Herb being used for depression

BY SUSAN OKIE

Washington Post

CONSUMERS are snapping up St. John's wort preparations from the shelves of
supermarkets and healthfood stores. During the month of July, after
``20/20'' aired a segment about psychiatrist Harold H. Bloomfield's book,
``Hypericum and Depression,'' Americans spent $2.5 million on extracts of
the herb, according to Bob Bidlingmeyer, vice president of Lichtwer Pharma
USA.

Doctors uneasy

Many doctors are uneasy that so many people are using St. John's wort to
treat themselves, particularly if they are combining it with other
medications. Una McCann, chief of the anxiety disorders unit at the
National Institute of Mental Health, said she now routinely asks patients
in her clinic if they are taking supplements or herbal products. ``I never
would have asked that before,'' she said.

Predicting which drugs might interact dangerously with St. John's wort is
complicated because scientists still don't know exactly how the herb works.

Walter Mueller, director of the Institute of Pharmacology at the University
of Frankfurt in Germany, said his research in rats and mice shows that
hypericum extract acts similarly to the antidepressants Zoloft and Prozac,
blocking the ``reuptake'' by cells of a chemical called serotonin that
carries messages between nerves in the brain.

Thus, when serotonin is released at nerve endings, it hangs around longer
and over several weeks, this in turn produces changes in the number of
serotonin receptors, molecules on nerve surfaces that respond to the
chemical message. He said this gradual change in receptors may be part of
the reason why it often takes several weeks for hypericum as well as
some other antidepressants to take effect.

How it works

But in addition to blocking serotonin reuptake, Mueller said, hypericum
extract also blocks reuptake of the chemical messengers dopamine and
norepinephrine. This nearly equal effect on three distinct messenger
systems in the brain ``has never been shown for any of the other
antidepressants,'' he said.

Some psychiatrists said an interaction between Zoloft and St. John's wort
may cause dangerous rise in blood pressure. They said people taking
antidepressants or other prescription drugs should not stop them suddenly
and should not try St. John's wort without consulting a physician.

For people with mild depressive symptoms who are not taking any
prescription drugs, opinion is divided. Mueller cautions that the herbal
extract does not work for everyone. Bloomfield's book suggests the dose
used in Germany 300 milligrams of hypericum extract three times a day
and contains information about specific products and possible side effects,
including indigestion, allergic reactions, tiredness, restlessness and a
theoretical risk (seen in animals but so far not in humans) of severe skin
reactions after sun exposure.

Published Wednesday, October 22, 1997, in the San Jose Mercury News