Throughout my many years as a practicing psychiatrist, I have searched for natural remedies to help my clients. I am well aware of the benefits of conventional drugs, and have employed them in my practice when appropriate. But I am also aware of the side effects and expense associated with synthetic antidepressants such as Prozac, and of the fact that there are many people- perhaps millions-who simply do not need them. For these people, St. John’s wort is a godsend.

I have used St. John’s wort extensively, and can testify that it is as effective as it is gentle. I have seen this remarkable herb help bring welcome relief to many of my clients. People who had known depression all their lives have been overjoyed to find a new sense of peace and calm. Freed from sadness and anxiety, they have gained new insight into their problems and concerns, and have been able to tackle these issues-often for the first time in years. As a therapist, I have found this experience to be deeply gratifying.

Excited by the benefits of St. John’s wort and similar remedies, I have read extensively in the field, exchanged opinions and information with my colleagues, and contributed to many articles and books on the subject. While this remarkable herb has not yet been widely studied in this country, research done around the world has testified to its powers. What doctors have found is that St. John’s wort is not only useful in treating certain types of depression, including seasonal affective disorder, but that it has infection-fighting and immunity enhancing effects that make it a promising treatment for disorders ranging from skin infections to AIDS. It also seems to be especially helpful for women in its ability to fight premenstrual syndrome, menstrual cramps, and the symptoms associated with menopause.

Of course, no medicine, natural or synthetic, is a cure-all, and St. John’s wort is no exception. At this time, it is not recommended as a sole treatment for major depression, nor is it recommended for bipolar disorder (also known as manic-depressive illness). In addition, there are conditions, such as chronic fatigue syndrome, that can mimic depression, and that require a comprehensive treatment program if they are to be successfully treated.

Actually, all medicines, including St. John’s wort, work best when used as part of an overall treatment program. Such a program complements the use of St. John’s wort with important nutrients and other herbs, as well as with a healthful diet and exercise regimen. It also takes into account the psychological factors of depression, and provides the appropriate therapy.

In this book, I explain what depression is, and how both the mind and the body affect mental health. I then tell you about the many possible benefits that St. John’s wort can offer and provide information on its use, including its combination with other herbs. I not only review the studies that have been done on this plant, but provide facts on the synthetic antidepressants as well. I discuss St. John’s wort’s nutritional cofactors, including amino acids, vitamins, and minerals. Finally, I make lifestyle recommendations concerning diet, exercise, and stress reduction, without which no mental health program can be entirely effective.

If you suffer from depression, or if you know someone who does, I strongly urge you to learn about St. John’s wort. It could make a very real difference in your life.

The herbalists of ancient times knew about the powers of St. John’s wort, and they used it for a wide variety of ailments. However, Western medicine discarded the ancient knowledge, dropping the study of herbs from medical school curricula. In its assumption that the old teachings were unscientific old wives’ tales, the medical profession lost touch with these gifts of the natural world.

In this chapter, we’ll first look at the history of this fascinating plant. I’ll then discuss St. John’s wort’s antidepressive effects and its numerous other benefits.

An Ancient Medicine Rediscovered

St. John’s wort presents a wonderful paradox. Known to healers for thousands of years, it has become an overnight sensation in the modern media. No doubt utilized by some of the earliest civilizations, the oldest records of its use come from Greek and Roman times, according to herbalist Christopher Hobbes. Dioscorides, the foremost Greek herbalist, recommended it for sciatica and malaria relief, and as a diuretic and female tonic. Pliny the Elder, the Roman naturalist, found it effective against snakebite when mixed with wine. (We’re not sure whether the wine was to be mixed with the herb, or just drunk to take one’s mind off the pain!)

The botanical name Hypericum comes from the Greek words yper, meaning upper, and eikon, or image. The Greeks and Romans believed that St. John’s wort protected them from evil spirits and witches’ spells, and often placed the herb in their homes and above statues of their gods. Perhaps the spirits and spells referred to depression and anxiety, mental disorders with no obvious physical cause.

The early Christians incorporated many ancient beliefs into their new religion. Preexisting spring rituals, for instance, were renamed as saints’ feast days. In this tradition, Christian mystics named Hypericum after St. John the Baptist. It was traditionally collected on St. John’s Day, June 24, and soaked in olive oil for days to produce a blood-red anointing oil, said to symbolize the blood of the saint.

By the thirteenth century, belief in the herb’s mystical power was well established. People brought the flowers of the plant into their houses on Midsummer Eve, or St. John’s Eve (June 23), to protect them from the powers of evil. In another common practice, they put the plants under their pillows on St. John’s Eve. According to legend, the saint would appear in a dream, give his blessing, and protect the sleeper from dying during the following year. St. John’s wort was also burned in bonfires on St. John’s Eve to drive away evil spirits, purify the air, and protect crops.

According to the traditional doctrine of signatures, an herb’s physical appearance gives an indication of its specific healing power. Red plants, reminiscent of blood, were felt to be good for wound healing. The red oil in St. John’s wort was no exception. Crusaders not only carried the plant to protect themselves from sorcery, but also used the soaked flowers and leaves as an ointment to help heal the wounds of battle. Physicians in the sixteenth century found the herb to be very effective for treating deep wounds. The first London Pharmacopoeia, published in 1618, recommended that the flowers be placed in oil and allowed to stand for three weeks. The resulting tincture was used for wounds and bruises. Other traditional folk uses for St. John’s Wort include the treatment of gout, rheumatism, and jaundice.

When the first European colonists arrived in North America, they found that the Native Americans were already familiar with the herb. The latter used it for diarrhea, fevers, snakebite, and wounds and other skin problems. It later served as a valuable medicine for treating soldiers’ wounds during the Civil War. St. John’s wort was also prescribed by the homeopaths of the period for a variety of ailments, as it is to this day. (For a list of the active ingredients in St. John’s wort and their effects, see “The Many Active Ingredients in St. John’s Wort” )

Unfortunately, toward the end of the nineteenth century, the medical establishment in the United States turned its back on traditional folk remedies. Teachings that had been passed down through the ages were dismissed as primitive superstition. Medical researchers considered most of the complex chemical constitution of a plant to be extraneous, and their objective was to isolate the plant’s so-called “active ingredient.” Now, of course, we realize these “extras” are often the ingredients that hold the secret to a plant’s strength and healing power.

Medical authorities established what we now know as conventional medicine, focusing their attention on medical and surgical techniques, and manufactured drugs. They lobbied Congress and the state legislatures for the prohibition of herbal medicine, which had a chilling impact on the legitimate use of herbs to promote health. Current laws still restrict the use of specific healing claims on herbal medicine labels. Only recently has conventional medicine begun to explore once again the potential contributions that herbs can make to health.

St. John’s Wort and Depression

Conventional medicine may be scratching its collective head about the value of St. John’s wort, but that hasn’t stopped ordinary people such as Kate from reaping its benefits, including its remarkable ability to fight depression.

Kate, a 48-year-old married author and public speaker, had a super-busy lifestyle, with frequent deadlines and an intense travel schedule, and it had caught up with her. “While on an impossible deadline, I had a total collapse. I was exhausted, stressed, and depressed. My doctor put me on Prozac, but it made me even more depressed, and then, I couldn’t sleep. He gave me sleeping pills that zonked me, and that was it. I stopped the Prozac. Then I read about St. John’s wort, and thought I’d try it, 250 milligrams twice daily. I figured it couldn’t hurt! Three weeks later, my husband Mike suddenly noticed: ‘You’re different! You seem more relaxed, less tense. What’s going on?'”

Kate hadn’t told him she was taking St. John’s wort, but her change in attitude was obvious. “One of the most dramatic things I began to notice is I felt happy and ebullient in the mornings, which I never was before. It was never like this on Prozac. I’m more energetic and focused, and there’s more laughter!”

Her good news continued. “Our sex life has always been very sporadic and difficult. Four weeks after starting St. John’s wort, we had a sexual experience that was distinctively different from any we have had in our twenty years together. I felt an openness, a sexuality, that was a pervasive feeling, coming from my very core. It was extraordinary for me, and Mike was just swept away. I don’t think I’d ever felt that way, even when I was younger. And this openness has continued.”

In a separate conversation with me, Mike was even more effusive than Kate. “I can’t believe how she’s changed. She’s always been so tense, barely available, especially when she’s stressed. Now, she’s a delight. We are having the time of our lives!”

This all sounds too good to be true, you might say. Maybe it’s an isolated incident, or simply the power of suggestion as a result of all the positive publicity surrounding St. John’s wort. How representative is Kate? According to the research I have read, reports from other physicians and practitioners, and my own clinical experience-hers is not an isolated case.

In fact, one of my colleagues, a holistic physician, had been asked by a woman in his yoga class what he knew about St. John’s wort. He gave her what information he had. Two months later, she came running up to him in class, exclaiming, “I must thank you. The St. John’s wort changed my whole life, my outlook, everything. It’s like a veil lifted from around my head. I’ve never felt so good. And I’m dreaming again, and remembering my dreams. I can hardly believe it!”

Contemporary Research Proves the Value of St. John’s wort

In Germany, where herbal medicine is a standard part of the medical-school curriculum, 80 percent of German doctors prescribe herbs such as St. John’s wort on a regular basis. Not surprisingly, a great deal of the research on this most valuable herb has been conducted in Germany.

Mild to moderate depressions respond well to treatment with St. John’s wort. More than twenty studies involving thousands of patients confirm the herb’s ability to reduce and often eliminate the symptoms associated with these conditions. Compared with both placebos-inert comparison substances-and various antidepressant drugs, St. John’s wort has come out on top every time.

The herb’s success rate as an effective antidepressant is between 60 to 80 percent, a rate equal to that of prescription drugs such as Prozac, with far fewer side effects. A drug monitoring study published in 1994 looked at the experiences of 3,250 patients who were treated with St. John’s wort. It found that only 2.4 percent of these patients reported any side effects at all, a rather remarkable finding when you consider that Prozac produces side effects at least ten times more frequently, and that even the placebos produced side effects.

Scientists are not yet sure of exactly how St. John’s wort works. For example, a preliminary National Institute of Mental Health (NIMH) in vitro, or test tube, study indicates that St. John’s wort has a high affinity for GABA receptor sites in the brain (see Chapter 3 in St. John’s Wort: Nature’s Blues Buster). The amino acid GABA (gamma-amino-butyric acid), plays a role in mood regulation: GABA levels are low in people with depression, and GABA-enhancing agents show both antidepressant and antianxiety effects. Despite the herb’s Valium-like effect on anxiety, there is a lack of sedation, which is an obvious advantage in treatment.

Let’s see how St. John’s wort can help several specific problems.

Sleep Disorders and Insomnia

One of St. John’s wort’s major advantages over prescription antidepressant medications is its ability to promote a better quality of sleep. Unlike St. John’s wort, most antidepressants lengthen the time it takes to enter the REM (rapid eye movement) sleep phase, reducing or even eliminating REM sleep. Far from inactive during sleep, the subconscious mind is busy analyzing the day’s events and processing feelings during the dreaming or REM phase. This is essential for mental health.

Pete is an example of someone whose sleep disorder was relieved by a combination of St. John’s wort and sedating herbs.

Pete, a 40-year-old businessman, blamed his inability to sleep on his stressful job. He would toss and turn, worrying about his work problems and about being too tired to handle them the next day. He was always exhausted from lack of sleep.

Dreading the thought of another tormented night, Pete asked his family doctor for a sleeping pill prescription. Fortunately for him, his doctor was aware of natural alternatives, and suggested an herbal approach to the problem. For the insomnia, he recommended an herbal combination of valerian and kava, both excellent sedating herbs, and for the underlying depression, St. John’s wort. Pete was then able both to get to sleep and to remain asleep through the night. Just having sufficient rest was enough to help his mood. Then, after a few weeks, the St. John’s wort began to work more noticeably, and he could feel his mood lift further, and he had less need for the other herbs.

Had Pete gone the standard medical route, the requested sleeping pill prescription would have handled the symptom-temporarily. The downside would have been habituation, in which he would have needed increasing doses for the same result, in addition to the lack of REM sleep.

St. John’s wort is also helpful for insomnia in general, not just that associated with depression. Prescription sedatives often produce grogginess or a hangover effect the next morning, and can also be addictive. St. John’s wort, on the other hand, works with the body’s own sleep-promoting mechanism to bring on restful sleep. It harmoniously enhances the natural actions of the brain, instead of drugging it into submission. Consequently, one awakens feeling more relaxed and refreshed. Since it can take a week or so for this effect to begin, St. John’s wort is recommended mainly for recurring insomnia, and not just an occasional night of tossing and turning.

Seasonal Affective Disorder (SAD)

St. John’s wort can also be used to treat SAD. As we saw in Chapter 2, persons with SAD, a form of major depression, are profoundly affected by the lack of sunlight that occurs in autumn and winter. This triggers biochemical changes in the brain, directed by the brain chemicals melatonin and serotonin, and leads to such symptoms as depression, impaired concentration, anxiety, marked decrease in energy and libido, and carbohydrate cravings. Also, like bears preparing to hibernate, these people eat more, gain weight, and need more sleep.

Scientists have found light therapy to be effective in treating SAD. Light therapy consists of exposing the individual to a set of full-spectrum fluorescent lights during the early morning and evening hours. Alternatively, lighted visors can be worn that shine light through the eyes and into the pineal gland. This stimulates the production of melatonin, a hormone associated with cyclic bodily processes. St. John’s wort can be combined with light therapy for greater effect. In the view of herbalist Terry Willard, the herb “brings light into dark places.” He finds it extremely effective in treating the rampant SAD that occurs during the long, dark winters of northern Canada, where he lives and works.

Premenstrual Syndrome (PMS)

PMS is a common complaint that produces both physical and mental symptoms. Since some of its mental symptoms are similar to those experienced during depression, including irritability, tension, and restlessness, it should come as no surprise that St. John’s wort can help. For centuries, herbalists have recognized the herb’s value in treating discomforts associated with the menstrual cycle, and it remains a most widely utilized natural treatment for PMS, as well as menstrual cramps. The latter is likely due to the herb’s ability to reduce uterine levels of prostaglandins, substances that can promote inflammation. You will often find women’s tonics that contain St. John’s wort in combination with other ingredients that function in a similar manner.

What to Expect and When to Expect It

As with most antidepressants, it may take three or four weeks before you notice a significant effect. Larger dosages are unlikely to reduce this time lag. On the other hand, positive results often occur sooner. For example, within a week to ten days, many people notice improved sleep: better quality, fewer interruptions, and even more dreaming. After one to two weeks, there may be improvements in appetite, energy levels, and physical well-being. By the second or third week, there is a reduction in emotional symptoms, with less anxiety, a more positive mood, and a greater sense of peace.

Many of my patients report positive effects almost immediately, with a sensation in their brains of “a weight being lifted,” decreased anxiety, and an enhanced ability to concentrate. We don’t know if this is a “real” response, or simply a placebo effect brought on by positive expectations. It is also important to remember that as with any remedy, natural or synthetic, St. John’s wort affects different people in different ways. Some people experience changes sooner or later than average, and some don’t experience changes at all.

How does St. John’s wort work? At this point, it is hard to give a definitive answer. While initially thought to be an MAO inhibitor, St. John’s wort is more likely similar in its action to the SSRIs such as Prozac (see Prozac and Beyond-The Synthetic Antidepressants). These reduce the rate at which the brain cells reabsorb serotonin, leaving more of the neurotransmitter molecules in the synapses, thereby enhancing receptor-site activity. And, as I’ve said before, in people who are depressed, the brain’s receptor sites are often less sensitive than normal, and it is possible that the herb enhances the sensitivity of these sites. It has also been suggested that St. John’s wort inhibits interlukin-6, a chemical messenger that mediates the stress response. This gives St. John’s wort an antistress effect.

In any case, do not expect instant results, like Rob did.

Rob, an artist acquaintance of mine, was a moody, impulsive guy who, for example, would go from being excited about a project to forgetting about it entirely. He heard about St. John’s wort, and thought it might smooth out his moods. He asked my opinion, and I agreed that it was worth a try. He began that very day. When he didn’t feel any different an hour after his first capsule, he took another. And another. By the end of the day, he had taken four. Then he called me, asking why it wasn’t working! I explained that St. John’s wort was not a stimulant, nor was it rapid in its action. Rather, the antidepressant effects accumulate over time, and that he had to take it regularly for a few weeks before he would begin to notice a difference. Rob was disappointed.

Rob seemed to be caught up in the “take a pill for fast, fast relief” mentality.

Some depressions may not respond at all to St. John’s wort, depending on the source of the depression. Take Gretchen, for example.

Gretchen, a bright, creative hairstylist and artist, had been depressed for a couple of weeks. “I was going home at night and crashing, not wanting to see anyone. I just wanted to sleep when I wasn’t working. I had read about St. John’s wort, and decided to try it for two weeks. Nothing changed. Then I remembered that I have a tendency to be anemic.” When her iron was low, Gretchen would feel tired and depressed. “I went off to the health food store, bought some iron, took it daily, and within a week, was feeling normal.”

Was this a St. John’s wort failure? I don’t think so. Rather, Gretchen is a great example of someone who understands her own body, looks for a recognizable pattern, and feels confident enough to take charge of her own health when necessary. Before assuming that the source of a depression is a neurotransmitter imbalance, you should look for a nutritional deficiency or other physical disorder. We will look at this in more detail in Nutritional Approaches to Mental Health.

When there is a neurotransmitter imbalance, my preference is to start with St. John’s wort, unless in one of the exception major depression or bipolar disorder. This herb still has many advantages over the synthetic antidepressants.

St. John’s Wort’s Effects on Other Disorders

Though current attention focuses on St. John’s wort’s role in the treatment of depression, the herb has been shown to have many other valuable medical uses as well. Studies have shown that St. John’s wort has broad antiviral and antibacterial properties, and relieves inflammation. This confirms its traditional usage as an excellent treatment for wounds and burns. Also, St. John’s wort may be useful in cancer treatment.

How can one herb produce so many different benefits? St. John’s wort is a complex mixture of at least ten groups of active ingredients (see chart), each with its own effects. It works with our bodies to achieve healing in multiple ways. A manufactured drug, in contrast, is aimed at one specific target, and often produces negative side effects when its action expands beyond that target. The opposite is true of herbs such as St. John’s wort, which contain compounds that work together to accomplish more than any one component could do on its own. Rather than unwanted side effects, you receive bonus healing effects.

It is also important to remember that the holistic view of medicine does not separate illness into two neat stacks, physical ailments and mental ailments. To begin with, many physical disorders can lead to depression, and depression in turn can lead to physical illness. In addition, the mind-body continuum has common influences, and imbalances can be bodywide in nature. Therefore, the use of St. John’s wort, by relieving your physical problems, may very well help lift your mood.

Antiviral Actions

St. John’s wort has been shown to have dramatic antiviral activity, although in dosages much higher than those required to treat depression. Experiments, both in test tubes and in animals, have indicated that two of the active chemicals in the plant, hypericin and pseudohypericin, are clearly effective against a number of retroviruses, including the herpes and hepatitis C viruses. The herbs show significant activity against influenza types A and B; the vesicular stomatitis virus, which causes inflammation of the mouth; and even the Epstein-Barr virus, which is associated with infectious mononucleosis and chronic fatigue syndrome.

Hypericin and pseudohypericin show great promise for several reasons. They inactivate or interfere with the ability of viruses to reproduce. They are also able to cross the blood-brain barrier, an organic safety mechanism that prevents many substances from reaching the brain. Intended to filter out toxic substances, this barrier also denies entry to many beneficial ones. The ability to cross this barrier is particularly meaningful in dealing with viruses that target the brain.

In several cases, the two chemicals have proven effective in preventing disease after a single oral or intravenous dose. This is highly unusual, since viruses are normally much more resistant than that to treatment. Compared with other antiviral medications, St. John’s wort has very few side effects, although there can be some phototoxicity, or extreme sensitivity to light, when it is administered in very high doses. Researchers are now studying the potential of hypericin against other viruses.

At New York University, Dr. Daniel Meruelo and Dr. Gad Lavie are researching the use of hypericin in fighting the human immunodeficiency virus (HIV), the virus associated with acquired immunodeficiency syndrome (AIDS). In mice, hypericin has been shown not only to inactivate the virus, but also to shield the membranes of healthy cells from attack. No other current antiviral drug is able to do this. It is also possible that hypericin, if added to donated blood, may protect transfusion recipients from becoming infected with HIV.

In Cooper and James’s study of thirty-one AIDS patients, the researchers found a 13 percent increase in counts of T helper cells (T cells), an important component of the immune system, after one month of supplementation with St. John’s wort. This higher level was maintained after four months. In a study by Stenbeck and Wernet, sixteen patients saw their counts of CD4, another immune-system component, either improve or remain stable when they took St. John’s wort over a forty-month period. Only two of the sixteen developed the kinds of opportunistic infections that often affect people with faulty immune systems. These studies indicate that St. John’s wort may very well play an important role in the fight against AIDS, and research is continuing in this area.

It is worth noting that, so far, the antiviral research has been done using refined synthetic hypericin, identical to natural hypericin but lacking the other medicinal compounds found in the whole herb. Unrefined St. John’s wort extract has been shown clinically to have antiviral properties, but no study has yet been done comparing the two forms.

Wound-Healing and Antibacterial Actions

Several studies have confirmed the traditional use of St. John’s wort in wound healing. Hyperforin and novoimanine, antibiotic chemicals found in the plant’s flowers and leaves, are at least partly responsible for these antibacterial and healing properties. One German study showed that an ointment containing the herb reduced healing time dramatically and resulted in less scarring. First-degree burns healed within forty-eight hours, and third-degree burns healed three times faster without the usual formation of scar tissue.

A friend of mine verified St. John’s wort’s healing powers through personal experience. When her four-year-old son accidentally scalded his hand with boiling water, she immediately applied St. John’s wort oil to the site. The pain ceased, and he stopped crying. The redness cleared in a few days, with none of the blistering or scarring that generally follows such a burn.

St. John’s wort acts against a wide variety of bacteria. In one study, it was found to be more effective than the antibiotic sulfanilamide against the Staphylococcus (staph) bacteria responsible for many hospital epidemics. The bacterium that causes tuberculosis, the fungus Candida, and the gastrointestinal parasite Shigella have all responded to St. John’s wort. These findings are particularly important because of the increasing incidence of antibiotic-resistant strains of bacteria.

Anti-Inflammatory and Immune-Enhancing Actions

St. John’s wort has been used for centuries to reduce inflammation and to stimulate the immune system. Ointments containing the herb have been valuable tools for medics on the fields of battle until this century, when they were replaced by synthetic drugs. It appears that the flavonoid component in the herb is the main anti-inflammatory agent, although others contribute to its immune-enhancing activity. Russian researchers recently discovered that this complex herb contains substances that both stimulate and suppress immunity. This allows St. John’s wort to boost the ability of the immune system to fight infection, while at the same time decreasing the immune processes that promote inflammation in wounds and other injuries. Substances that can perform such balancing acts are called tonics, or adaptogens. A synthetic drug only has one active ingredient, so it simply can’t manage such a harmonious balancing of the body’s immune response. This is one of the main advantages of herbal remedies.

Someone who has learned about St. John’s wort’s immune-boosting powers is Renata.

Renata, a 38-year-old woman with severe chronic fatigue syndrome, was depressed and constantly exhausted. She consulted a doctor at a major university medical center, who simply recommended that she rest. Then, a clerk in a health food store suggested St. John’s wort in 300-milligram capsules. Renata took a capsule twice a day before increasing her intake to three times a day. Within a few weeks, her depression lifted and her energy began to return. By six weeks, not only was she free of symptoms, but she noticed that she did not get her regular attack of herpes in conjunction with her period, a common occurrence in susceptible women. Moreover, a year later, Renata is still taking St. John’s wort and remains completely symptom-free.

This case is a great illustration of St. John’s wort’s multiple functions. Renata’s experience is particularly remarkable considering the usual difficulty in treating herpes. (For more information on chronic fatigue syndrome, see Nutritional Approaches to Mental Health)

St. John’s wort and Cancer

There is promising research showing that St. John’s wort has anticancer effects. It also has been shown to be effective in preventing cell damage from radiation, including damage to delicate intestinal lining and bone marrow cells in test animals. I believe that if these results can be replicated in human beings, this herb could be used during radiation therapy as an additional, or adjunctive, treatment for the cancer itself, as well as for protection from radiation damage.

St. John’s wort is an excellent antidepressant that also provides a remarkable range of other healing properties. Its ability to fight viruses is giving new hope to patients with diseases as varied as herpes and AIDS, while its wound-healing and antibacterial actions can offer protection against the multitude of potentially dangerous organisms in the world around us. Even better, its complex structure allows it to balance the immune system, helping to control inflammation as it boosts the body’s ability to fight off disease. In the next chapter, I will explain how to use St. John’s wort.