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Dr. Michael Tierra L.AC., O.M.D.

Remember Woody Allen's film Annie Hall? The name was changed from the original Anne Hedonia (or 'anhedonia' from an meaning "not" and hedonia from hedonist meaning "pleasure") the clinical name for those individuals who lack the ability to experience pleasure or contentment. In the film, it represented the description of Woody Allen's character who seems to be always complaining or in Yiddish, "kvetching" with little or no life satisfaction or enjoyment.

The fact that we so often tend to glibly identify people by their personality quirks, does not belittle the fact that depression, for those who are so afflicted, is never a funny, light-hearted matter. I remember once reading, 'nature always has an answer'. The herbal answer for mild to moderately severe depression, St. John's Wort also known as Hypericum (H. perforatum).

Because of the obvious problems involved with denial and self-deception, clinical depression remains the most under-diagnosed condition. A list of characteristic symptoms of depression outlined by the National Institutes of Health (NIH) may be a veritable collection of vague symptoms that are frequently kept hidden under a guilt ridden cloak of denial. These include:

  • Persistent sad or "empty mood"
  • Loss of pleasure in ordinary activities, including sex
  • Sleep disturbances (insomnia, early-morning wakening, or oversleeping)
  • Eating disturbances (loss of appetite and weight, or weight gain)
  • Feelings of guilt, worthlessness, helplessness
  • Thoughts of death or suicide, suicide attempts
  • Irritability
  • Excessive crying
  • Chronic aches and pains that don't respond to treatment

In the workplace, these symptoms are often the stuff of derision and gossip and may be identified as:

  • Decreased productivity
  • Morale problems
  • Lack of cooperation
  • Safety problems, accidents
  • Absenteeism
  • Frequent complaints of being tired all the time
  • Complaints of unexplained aches and pains
  • Alcohol and drug abuse

The key here is that while one or more of these symptoms are regularly a part of the normal "ups" and "downs" of daily life, a diagnosis of clinical depression must be based on the sum total of conditions, intensity, duration and frequency. The NIH recommends a diagnosis based on four or more of the symptoms of depression persisting for more than two weeks and seriously interfere with work or family life.

There are over eighteen million people in the country suffering from clinical depression, hypericum having little or no side effects, costing considerably less than synthetic antidepressants and now commonly available without prescription, therefore offers hope to over twelve million who are currently receiving no treatment whatsoever.

Backed by extensive scientific research especially from Germany where some 3 million prescriptions for hypericum and almost 66 million doses of hypericum preparations are consumed annually, this ancient botanical, the favorite of herbalists of present and centuries past, is beginning to catch on in North America as a treatment for this all to common disorder as well as other forms of nervous anxiety, and sleep disorders.

To date, there have been numerous case reports and drug monitoring studies with more than 5000 patients on the efficacy and safety of standardized St Johnswort preparations. Twenty three controlled double-blind studies have been conducted on more than 1757 patients. Sixteen of these compared hypericum with placebo (sugar-pills) and 9 with standard reference treatments including Imipramine-2, Amitryptilin-2, Maprotiline-1, Desipramine-1, Diazepam-2 and Light therapy. In most of these studies, both depressive symptoms (depressed mood, anxiety, loss of interest, feelings of low worth, decreased activity) together with secondary symptoms (sleep disturbance, lack of concentration, bodily complaints such as fatigue) showed a general clinical improvement ranging from 50 to 80% when compared to that of low to medium dose treatment with "classic" synthetic antidepressants .

In another German study on 3,250 patients (76% women and 24% men), recorded by 663 private practitioners, the proportion of improvement in depressive and secondary physical symptoms (ranging from fatigue, cardiac, digestive and sleep disorders, to generalized pains) is similar to the previous studies with about 80% of all patients feeling better and only 15% unchanged or worse when asked an overall judgment. In these studies hypericum extracts were significantly superior to placebo and similarly effective as standard antidepressants (about 80%) with significantly fewer side effects than standard antidepressant drugs.

Antidepressants are generally among the safest of prescription medications, the most common side effects however, include decreased sexual desire or function, dry mouth, nausea, tiredness, restlessness, and negative interactions with alcohol or other drugs. Of all of these, the most experientially disturbing is the lessening of sexual desire. For those seeking relief from their depression without becoming an unwillingly celibate, St. John's Wort offers a pleasurable and welcome natural alternative. Its not hard to understand why in Germany, a highly developed country that requires its medically trained doctors to study and practice herbal medicine as phytotherapy, hypericum is being used as the treatment of choice for more than 50% of depression cases compared to only 2% who are given Prozac?

With its long revered status as one of the most benign yet highly effective of all botanicals, it would be a great loss if the public were to recognize St. John's Wort only as an antidepressant. As an anti-inflammatory, the aromatic polycycline compounds hypericin or pseudohypericin derived from St. John's Wort have been found to markedly suppress the spread of murine retrovirus both in vivo and in vitro possibly making it of therapeutic value for the treatment of HIV and AIDS as well as other viral diseases .

If one were to believe in a world where divine providence has doggedly placed at our feet a common wayside herb to assuage our every affliction, St. John's Wort would be among the elect handful. We identify St. John's Wort as a short, yellow-flowering herb of the Hypericaceae family mentioned and used by Hippocrates some 2500 years ago. Throughout history, it has had an honored use both externally and internally for the relief of cuts, burns, neuralgia and depression. Just as it is effective for depression, a disorder of the central nervous system, St. John's Wort is specifically indicated for all nerve related injuries and diseases.

The oil of St. John's Wort which is made by macerating the flowers in vegetable oil, can be externally applied to relieve sciatica and other neuralgic pains including repetitive injuries such as carpal tunnel and tennis elbow. The oil is also applied to speed the recovery of burns. The oil is never taken internally but for all such conditions, it is important to internally take the tea or tincture made from the fresh plant. Other effective internal applications of St. John's Wort includes the treatment of gastritis and stomach ulcers, symptoms of gout and arthritis, fevers, as an expectorant for bronchitis, a diuretic for urinary tract infections, and as a general calmative for the nervous system.

I one of the problems with a multifaceted herb such as St. John's Wort, is that with such a broad range of action, the average individual may be inclined to think that it is not so effective for any one condition. Nothing could be farther from the truth, any condition that involves an injury or imbalance to the nervous system would benefit greatly from the use of St. John's Wort.

The legendary common name, St. John's Wort, identifies it with St John the Baptist, the legendary new testament desert healer and the "baptizer" of Christ. This may be because of its honored healing properties but also because it happens to flower around the feast of St John during the summer. In medieval times, it was believed that if you slept with a sprig of St. John's Wort under your pillow on St. John's Eve, the saint would appear in a dream, giving his blessing and protection for the new year.

The medicinal properties are derived from the above-ground portion collected shortly before its flowering. It contains essential oil, hypericine (a glycoside that is a red pigment), and a polyphenolic flavonoid derivative (hyperaside) .

No one knows how antidepressants work, nor why they seem to take so long to exhibit their effects. In this, St. John's Wort is no exception and it should be taken in full, regular 300 mg dosage three times at different intervals throughout the day for at least a month to six weeks before making an objective evaluation. Hypericum is not a "more is better" herb and after six weeks, the dose can be slightly reduced.

If you are already taking prescription antidepressants, do not alter your dosage or combine with St. John's Wort without first consulting with your doctor. Nor should St. John's Wort be concurrently used with MAO (mono amine oxidase) inhibitors such as Nardil or Parnate. It seems that at least part of the action of hypericum is as a serotonin uptake inhibitor (SRI). Clinically, combining an SRI with a MAO inhibitor can cause a dangerous rise in blood pressure. In general one should wait for at least 4 weeks before taking any SRIs. However, there has been no specific research to date in the use of hypericum so that it should be treated as an SRI.

Some of the most popular antidepressants are SRIs, and include Prozac, Paxil, Zoloft and Effexoris. If hypericum acts as a serotonin reuptake inhibitor as do these drugs, it seems that it could be gradually introduced over the course of a couple of weeks as the SRI antidepressant drug is reduced. There is a danger however, from the accumulation of too much serotonin in the brain which is the opposite of that of depression -- agitation, sweating, confusion, lethargy, tremor and muscle jerks being some of the most common symptoms. If this occurs, one should consult a doctor.

One of the reasons that one would want to substitute an herb such as hypericum for a drug is the lack of side effects. In this, it is heartening to know that no negative interactions and effects have been reported with the use of St. John's Wort with any other drug.

Toxicity is based upon risk versus benefit. The fact that 500 to 1000 people die in the United States each year from internal bleeding caused by aspirin is offset by the many millions more who benefit from its use. With not a single recorded human death in over 2400 years, hypericum is safer than aspirin.

In many books, St. John's Wort is listed as a dangerous poisonous weed. This is based on its toxicity to certain light-skinned animals such as sheep who develop a heightened sensitivity to the sun after ingesting large quantities of St .John's Wort. As a result large scale extermination of St. John's Wort has been undertaken in Australia where it is considered a dangerous weed and certain parts of the United States. While theoretically possible there has not been a single reported case of toxicity in humans taking the recommended dose for depression.

The over-the-counter sales of Hypericum is based on the provisions of the Dietary Supplement Health and Education Act of 1994 (DSHEA) which allows for the labeling of dietary supplements based on their truthful, non-misleading, scientifically backed "statements of nutritional support" and "structure and function claims." This allows the manufacturer of a product such as St. John's Wort to describe how a supplement alters the structure and function of the body. The extensive scientific research so far mostly emanates from German-speaking countries. Because in the United States, a plant cannot be patented, there is no incentive for the multi-billion dollar pharmaceutical conglomerates to fund research on a common herb such as St. John's Wort.

I have a friend who has suffered on and off for years with clinically diagnosed depression. For the last year and a half, he has found a new lease of happiness in life after taking the prescribed antidepressant, Zoloft. The other day, we were taking a walk in the nearby Santa Cruz mountains. While he claims to be happier than at any other time that he can remember, at the age of 45 he is concerned with his increasing lack of libido. I mentioned to him that St. John's Wort may indeed offer an alternative that will control his tendency to depression without interfering with his normal life passion. He was enthusiastic about the possibility of replacing a synthetic drug, whose long term effects are not yet fully understood, with a time honored herb whose benign safety and efficacy have been known and appreciated for over three thousand years.


Dr. Michael Tierra is one of the most reknowned herbalists in both the United States and other parts of the Western world. His book The Way Of Herbs (Pub. Pocket Books) has sold over 400,000 copies. Besides this he is author of Planetary Herbology (Lotus Press), The Natural Remedy Bible co-authored with John Lust (pub. by Pocket Books), Traditional Chinese Herbalism co-authored with his wife, Lesley (pub. by Lotus Press), The Way of Chinese Herbs (pub. Pocket Books), Biomagnetic Healing (Lotus Press). He is also author of the East West Herbal Correspondence Course, P.O. Box 712, Santa Cruz, CA 95061, 1-800-717-5010.

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