St. John’s wort helps with depression -- especially if you’re German

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It works. It doesn’t. It works. It doesn’t. That’s health research news for you. One item that gives me whiplash, is the effectiveness -- or not -- of the herb St. John’s wort for relief of depression.

Here, for example, is what the National Institutes of Health says: ‘There is some scientific evidence that St. John’s wort is useful for treating mild to moderate depression. However, two large studies, one sponsored by NCCAM [the National Center for Complementary and Alternative Medicine], showed that the herb was no more effective than placebo in treating major depression of moderate severity.’

The University of Maryland Medical Center says that, ‘In numerous studies, St. John’s wort has been effective in reducing depressive symptoms in those with mild to moderate but not severe (called major) depression.’

So one site says the herb’s effective in treating moderately severe major depression and the other says it’s not effective for major depression but is effective for moderate and mild depression that would not be defined as major.

Argh! Argh! At this point one starts to wonder if the most confusing thing about these studies is the definition of depression. (According to Medline, ‘major depression’ is diagnosed when five or more symptoms of depression persist for more than two weeks -- symptoms including feeling sad, hopeless, worthless or pessimistic.)

Perhaps it helps to not get overly hung up on such definitions. In any case, our friends from the Cochrane Collaboration have just weighed in with a Systematic Review that evaluated 29 trials on the topic and concluded the following: The herb does appear effective for major depression, at least mild and moderate versions thereof -- and, in fact, is as effective as antidepressants (and slightly better than placebos, suggesting that none of these items appear to be miracle-workers, antidepressants included).

But ... for some perplexing reason, trials conducted in German-speaking countries had better results than trials conducted in other countries. What the ?! Should melancholy, herb-chugging types all quickly move to Germany?

‘This difference could be due to the inclusion of patients with slightly different types of depression,’ the review authors write. Use of the herb is quite accepted in such countries, which might influence what kind of patient enters a trial. ‘But it cannot be ruled out that some smaller studies from German-speaking countries were flawed and reported overoptimistic results.’

The authors end their report with two reminders -- to tell your physician if you’re taking the herb since it might interact with other meds, and bear in mind that supplements can vary a lot in quality.

-- Rosie Mestel

/ Los Angeles Times