• St John's wort projects

Background: Depression is commonly treated with antidepressants. These medications are generally very effective, particularly in moderate to severe major depressive disorder. The case for milder cases of depression is less clear. Antidepressants are also associated with side-effects, such as nausea, insomnia, headache, dizziness, constipation, and sexual dysfunction. This can reduce compliance and life quality. In milder depression side-effects of antidepressants might outweigh beneficial outcomes. Consequently, other forms of treatment might benefit such individuals. In recent years complementary medications have been suggested as a potential solution. One of the most popular of these is St John’s wort (as known as Hypericum).  Some studies have shown that St John’s wort is an effective treatment for depression. However, most trials have been conducted in clinical populations; few have explored community samples (which may be more representative of ‘typical’ low level depressive symptoms in the general population). We sought to address two aspects of St John’s wort: the extent of use in a community sample; the perceived efficacy of use for mild to moderate depression and anxiety in such a group.

What we did: We recruited participants from the membership of Depression Alliance UK, a leading self-help organisation. These members typify those in community displaying a range of depressive symptoms across the spectrum of severity. In the first part of our investigation, we retrospectively explored the use of herbal remedies for depressive and anxiety symptoms (using questionnaires).  In the second part, we prospectively examined the effectiveness and tolerability of St John’s wort.  Subjective reports of affective states were measured using the Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983), while general symptom improvement was examined via the Clinical Global Improvement Scale (CGI; Guy, 1976).

For the retrospective analysis of prior complementary medication use, we elicited responses from 452 Depression Alliance members (mean age 46.9; 72.7% women). 80.8% of the respondents were currently taking medication; 50.2% were taking a traditional antidepressant; 66.8% reported taking a herbal remedy, with 75.8% of those taking St John’s wort. 28.8% reported combining St John’s wort and an antidepressant. There was no overall effect for age, but those aged over 65 were significantly less likely to use St John’s wort than younger members. There was no effect of gender. The sample reported a wide range of psychiatric, but most (91.7%) of the herbal remedy users described symptoms that might receive a DSM-IV diagnosis of major depressive disorder. Anxiety symptoms were also common. Reporting retrospectively, 51.9% of St John’s wort users recalled an improvement in their symptoms; 40.2% described their symptoms as unchanged; and 18 7.9% said that their symptoms had got worse.  27.5% of St John’s wort users reported adverse effects, but these were mostly mild and relatively short-lived. Our data suggest that patients with mild depression may respond well to St John’s wort, and that side effects are few. It may pose a reasonable alternative to conventional antidepressants. To read more about these findings, see our paper Dyson, Baldwin, Mayers et al., 2002.

For the prospective analysis of perceived efficacy, we examined subjective reports from 39 Depression Alliance members (mean age 43.7; 51.2% women). Participants were given daily doses of 300mg St John’s wort (LI 160). Subjective ratings, measured via HADS and CGI, were taken at baseline (prior to treatment) and at 4, 8, and 12 weeks post-treatment. The results showed that anxiety perceptions significantly improved at week 4, and again at week 8, post-treatment; depression perceptions improved only at week 4 (but remained stable thereafter). Regression analyses suggested that baseline anxiety perceptions were explained by gender and by depression severity at baseline; no single variable explained pre-existing depression. Improvements were greater for those reporting milder depression at baseline, than moderate or severe depression. On the other hand, improvements were greater for those reporting more severe reports of anxiety at baseline, than milder anxiety. Women tended to show improvements in reported anxiety and depression, while men only reported improved depressive symptoms.   These results suggest that St John’s wort can be successful in reducing self-reported symptoms of depression and anxiety, particularly for those reporting more severe symptoms of anxiety and milder symptoms of depression. To read more about these findings, see our paper Mayers, Baldwin, Dyson, Middleton & Mustapha, 2003.