The National Foundation for Depression Illness, Inc.
Monday, April 15, 2002
IS NATURAL BETTER? We are often asked "Wouldn't I be better off using a natural remedy like St. John's Wort than a man-made antidepressant?" This question seems to assume that "natural" is better. We see no basis for this assumption. We would ask rather whether the remedy, whatever its origin, does indeed work, and whether it does so safely and reliably. The example given, St. John's Wort, can be effective for some people's mild to moderate depression. It has a low side-effect profile: Photosensitivity, stomach upset, fatigue or agitation are the most likely to occur, and these are rare. It is less expensive than many pharmaceutical antidepressants, and can be acquired without a physician's prescription - a further savings. But would you be better off using it? If so, would you be better off using it with or without a doctor's supervision? We would urge you to ask these questions about any treatment: a) What is your diagnosis? Is this illness really clinical depression? The symptoms of depression can also be caused by heart disease, the side effects of other medications, hormone imbalance, and other illnesses. You may also have manic-depression (bipolar disorder), but mistake it for unipolar depression. An evaluation by a psychiatrist skilled in treating mood disorders, such as those found on NAFDI referral listings, can help rule these out. b) Is it reasonably safe to try to treat this yourself? If your illness is indeed mild depression, then, you might try it. You may wish to set a certain limit for yourself to help you recognize when your depression is worsening, and consult an expert in mood disorders, if that should happen. For example: Look for a specialist's help if: insomnia is your danger sign, and you have trouble sleeping every night for a week. Have a contingency plan ready. One method is to make a psychiatrist appointment for three months after you start, which should allow time to test the St. John's Wort's efficacy. If it works, you may cancel the appointment and rejoice. If it doesn't work, stop taking the herb at two and a half months. This will allow it to wash out of your system before your psychiatrist appointment two weeks later, and you will be able to start any prescription s/he may write immediately without danger of a drug interaction. If your illness is actually manic-depression (a.k.a. bipolar disorder), then St. John's Wort may thrust you into a dangerous mania (as may other antidepressants when taken without a mood-stabilizer). Manic-depression is not something to attempt to self-doctor. Neither is severe depression, for which St. John's Wort is not effective in any case. If you've ever considered suicide, do not attempt to "go it alone" - rather, work with a psychiatrist. For moderate depression, also, your doctor's supervision and feedback on your use of it would be a wise precaution. c) Is this an appropriate, proven treatment? A serious illness such as depression necessitates a well-tested approach, preferably one supported by multiple well-conducted double-blind studies. Because depression is an illness that often spontaneously remits, individual testimonials are not reliable evidence - there is no way of telling whether the episode would have passed in any case. There seems to be reasonable scientific support for St. John's Wort for treatment of mild to moderate depression, but not sufficient proof for many other substances being sold. Be suspicious of any product that claims to be a panacea. d) What's actually in that bottle? "Natural" substances such as herbs are not currently regulated in the U.S., so the product you buy may not contain what the label claims. Indeed, consumer groups have found that most of the "St. John's Wort" sold varies wildly as to the actual contents. It may have far more or less hypericin, a chemical thought to be important to the antidepressant effect, than is advertised. Do some research about which brands are reliable. The unpredictability of potency is why teas, infusions and tinctures of St. John's Wort should be avoided also. e) What's an appropriate amount to take, and for how long should I try it? For St. John's Wort, generally you would start at 300mg per day of capsules that are standardized to contain 0.3% hypericin, unless there are reasons to do otherwise, as discussed with your doctor. If there is no result after two weeks, you may increase that to 600mg a day, and, after another week, 900mg a day. For a fair test, try this dosage for four to six weeks. If you're having little or no result, it is high time to consult an expert in mood disorders. For other non-prescription remedies, research the substance, using multiple sources of information, and proceed cautiously. Any substance, natural or otherwise, may be toxic at the wrong dosage or may have dangerous side effects. f) Does it mix, or mis-match? Keep in mind that any herb or supplement may interact dangerously with another medication you may be taking. St. John's Wort will clash harmfully with certain AIDS treatments, with some pharmaceutical antidepressants, and possibly with the contraceptive pill. Other interactions may become known. Don't add anything to your treatment regimen without discussing it with your physician(s).