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St. John's Wort fails

Carla McClain (The Arizona Daily Star) -- In a major blow to "alternative medicine," researchers say the first major U.S. study of the the widely popular herbal remedy St. John's wort -- long touted as a "natural" antidepressant -- has found that it does not work.

"This study shows that St. John's wort was no better than placebo (inactive pill) for treating moderate to severe depression," said Dr. Alan Gelenberg, head of psychiatry at the University of Arizona -- one of 11 U.S. medical centers involved in the trial.

"We cannot say it doesn't work for mild depression, but it's hard to know, because mild depression tends to heal on its own over time, without treatment."

The study is published in today's Journal of the American Medical Association.

However, the size of this study -- only 200 patients nationwide, including less than a dozen in the Tucson area -- is being questioned as possibly inadequate by a UA clinical trials expert, Dr. David Alberts, researcher at the Arizona Cancer Center.

And Dr. Andrew Weil - a founder of the alternative medicine movement in this country -- said it is not yet known exactly what the active ingredient in St. John's wort is, so the extract tested in this study may not have contained it.

"I have questioned whether it is premature to do this study and spend this much money before we have pinned down what causes the antidepressant activity in St. John's wort," he said.

Praising the study as "exactly the kind of study we need to distinguish what is useful from what is not," the medical director of Weil's integrative medicine program at the UA, Dr. Victoria Maizes, cautioned that there is "substantial" evidence St. John's wort is effective in mild depression.

"This study excluded those patients," she said.

A yellow-flowering, wild-growing plant, St. John's wort has been used for more than 2,000 years for a variety of "nervous conditions," including anxiety and depression.

Widely available over the counter, the herb requires no prescription, has significantly fewer side effects and is considerably cheaper than standard antidepressant medications. It is neither tested nor regulated by the U.S. Food and Drug Administration, as all U.S. medical drugs are.

The popularity of St. John's wort skyrocketed worldwide five years ago, after a British analysis of some two dozen, scientifically controlled German studies concluded the herb was significantly superior to placebo and at least as good as standard antidepressants -- with fewer side effects -- for treating various degrees of depression.

The herb's apparent credibility as a natural remedy has helped spur the alternative medicine movement in this country.

That is why mainstream medical researchers finally decided to take a hard look at St. John's wort.

Of the 200 adult patients in the study -- all diagnosed with depression "of at least moderate severity" -- half were given 900 to 1,200 milligrams of a German extract of St. John's wort daily, and the other half a daily placebo.

After eight weeks on this regimen, slightly more than 26 percent of those on St. John's wort showed a significant improvement in their depression ratings, and about 14 percent were actually cured of it.

In the placebo group, just over 18 percent showed significant improvement, and nearly 5 percent were actually cured of their depression.

While St. John's wort performed slightly better overall than placebo -- and significantly better at curing the problem -- it did not help enough patients to recommend it for the treatment of moderate to severe depression, researchers concluded.

"Who's going to go buy something that fixes the problem in only 14 percent of the patients?" Gelenberg said. "The numbers of patients that were helped were too small to call this an effective remedy."

But Gelenberg stopped short of telling people not to take St. John's wort.

"If someone is considering it for depression, I certainly will not recommend it," he said.

"But nothing bad has happened to anyone taking it. So if someone thinks it is working, great. Continue to take it until it stops working, which is what usually seems to happen.

"But if it's not working, then do see a doctor for real treatment -- either a prescription antidepressant or psychotherapy."

The national head of the study stressed that major depression can be life-threatening, with 5 to 10 percent of those who go untreated ending as suicides.

"For that reason alone, we recommend that patient suffering from depression take established treatments," said Dr. Richard C. Shelton, professor of psychiatry at Vanderbilt University Medical Center.

(c) 2001 The Arizona Daily Star

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