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St. John’s Wort (and Other Supplements) for Depression: Do Any Help?

by Wellness Letter  

A nonprescription alternative for depression is an herbal remedy called St. John’s wort (Hypericum perforatum). A yellow flowering weed, St. John’s wort has been used to treat various “nervous disorders” for centuries. It’s approved in Europe as a treatment for mild to moderate depression, and sold in the U.S. as a dietary supplement.

St. John’s wort may raise levels of mood-influencing neurotransmitters in the brain, similar to the way certain antidepressants work. It is one of the most researched herbal medicines, in particular for its use in depression. Most studies have shown effectiveness, and the consensus is that St. John’s wort works better than a placebo in treating people with mild to moderate depression, at least in the short term.

The Natural Medicines database, which evaluates complementary and alternative therapies, has deemed St. John’s wort “likely effective” as a treatment for depression. It cites more than a dozen studies demonstrating effectiveness. Studies do not support the use of St. John’s wort for severe depression, depression of long duration, or bipolar disorder.

Before you take St. John’s wort

If you are thinking of trying St. John’s wort, talk with your doctor or therapist first. Don’t combine it with SSRI antidepressants you may be taking, since it seems to work on the same neurotransmitter system. Also avoid it if you are taking triptan medications for migraines. Anyone taking or planning to take St. John’s wort for depression should be under a physician’s care, since the herb can interfere with many medications including statins, warfarin (a blood thinner), digoxin (a heart drug), oral contraceptives, and certain HIV drugs. It also increases sun sensitivity.

Keep in mind that just because St. John’s wort is an herb, that doesn’t mean it’s healthier or gentler or that it won’t have side effects. And the downside with all herbal remedies is that it can be difficult to standardize the dose. There’s no assurance that you’re getting the pure active ingredients, as you would in a prescription medication. Also be aware that such products are not regulated by the FDA as are prescription medications, and may be adulterated.

For the best assurance that you are getting what the label says, look for seals from the nonprofit U.S. Pharmacopeial Convention(USP) or NSF International. The private also has a certification program and, for a membership fee, you can see testing results. In its 2016 analysis of 10 St. John’s wort products, six did not meet ConsumerLab’s quality criteria.

What about other supplements?

Though less well-known as depression treatments than St. John’s wort, other supplements that may improve mild depression include folate, SAM-e, and fish oil. These generally won’t hurt you, as long as you take recommended doses, exercise caution about combining with depression medications, and keep your doctor informed.

Folate. This B vitamin, affects levels of serotonin and other neurotransmitters that are linked to depression. Many observational studies have found that people with low dietary intakes or blood levels of folate have higher rates of depression. Some studies testing the effects of folic acid (the form of folate used in supplements) have found modest benefits in depressed people, especially those who are folate-deficient—but some have not found benefits. Other research has shown that antidepressants tend to be less effective in folate-deficient people. Back in 2004, a Cochrane Collaboration review found “limited” evidence for folate as an adjunct treatment for depression.

But it’s hard to tease apart the many factors that can contribute to depression as well as to folate deficiency. Moreover, it’s possible that low blood levels of folate may be the result, rather than the cause, of depression.

Folate is found in leafy greens, legumes, and other plant foods, and it is added to wheat flour and fortified foods in the form of folic acid. If you have chronic or recurrent depression, talk to your doctor about having your blood folate measured. If your level is low, ask about supplemental folate as an adjunct therapy, especially if medication is not helping enough.

  • SAM-e. This chemical, which is found naturally in the body and also made in the lab, may help mild and even moderate depression. It’s approved for treating depression in parts of Europe, though studies are mixed. Before taking it, be sure to discuss with your doctor, and don’t mix it with SSRI antidepressants because SAM-e has a direct effect on the serotonin system.
  • Omega-3 fatty acids. Some experts suggest that people with depression try upping their intake of omega-3 fatty acids, found in fish. A 2015 Cochrane review concluded that there is insufficient evidence to determine the effects (good and bad) of omega-3 supplements on major depression.
  • Vitamin B12. A vitamin B12 deficiency in older people can cause depression and cognitive problems, but this should be ascertained by a health care provider before high-dose supplements are taken.

This article first appeared in the UC Berkeley Wellness Letter.