Depression and Saint John's Wort

This health care triage video is supported by Giving What We Can, an organization that exists to help you find and donate to the charities that can do the most good per dollar donated. Head to givingwhatwecan.org slash triage to figure out how to get the most impact for your donation. St. John's wort has been used throughout history for various ailments and is currently promoted in some circles for various skin conditions and psychological disorders. It's often promoted But what do the data have to say about that? That's the topic of this week's health care triage. St. John's wort, also known as goat weed and a few other names, is a flowering plant generally available at your local drugstore in pill or tablet form, though it can also be taken as a liquid or dried herb. It is often recommended as a natural remedy for depression, in part because of its effects on serotonin levels. But does it actually work? And is it safe? To the research! The main message that jumps out from the existing scientific literature is that while St. John's wort may be more effective than a placebo, the quality of the data is somewhat lacking, and the results are inconsistent. We also don't know much about long-term effects, and importantly, it can have dangerous reactions with some prescription medications. Two meta-analyses from the 1990s examined randomized controlled trials that compared St. John's wort to either placebo or existing antidepressants and found it to be overall better at treating depression than a placebo and about the same as the antidepressants. However, there are some issues with these trials and with comparing them. Participant numbers were a little low. Different studies classified and tested for depression differently, and each study used different doses and preparations of the herb. One randomized controlled trial from the year 2000 reported superior effects of St. John's wort on one measure of depression, but not another when compared to the effects of fluoxetine, a commonly used antidepressant. However, another randomized controlled trial published one year later found no effect to the herb, even when compared to placebo. Importantly, the authors of that last paper note that many of the studies conducted prior to theirs and covered in previous meta-analyses had several issues. These included the ones we mentioned previously, along with failure to mask the taste of St. John's wort, therefore unblinding participants to which condition they were in, and failure to administer effective doses of antidepressants. How one expects to determine the effectiveness of an herbal supplement compared to an antidepressant if they aren't even using a clinically effective dose of the antidepressant is a mystery to us. There are a handful of more recent systematic reviews and meta-analyses, most of which conclude that St. John's wort is a better option than placebo for mild to moderate depression and is comparable to the effects of many standard antidepressants. However, the most recent meta-analysis reported that the evidence was inconsistent and confusing, with some trials reporting minimal effects. Importantly, they specified that the more recent trials, which were deemed to be of better overall quality, are the ones reporting minimal benefits. So, the existing research is a little confusing, though higher quality evidence doesn't suggest a strong effect. In addition, evidence for the herb's effects in severe depression, or for the effects of taking it long-term, are sorely lacking. But maybe you're saying, so what? Makes me feel better and that's all I care about. That's fair, I don't want to yuck your yum, but you should definitely talk to your doctor first, particularly if you're on any medications or about to start new medications. Combining some antidepressants with St. John's wort can dangerously increase your serotonin levels, resulting in severe serious side effects, including rapid heartbeat, increased blood pressure and body temperature, and hallucinations. It may also worsen symptoms for some disorders, including schizophrenia and bipolar disorders. St. John's wort can also weaken many prescriptions, including, but not limited to, birth control pills, some heart and medications, the blood thinner warfarin, and cyclosporine, a drug given to transplant patients to help head off rejection of a new organ. So, we can't say the evidence paints a particularly strong case for the use of St. John's wort in depression. We can say that there are considerable risks to taking it. So, please do talk to your healthcare professional if you feel strongly about giving it a try. Here at the end of the year, consider doing some good with Giving What We Can. They're an organization that aims to help you find and donate to the charities that can do the most good per dollar donated. Giving What We Can isn't asking for your money, and they don't take a cut from your donation. Their website is full of free resources to find great charities, and they spend their resources working with experts to identify the most impactful causes and the best charities working on them. They've identified over 30 top-rated charities and funds working on high-impact causes, like reducing poverty and illness, addressing climate change, and advocating for farmed animals. And their top-rated organizations have been vetted by expert evaluators so you know your donations will be used effectively. To make the most impact you can when you donate this holiday season, you can head to givingwhatwecan.org slash triage. Thanks to Giving What We Can for supporting healthcare triage. Hey, did you enjoy this episode? You might enjoy this previous episode on the stigma of mental illness. We'd appreciate it if you'd like the video and subscribe to the channel down below. Consider going on over to patreon.com slash healthcare triage, where you can help support the show make it bigger and better. We'd especially like to thank our research associates, James Glasgow, Joe Sevitz, Edward Lilleholm, and Brian Nam, and of course, our surgeon Amaral Sam.