Although promoted as an alternative therapy for depression, the herbal supplement St. John's wort appears ineffective for people with moderate clinical depression.

In the study of 340 patients diagnosed with moderate depression, St. John's wort proved no more effective than inactive treatment with a placebo in alleviating symptoms. Active treatment with the antidepressant drug Zoloft worked somewhat better than placebo.

A body of evidence suggests that St. John's wort (Hypericum perforatum), used for more than 2,000 years to quell mood problems, does help symptoms of depression. In Germany, where many of the positive studies have been conducted, St. John's wort is available as a prescription antidepressant.

But the quality of much of this research has been criticized -- including the lack of studies using a placebo and a selective serotonin reuptake inhibitor (SSRI) like Zoloft according to the authors of the new study. SSRIs are a newer class of drugs commonly used to treat depression.

To address these concerns about earlier studies, researchers assigned patients to take St. John's wort, sertraline or placebo for up to 26 weeks.

At the study's end, the researchers found that neither the herb nor the drug was better than placebo in improving patients' scores on a standard scale of depressive symptoms. Overall, nearly one third of placebo patients showed a full response to treatment, compared with roughly 24% in both the St. John's wort and Zoloft groups.

Patients on Zoloft did, however, do better than placebo patients on a secondary test used to gauge a person's daily functioning and levels of distress. The Zoloft group also had a higher percentage of so-called "partial responders" to treatment than either the placebo or St. John's wort groups.

Still, the findings do not indicate whether the herb can help people with mild depressive symptoms -- a question additional research will have to address. St. John's wort is marketed for the treatment of mild to moderate depression, but it's likely people with a range of depressive disorders try the herb.

The researchers believed that dosing almost certainly contributed to Zoloft's less-than-stellar performance in the study.

This study -- along with a second one in the same journal issue documenting the rise of the "placebo effect" in recent research on depression drugs -- highlight the importance of using a placebo and an active comparison drug in studies of unproven antidepressant agents.

The main researcher for the study holds stock in Pfizer, the maker of Zoloft, and has received speaker fees from Pfizer. Co-authors on the study have received funding from a number of pharmaceutical companies. The study itself was funded by the US National Institutes of Health.

JAMA April 10, 2002;287:1807-1814, 1853-1854

Dr. Mercola's Comments:

Following the eating plan and limiting sugars will be profoundly beneficial for treating depression. Additionally, many of us forget that exercise can be used as a drug. When using exercise as a drug, it will be important to have as a goal at least one hour per day, every day. Obviously, depending on one's current condition, one needs to work slowly up to this level. My experience is that weight-bearing exercises, such as walking, jogging, running, Nordic Track, Health Rider are better than cycling and swimming. If you have access to a health club, my favorite piece of equipment there is the elliptical machine. You can read my current review of elliptical machines for further information. Cycling and swimming take far longer to produce the same benefit and each have their own problems. If you are cycling outdoors you run the risk of being killed or injured by a motor vehicle. Swimming is usually done in chlorinated pools, which has its own problems. However, if you are able to swim in the ocean, the salt water provides an incredible synergism that far exceeds the value of the exercise. The practical problem with using exercise in depression is that the desire to pursue any activity, let alone exercise, is not very high. The converse though also needs to be considered. Just because one exercises, that does not mean you cannot become depressed. Exercise makes it easier to treat depression, but it certainly does not cure it in everyone. One of the major problems with diet and exercise however, is that it is very difficult for most of us to get motivated to follow these programs. That is one of the reasons why I am so fond of EFT. I have consistently seen people use this approach to improve their ability to follow the proper eating plan and improve their ability to exercise regularly. If EFT only allowed you to exercise and eat better that would be more than enough. However, of course, EFT is a wonderful modality to actually allow your body to resolve the deep-seated emotional traumas that are contributing to the problem in the first place. Part of the reason EFT works is that it helps you to love and accept yourself at a very deep level. Most of the time it is our self-critical thoughts that perpetuate much of the misery of depression. If you are interested in learning more about EFT you can review the videos of a workshop that I recently conducted. Related Articles: Exercise Better Than Drugs For Depression