as the cost of the drugs have led many people to consider natural alternatives, such as Saint-John's wort, The name comes from early Christians, who noted that the plant begins blooming on June 24, the feast of St. John the Baptist. Won is an old English word for herb. The use of this plant dates back to the ancient Greeks and Romans, who used it to drive away evil sprits. That belief extended to the Middle Ages, when Saint-John's-wort was thought to protect against witches and demons.

From a medicinal point of view, the herb has long been used to treat anxiety and depression and as an antibacterial and anti- inflammatory. Recent evidence shows that ingredients in Saint-John's-wort may be active against several types of viruses, including those that cause AIDS, herpes and hepatitis C. Test tube studies also show that the herb is active against many types of bacteria.

The problem with using herbs for therapeutic purposes has always been a lack of uniformity in potency. The recent popularity of using herbs as part of an alternative medicine regimen has led to a more integrated standardization process, in which each herbal source contains the same amount of active constituent per dose, similar to the standard for drugs. In the case of Saint-John's-wort the standard is 0.3 percent hypericin content. Saint John's-wort contains several other ingredients besides hypericin, and nobody is certain which one is responsible for the mood-elevating effects.

A study of commercially available Saint-John's-Wort supplements commissioned by the Los Angeles Times was reported in the August 31, 1998, edition. The article noted that sales are estimated to be $400 million in 1998, up 3,900 percent since 1995. That's no doubt due to publicity the herb received in several recent books and television reports. The Times' independent lab tests examined 10 popular brands of Saint-John's-wort, finding that three had only half the 0.3 percent active hypericin content listed on the label and four others had less than 90 percent of the promised potency. The results indicate the ongoing problems consumers encounter in buying herbal supplements.

As to how Saint-John's-Wort may relieve depression, scientists originally attributed it to an MAO-inhibiting effect. Later examination, however, showed that the herb was more active in test tubes than in the human body in this regard. While it does appear to have mild MAO-inhibiting properties, Saint-John's wort works mainly as an SSRI, similar to Prozac. For that reason it's often called nature's Prozac.

Because Saint-John's Wort does have some minor MAO-inhibiting activity, you should avoid foods that are rich in tyramine, as discussed above. You should also avoid combining Saint-John's-wort with any SSRI drug, such as Prozac, as it may lead to a condition called serotonin syndrome, which is characterized by excessive amounts of serotonin in the body. Symptoms include excessive sweating, agitation, confusion, lethargy tremors and muscle spasms.

Other studies show that Saint-John's-Wort may interact with brain GABA receptors. That would have a tranquilizing effect, since GABA is the brain's pri mar inhibitory neurotransmitter, which means that it slows brain activity. That's great for inducing sleep or relaxation, but one can only wonder why Saint-John's-wort is often included in food supplements used for the purpose of increasing workout focus and concentration.

Another reason for the herb's growing popularity is that it has a far lower side-effect profile than the prescription drugs. The primary side effect is photos enstivity; in other words, Saint-John's-won may make your skin more sensitive to sunlight. While that more often occurs in cows who consume the herb while grazing, it could also occur in some people.

For instance, a report in the October 3, 1998, issue of Lancet discussed the case of a 35-year-old woman who took 500 milligrams a day of Saint-John's-wort to self-treat depression. She developed pain in her hands and face-both of which were exposed to sun-which progressed to nerve damage. Her symptoms subsided within three weeks after she stopped using the herb, then disappeared within two months with no apparent residual damage.

Her condition may have been caused by the hypericin, which is known to cause photosensitive reactions. The mechanism involves a heightened production of free radicals, the by-products of oxygen metabolism, when hypericin reacts with sunlight. Taking dietary antioxidants such as lycopene, vitamin E, selenium and others in conjunction with Saint-John's-wort may partially protect against this reaction, but it's best to avoid sunbathing while taking the herb.

A study that examined previous studies of Saint-John's-Wort and conventional antidepressant drugs appeared in a 1996 review in the British Medical JournaL The study examined 23 randomized trials of 1,757 people with depression who took either drugs or Saint-John's-wort. Those taking the drugs showed a side effect incidence of 35.9 percent compared to 19.8 percent for the subjects who took the herb.

The suggested dosage of Saint-John's-Wort for treating depression is 300 milligrams three times a day of a standardized 0.3 percent hypericin extract. Studies show the positive response rate to that dose is between 50 and 80 percent. Similarly to what happens with drugs, Saint-John's-wort doesn't produce immediate effects. While some improvement may be evident after four to six weeks, it usually takes two to three months to gauge the depression-relieving effects. Half the dose of hypericin breaks down in about one day.

In addition to the light sensitivity effect, too much Saint-John's-wort may cause such side effects as dry mouth, constipation, confusion and dizziness, although they're all far more likely to occur with prescription drugs.

From a bodybuilding perspective, an interesting property of Saint John's-wort involves its inhibition of a substance made in the body called interleukin-6, a cytokine, or immune-modulating substance, that has pronounced catabolic effects in muscle. Some scientists think that the catabolic effects associated with cortisol are caused by its ability to elevate interleukin-6 levels in muscle. By inhibiting interleukin-6, Saint-John's-wort may be a true anticatabolic supplement. Due to both its promotion of serotonin and its interaction with brain GABA receptors, however, it's not a good idea to use Saint-John's-wort prior to a workout - unless you plan to take a nap at the midway point.