Terry Talks Nutrition » selective serotonin reuptake inhibitor

Weekly Articles-August 3, 2012

Depression robs us of our most treasured gifts: happiness, pleasure, comfort, and energy. Many people feel they have only the choice of taking prescription drugs that have significant side effects or continuing to live in misery. But there are natural products that are even more effective than these drugs and can literally change lives!

One such natural medicine is St. John’s wort (Hypericum perforatum). Shown in multiple studies to have extraordinary impact on alleviating depression, this wonderful herb has not always lived up to its promise. Why? Because of irregular dosing and lack of standardization to the most beneficial compound in the plant!

In today’s Terry Talks Nutrition®, we are going to look at ways to use St. John’s wort safely—and effectively—to help people reclaim their lives from the insidious thief: depression.

What Causes Depression

The causes of major depression aren’t completely understood. They can have a genetic component, and people with parents who suffered from depression are typically more likely to experience it themselves. Certainly, traumatic events and chronic stress can bring about depression, as can hypothyroidism, cancer and cancer treatment, and lack of sleep. Nutrition – or the lack thereof – can’t be ruled out either.

In any case, during a depressive episode, our brain pathways don’t function properly. Signals that should get through – signals for joy, for example – simply don’t connect. The biochemistry behind all of this is extremely complicated and elusive. This may account for the astronomical amount of medications prescribed each year for depression, many of which try to inhibit the breakdown of specific neurotransmitters like monoamine oxidase inhibitors – MAOIs – which help prevent the breakdown of serotonin, epinephrine, and norepinephrine, or selective serotonin reuptake inhibitors –SSRI’s – which help keep circulating levels of serotonin available. These drugs attempt to alleviate depression by focusing solely on the communication signals, and trying to restore chemical signals that have been minimized by this disease. However, these medications bring many problems with them, too, and for many people, they may have to be switched often from one drug to the next.

The statistics for depression are daunting: over 15 million Americans suffer from the condition. While I believe depression is a serious disease, there are times when I have to wonder if there’s something of a “depression industry” going on. It seems that you can’t watch TV these days without seeing an ad pop up that recommends a prescription drug for this debilitating condition. Unfortunately, these medications are often risky and can create almost as many problems as they attempt to solve, including weight gain, loss of sexual feelings, altered thinking, joint stiffness, hair loss, and most paradoxically, suicidal thoughts.

However, there is hope. You don’t have to choose between feeling lost or hopeless or taking prescriptions with frightening side effects. Instead, you can look to a specialized extract of a time-tested botanical: St. John’s wort.

St. John’s Wort – Natural, Effective Hope for Depression

St. John’s wort (Hypericum perforatum) has a long history of use. Even though this perennial plant is native to Europe and Asia, it was introduced to North America over 300 years ago in the 1690’s, so it has become quite common.

Since that time, it has been heavily researched and studied. In fact, St. John’s wort has shown great promise in numerous double-blind, placebo controlled clinical trials – without the side-effects that are often seen in conventional approaches.

One of the plant’s key compounds is hypericin, and clinical studies have found that St. John’s wort standardized at 0.3% hypericin has shown the most (and most consistent) benefits. Interestingly, hypericin – concentrated in the flowers and buds of the plant — is generally a more stable component of St. John’s wort, (compared to hyperforin) and is easier to measure and standardize.^1-3

Over 26 clinical studies have found that St. John’s wort is effective for people with mild, moderate, and even severe depression. In most cases, St. John’s wort was far superior to the placebo. In others, it was at least equal to (if not slightly better than) the prescription medication. And it was certainly tolerated much better.

Impressive Clinical Results for St. John’s Wort

One multi-center clinical study in Germany divided patients into two groups; one taking St. John’s wort, and the other imipramine (a prescription drug for major depression) for 6 weeks. Both groups showed similar improvements, but St. John’s wort was much better tolerated. In fact, the researchers concluded that St. John’s wort was, “therapeutically equivalent to imipramine in treating mild to moderate depression, but patients tolerate hypericum better.” They also felt that St. John’s wort should be the first-line treatment, rather than some drug, because of being so much easier on people’s systems.⁴

In a double-blind, placebo-controlled clinical study involving 105 individuals with depression for a total of 4 weeks, depressive symptoms were reduced by half. Of those in the St. John’s wort group, 67% responded to the botanical extract, which was provided at the standard dose of 300 mg, three times daily.⁵

A randomized, double-blind, 6-week study comparing St. John’s wort to fluoxetine (an SSRI commonly marketed as Prozac®) found the botanical to be just as effective as the drug, but, once again, St. John’s wort’s safety was found to be “substantially superior to fluoxetine”. The fluoxetine group, by contrast, reported agitation, dizziness, tiredness, anxiety and erectile dysfunction. In fact, here the authors of the study concluded, “Although hypericum (St. John’s wort) may be superior in improving the responder rate, the main difference between the two treatments is safety. Hypericum was superior to fluoxetine in overall incidence of side-effects, number of patients with side-effects and the type of side-effect reported.”⁶

In a clinical trial comparison of St. John’s wort with citalopram, (an SSRI commonly marketed under the brand Celexa®), and a placebo, St. John’s wort was markedly better at preventing a relapse into depression symptoms. The 900-mg daily dosage of St. John’s wort not only showed a much lower relapse (14.8%) than either citalopram (25.9%) or the placebo (17.4%), but it took longer before relapse symptoms showed up for the St. John’s wort group.⁷

Another placebo-controlled, double-blind efficacy trial of St. John’s wort for individuals with major depression showed impressive results at the end of the 6 week study. The researchers found that the 300 mg dose, 3 times daily of hypericum was “safe and effective for those with moderate to mild depression”, and “led to global reduction of depression-related core symptoms, assessed with the melancholia subscale of the Hamilton scale.”⁸

And, St. John’s wort has been found to be better than prescription drugs as well. In a double-blind, placebo-controlled study, patients received 900 mg of St. John’s wort, 20 mg of fluoxetine, or a placebo. The authors concluded that “St John’s wort was significantly more effective than fluoxetine and showed a trend toward superiority over placebo.”⁹

Aside from these individual clinical trials, there have been numerous reviews that have totaled up the evidence for St. John’s wort based on a compilation of the studies. One of the most recent, completed in 2008, tallied the results of 29 clinical trials that included 18 placebo comparisons and 17 comparisons with standard antidepressant drugs. They concluded that St. John’s wort was consistently superior compared to placebo, and “similarly effective as standard antidepressants” – but with fewer noted side effects.¹⁰

In scientific studies using models of alcoholism, St. John’s wort extracts reduced the voluntary intake of alcohol. There’s a lot more research that needs to be done in this area to make solid recommendations, but it is an exciting prospect as well.^11,12

Then Why Does St. John’s Wort Have Inconsistent Results?

One of the biggest problems with St. John’s wort is that supplements are on the market that contain little—if any—of the key compounds needed for effectiveness. The most important compound is hypericin, and it is found in the flowers and aerial parts of the plant. There is little in the stem and virtually none in the roots. When St. John’s wort became enormously popular, unscrupulous companies decided to turn St. John’s wort waste material into money, so they cleaned up stems and roots, ground them up and sold them as St. John’s wort powder. Were they “legally” St. John’s wort? Yes. Did they do anybody a bit of good? No. Therefore, MAKE SURE you buy St. John’s wort only from reputable companies that you trust, and make sure they are standardized to 0.3% hypericin.

Secondly, St. John’s wort was dosed at 300 mg, taken three times a day. It is human nature to forget the occasional dose. St. John’s wort can be ineffective if it is not dosed at the proper amount, so missing doses over time can lead to a greatly reduced impact on depression.

Thankfully, there are new developments in St. John’s wort science. There is a new supplement that can be taken once a day. This greatly increases the likelihood of maintaining healthy levels of St. John’s wort ongoing, for superior clinical effects.

That’s why the specialized extract I recommend remains in the bloodstream for 24 hours or more, and is available as a once-daily 900-mg supplement.

Any Problems with St. John’s Wort?

I’d also like to clear up any misconceptions about photosensitivity and St. John’s wort. It is often cited as a reason for people not to use this amazing herbal extract, but it shouldn’t be. While sun sensitivity was noted occasionally during clinical trials, it was generally only at doses that went above the recognized 900 mg levels, and even then, only rarely. In fact, clinical studies using doses as high as 1,800 mg did not show a photosensitive effect. ^2,11

Another consideration sometimes cited is that St. John’s wort interacts with prescription medication. The fact is that St. John’s wort is very liver healthy, and increases the liver’s ability to detoxify certain compounds. That’s a good thing most of the time, but some prescription drugs get “detoxified” so quickly that they aren’t fully effective. This does not happen with the majority of prescription drugs, so if you are on medication, check with your pharmacist or doctor to make sure this combination is right for you. I personally feel this aspect of St. John’s wort has been somewhat exaggerated, though it does exist.

Sometimes people wonder if they can add St. John’s wort to their prescription antidepressant. Hyla Cass, MD, psychiatrist, integrative medicine expert and author, reports in her book St. John’s Wort: A Common Sense Guide to Understanding and Using St. John’s Wort, that she has successfully used this supplement with patients who were already taking antidepressants, including both SSRI and MAOI varieties. Dr. Cass reports that initially, people were concerned that this would cause a problem called “serotonin syndrome” in which the combination might cause an excessive buildup of this neurotransmitter in the brain, which in turn can cause serious physical symptoms. While this is a very rare occurrence, it is therefore recommended by integrative doctors that the combination of prescription antidepressants with St. John’s wort should be done under the oversight of a health care practioner.

Nutrition and Exercise

One other thing I’d like to add: our mental outlook doesn’t exist in a vacuum, cut off from our diets and the amount of exercise we get. The diet I recommend will not only help you clear up your thinking and lose weight, but it provides the nutrients we were all intended to have. To find out more, see my article, “Terry’s Traditional Diet”.

And, for those of you who think that effective exercise means long, dull hours at the gym or running a marathon, I have some good news – it doesn’t! Check out my article, “Terry’s Exercise Plan” on the best short-burst exercise that you can work into your life at just 12 to 20 minutes a day.

There is Hope!

If you have had a difficult time just getting through the regular challenges of the day, or for that matter, don’t feel like getting out of bed in the morning, St. John’s wort may be nature’s gift to you. It has been clinically proven safe and effective, and has none of the dangerous side effects that plague common synthetic drugs. I believe it is one of the premier natural medicines, and should be a first-line of defense to help you feel vibrant, healthy, and happy again.

*Terry recommends a product with this ingredient. Look for it at your local health food store.*
St. John’s Wort (Hypericum perforatum) Extract (flower heads) standardized to contain 0.3% hypericin, (2.7 mg)	900 mg

References:

Lawvere S, Mahoney MC. St. John’s wort. Am Fam Physician. 2005;72(11):2249-54.
Linde K. St. John’s wort – an overview. Forsch Komplementmed. 2009 Jun;16(3):146-55.
St. John’s Wort. In: PDR for Herbal Medicines, 4th ed. Montvale, NJ: Physician’s Desk Reference; 2007:797-811.
Woelk H. Comparison of St John’s wort and imipramine for treating depression: randomised controlled trial. BMJ. 2000 Sep 2;321(7260):536-9.
Sommer H, Harrer G. Placebo-controlled double-blind study examining the effectiveness of an hypericum preparation in 105 mildly depressed patients. J Geriatr Psychiatry Neurol. 1994 Oct;7 Suppl 1:S9-11.
Schrader E. Equivalence of St John’s wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression. Int Clin Psychopharmacol. 2000 Mar;15(2):61-8.
Singer A, Schmidt M, Hauke W, Stade K. Duration of response after treatment of mild to moderate depression with Hypericum extract STW 3-VI, citalopram and placebo: a reanalysis of data from a controlled clinical trial. Phytomedicine. 2011 Jun 15;18(8-9):739-742.
Lecrubier Y, Clerc G, Didi R, Kieser M. Efficacy of St. John’s wort extract WS 5570 in major depression: a double-blind, placebo-controlled trial. Am J Psychiatry. 2002 Aug;159(8):1361-6.
Fava M, Alpert J, Nierenberg AA, Mischoulon D, Otto MW, Zajecka J, Murck H, Rosenbaum JF. A Double-blind, randomized trial of St John’s wort, fluoxetine, and placebo in major depressive disorder. J Clin Psychopharmacol. 2005 Oct;25(5):441-7.
Linde K, Berner MM, Kriston L. St John’s wort for major depression. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD000448.
Monograph. Hypericum perforatum. Altern Med Rev. 2004 Sep;9(3):318-25.
Overstreet DH, Keung WM, Rezvani AH, Massi M, Lee DY. Herbal remedies for alcoholism: promises and possible pitfalls. Alcohol Clin Exp Res. 2003 Feb;27(2):177-85.

Tags: adrenal, antidepressant, Anxiety and Stress, depression, DHA, dysphoria, dysthymia, fluoxetine, hypericin, Hypericum perforatum, MAOI, monoamine oxidase inhibitor, mood disorder, Prozac, selective serotonin reuptake inhibitor, SSRI, St. John's wort

Newsletter - August 3, 2012

In today’s Terry Talks Nutrition®, we are going to look at ways to use St. John’s wort safely—and effectively—to help people reclaim their lives from the insidious thief: depression.

Newsletter - April 13, 2012

In today’s Terry Talks Nutrition, we are going to look at ways to use St. John’s wort safely—and effectively—to help people reclaim their lives from the insidious thief: depression.

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General Health November 7, 2011-

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Newsletter - October 21, 2011

Tags: antidepressant, depression, DHA, dysphoria, dysthymia, fluoxetine, hypericin, Hypericum perforatum, MAOI, monoamine oxidase inhibitor, mood disorder, Prozac, selective serotonin reuptake inhibitor, SSRI, St. John’s wort