St. John’s Wort for Depression

The herbal antidepressant St. John’s wort is the most widely prescribed antidepressant in the world, and it is highly effective in treating depression. The botanical name is Hypericum perforatum. Its standard uses are for mild-to-moderate depression, but St. John's wort has been used for major depression as well. When researchers have compared St. John’s wort to Zoloft and Paxil, St. John’s wort was as effective as medications and patients reported fewer side effects. One of its constituients, hyperforin, has also been shown to be highly anti-inflammatory, and this likely contributes to its effectiveness in treating depression.


Used by itself, St. John’s wort has an excellent safety record. But there are two important cautions. First, it does interact with several classes of medications, so should not be combined with antidepressants, birth control pills, cyclosporins, and several other classes of medications. If you decide to take St. John’s wort, be sure to tell your doctor or other health care provider. Second, brands of herbal products vary widely in quality, and it’s not always possible to tell which product is good quality. Seek the advice of a naturopath or licensed herbalist to find a good product. Or for a small fee, ConsumerLabs.com provides information on specific brands. Below are some resources and recommendations regarding use of St. John's wort.

Dosage: 300 mg, three times a day

Standardized to 0.3% hypericin or 2% to 4% hyperforin

The Complete German Commission E Monographs available online and for purchase from the American Botanical Council, www.herbalgram.org

Exercise Can Treat Major Depression

Health care providers often believe that alternative treatments for depression are only appropriate for mild depression. For more serious depressions, the patient needs DRUGS. But is that true? As I mentioned in a previous post, there are a number of non-drug treatments for depression. For this posting, I’d like to focus on exercise.

Two recent studies at the Duke University Medical Center tested exercise as a treatment for depression by putting it head-to-head with Zoloft in two randomized clinical trials. The patients were older adults with major depression. In both studies, exercise was as effective Zoloft.

Other studies have found that exercise prevents or treats depression with a wide range of people. The strongest effects are for aerobic exercise, but weight lifting and stretching/yoga are also helpful. If you exercise at a moderate level, exercise is safe during pregnancy or breastfeeding. The guidelines for treating mild-to-moderate and major depression with exercise are listed below.

The recommended exercise regimen for treating major depression requires more effort than the regimen for mild-to-moderate depression. But it is a viable alternative to medications and many women find that it is worth the effort. In the second Duke study, the researchers found that the group that came to the lab to exercise had a lower rate of depression than the group that followed a home-exercise program. The fact that they needed to come to the laboratory probably meant that they also received social support from study staff and fellow participants in addition to benefits of exercise. The participants were also probably more likely to exercise regularly when they knew that they were expected to show up some place. You might find that exercise in a group setting works well for you too.

How much exercise do you need to do? Here are some guidelines summarized from several recent studies.

For mild-to-moderate depression
• Frequency: 2 to 3 times a week
• Intensity: moderate
• Duration: 20 to 30 minutes

For major depression
• Frequency: 3 to 5 times a week
• Intensity: 60% to 85% maximum capacity
• Duration: 45 to 60 minutes

Exercise is another thing you can do for yourself to increase your physical and mental well-being. Get off that couch and just do it! You’ll be happy you did.

Can Fats Make You Happy?: Omega-3 Fatty Acids and Depression

Is all the discussion about Omega-3 fatty acids in health just a bunch of hype? The short answer is “no.”

Our best evidence on the effectiveness of Omega-3s is in the prevention of heart disease. They are particularly good at lowering triglycerides. And as I described in a previous blog, heart disease and depression and not only related, but likely share a similar underlying mechanism.So the fact that Omega-3s are helpful for both makes sense.

The long-chain Omega-3 fatty acids, EPA and DHA, have been used successfully to both prevent and treat depression. Both of these are found in fatty fish. EPA is the Omega-3 that actually treats depression because it specifically lowers inflammation and lowers the stress response. It has been used by itself or has been combined with medications. When it is used with medications, it makes medications work more effectively. The American Psychiatric Association recently recognized EPA as a promising treatment for mood disorders.

DHA helps prevent depression, but does not treat it by itself. It is usually combined with EPA. There is a vegetarian source of DHA, but no vegetarian source of EPA; fish oil is still the best source. Sources and dosages are listed on the side bar. Even in relatively large doses, EPA and DHA are safe for children, pregnant and breastfeeding women, and other populations. In addition, they provide a number of other health benefits for men and women, including lower their risk of heart disease and making them less vulnerable to stress.

For vegetarians, the bad news is that ALA, the Omega-3 in flax seed and other plant sources, such as walnuts and canola oil, does not prevent or treat depression. ALA is not harmful and can be helpful in other ways. But it is metabolically too far removed from EPA to aid in lessening depression.

What I like is that there really is no downside to using Omega-3s. And there is considerable upside. Even if they doesn’t lessen depression by themselves, they increase overall health. And that is a good thing.