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With heightened interest from all-natural merchandises, in everything natural to acupuncture and yoga, many people are seeking more natural strategies for health problems, including herbal treatments for depression. Case in point: St. John’s wort.

St. John’s wort, botanically known as Hypericum perforatum, is a long-living yellow flowered plant used as far back as ancient Greece for its medicinal benefits. It is believed that the compounds hypericin and hyperforin are among its many chemical ingredients that give rise to its effectiveness as an herbal treatment of melancholy. Primarily available as pills or capsules, St. John’s wort is also produced in other kinds including tea, liquid extracts, and even as a popcorn topping (Nonetheless, it’d likely require 100 or more bags of popcorn to get a big enough dose, so other formulations are preferable.)

In Europe, St. John’s wort is commonly prescribed as a treatment for depression. But the U.S. Food and Drug Administration views St. John’s wort as an herbal product and classifies it as a dietary supplement. As such, it may go directly into stores without testing of its effectiveness, dosage, or security. Which begs the question, does it really work?

“Yes,” says David Mischoulon, MD, PhD, associate professor of psychiatry at Harvard Medical School and director of research in the depression and clinical research program at Massachusetts General Hospital. “There are about 40 published studies on the utilization of St. John’s wort for depression. In general, they suggest that St. John’s wort is more effective than a placebo and equally effective as tricyclic antidepressants.”

However, when compared with a different type of antidepressant, selective serotonin reuptake inhibitors (SSRIs), the results were a little less clear. “Recent comparisons against SSRIs like fluoxetine and sertraline have yielded inconsistent results,” says Dr. Mischoulon, “though the studies may suffer from methodological issues. St. John’s wort is likely as effective as the SSRIs as well, but we need more investigation to conclusively show this.”

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One example of such a methodological difficulty is that patients in the comparison with SSRIs may have been more severely depressed than those in the studies of St. John’s wort versus tricyclic antidepressants. “In general, natural products seem most successful for people with light-to-moderate illness, compared to more acute sickness,” says Mischoulon.

What Consumers Should Know About St. John’s Wort

Typically, the recommended dose for St. John’s wort is between 900 and 1800 milligrams per day. There aren’t any studies and there may be variations depending on the preparation, manufacturing methods, and purity. Label tips may not always be right. Mischoulon suggests picking a brand from manufacturers and reputable sellers who are prone to get their own production standards that are stricter of supplying the product they guarantee, and greater probability. As with everything, buyer beware.

St. John’s Wort Side Effects

Just because it’s natural and does not require a prescription doesn’t automatically mean an herbal product is without risks. “St. John’s wort has many side effects and can interact adversely with many prescription drugs, sometimes with devastating results,” warns Mischoulon. The most frequent side effects include dizziness, dry mouth, nausea, diarrhea, fatigue, and greater sensitivity to sunlight. Some, but by no means all, of the prescriptions it can interfere with contain antidepressants, birth control pills, blood thinners, cancer medications, and the heart drug digoxin.

Ultimately, using St. John’s wort to treat depression symptoms may be a good thought, but as with any natural treatment, be sure to check with your doctor first.

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