DISCLAIMER:  I debated for a long time about whether or not to post this entry.  This entry is about my personal experiences with an herbal remedy. I am not advocating St. John’s Wort as an alternative to prescription anti-depressants or advocating self-medicating.  I was young when I did this, and, honestly, very stubborn and very stupid, and I got lucky; I would not treat my depression, or any other disorder from which I suffered, without professional help now.  If you are feeling depressed, I strongly recommend that you seek professional help, starting with your personal physician.

Everyone suffers from depression at some point in their life.  Like many of you, I have had my bouts with mild depression here and there, mostly in reaction to life events.  Normally, I just get through it, because it never gets so severe that I cannot see better days ahead.  I think I am a reasonably happy, well-adjusted person, and when I do feel depressed, it is usually in reaction to something going on in my life rather than a chronic state.

Blue MeaniesThere was one point in my life, however, where the depression, although mild, was protracted and began to become disruptive.  I was working on my dissertation, and also running a laboratory, working many hours a week.  I was experiencing depression over the state of my dissertation, because it felt like I could not make any significant headway on it.  Compounding those feelings were what a good friend of mine referred to as “the 3am blue meanies.”  Every night, I would wake up with an anxiety attack about my dissertation, at around 3am.  I would lie in bed and worry about how I was not going to finish my dissertation in time, that the experiments I had designed were not going to work anyway, and how I would flunk out of graduate school and be a total failure for the rest of my life.  Images of myself as a sad bag lady filled my head, and there would be no sleep for me for the rest of the night.

I did not have any health insurance at the time, so going to see a counselor was out of the question, since I could not afford it.  In desperation, I looked around on the internet (I know, right?) for some solution to my problem.  I focused on depression, since I was convinced my nightly anxiety was related to depression (I do not know why, I am not a clinician, but that is where my mind went).  I came across several references to an herbal remedy called St. John’s Wort (pronounced “wert” by the way), which was touted as a remedy for depression.

St. John's WortAt the time, there was little in the way of information, but most scientific sources said that it was probably no more effective than a placebo.  Several European journals, however, reported that it was effective in treating depression, and had relatively few side effects.  St. John’s Wort (Hypericum perforatum) is a yellow-flowering plant with many chemical properties that are not, to date, well understood.  It has been used for centuries to treat various disorders, including depression and anxiety.  It is a prescription medication in many places in Europe, but is available over-the-counter here from many health food stores.  Delivery methods include capsules and teabags.

I was admittedly dubious, but also desperate.  At the very least, I told myself, as I bought a bottle of the stuff, I hoped that my extensive reading on the subject would not negate a placebo effect, and there were few reported side-effects from taking it.  Dutifully, I began taking my two capsules of St. John’s Wort a day and waited for results.

At first, nothing happened.  I still kept waking up at night, I still felt depressed and anxious, and, on top of that, now I was disappointed, because this stuff obviously did not work.  However, I had read that it sometimes took a couple of weeks to work, and I knew enough about anti-depressant medication to know that that was also the case with those.  So I stuck it out, and continued taking the pills.

Lo and behold, the 3am blue meanies went away, more or less.  I still felt anxious and depressed about the state of my dissertation, but less so.  The lessening of the anxiety and the better sleeping at night led to more productivity, and I actually began to make progress on my studies again.  My general mood improved over the first few months that I took it.

Feeling like I had been cured, and definitely making headway on my dissertation, I stopped taking St. John’s Wort.  Cold turkey.  Just quit one morning, and tossed the bottle into the dumpster on my way to work.  Within a few days, I developed an absolutely crushing headache that lasted for several days, I began sweating profusely, and was nauseous.  I also developed a horrible tremor.  I had to leave work one day, I felt so awful.  Being young and stupid, it did not occur to me that I was going through withdrawal from the St. John’s Wort until I mentioned that I had stopped taking it to my mentor and she looked at me like I was a complete idiot, which she followed with a lecture on the dangers of withdrawal from anti-depressant medication.

So, do these herbal remedies really work?  As I mentioned, at the time, the general consensus was that they do not, that any beneficial responses that occur while taking it are due to a placebo effect.  My experience, both as I took it and when I quit taking it, however, would suggest that St. John’s Word does something, but I’m not willing to say, definitively, that it does since I could have experienced a placebo effect, or simply gotten better due to the passage of time.  Over the years, I’ve checked in on the literature with respect to St. John’s Wort, and it is still mixed, but the idea that it is an effective treatment for depression is gaining traction in the United States.  NIH’s National Center for Complementary and Alternative Medicine (NCCAM) still regards St. John’s Wort as no better than a placebo.  A recent systematic review of many studies by Klaus, Berner, and Levente (2009) suggest that St. John’s Wort is more effective than a placebo for treating symptoms of depression.  A list of studies over the last decade continue to produce a mix of results.

If St. John’s Wort does work (and I do not take the fact that it worked for me as definitive proof that it does), I would predict that it probably works much like prescription SSRIs, such as Prozac, work, by blocking reuptake of Serotonin, making more of that neurotransmitter available to synapses in the nervous system.  I will say that the withdrawal symptoms I experienced when I stopped taking St. John’s Wort match up almost perfectly with the symptoms of SSRI withdrawal.

So, the jury is still out on these medications, which is why, despite my story, I cannot advocate their use.  I strongly suspect that the reason behind the mixed results is that St. John’s Wort is being tested in these studies on a variety of levels of depression.  I am no expert on the subject, but I do not believe I was experiencing major depression when I began taking it.  I was depressed, undoubtedly, but I would not characterize my symptoms as extreme.  It may be, and this is pure speculation on my part so take it with a grain of salt, the effectiveness of St. John’s Wort may be as a treatment for low to moderate levels of depression, as a sort of weaker SSRI, rather than as something that can be effective against full-blown major depression.  I do not know for sure, but I will continue to check in on the literature about St. John’s Wort from time to time, just see what progress is being made.  These remedies serve to remind us that there are probably many such remedies for various ailments out there, in nature, either as part of local tradition, or waiting to be discovered.  But caution and research are also needed to make certain they are safe and effective.

Reference

Klaus, L., Berner, M., and Levente, K. (2009). St. John’s wort for major depression. Cochrane Database for Systematic Reviews, 4, DOI: 10.1002/14651858.CD000448.pub

Advertisements