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St. John's Wort

Herbal Treatments for Depression

   Many herbal treatments are promoted for depression, but only St.John's Wort has any scientific proof of value.  There are so many studies with Hypericum (St. John's Wort) that it gets its own page.  Gingko, melatonin, Rhodiola Rosea, L. Angustifolia, and saffron are covered at the bottom of this page.

Ginkgo, Damiana, Yohimbe Promoted for Depression: www.vitacost.com notes that these are promoted although the website itself says there is no research! 1/10/03. Despite the admitted lack of research vitacost recommends damiana 250 mg bid for depression and calls it a "useful...antidepressant." Ginseng, black cohosh, mate and other promoted on other websites for depression, again with absolutely no research evidence of benefit.

Ginkgo No Help Winter Depression: Very small DB PC 27 SAD patients 10 weeks. Norway. Can winter depression be prevented by Ginkgo biloba extract? A placebo-controlled trial. Lingaerde O, Foreland AR, Magnusson A. Acta Psychiatr Scand 1999 Jul;100(1):62-6; This was the only study on PubMed of Ginkgo and Depression as of 1/17/03

Ginkgo No Help in Mood in Normal Young and Old Adults: In a 12-week, DB PC study of ginkgo (120 mg per day) on 93 healthy older adults (ages 55-79) and 104 young adults (ages 18-43), longer-term memory assessed by associational learning tasks showed improvement with ginkgo in older adults (d = 0.52, p = 0.04). There was no statistically significant difference on a wide range of other cognitive abilities, executive function, attention and mood. For the young adult group no measure showed statistically significant effects of ginkgo enhancement. Ginkgo biloba: no robust effect on cognitive abilities or mood in healthy young or older adults. Burns NR, et al. University of Adelaide, Australia. Human Psychopharm 2005 Dec 5. Ed: This study has 6 times as many patient days as the one below.

Ginkgo Helped Normal Middle-Aged Adults in Small, Short Study: In a small 66-subject, short 4-week DB PC study of healthy middle-aged adults ages 50-65 (called elderly by the authors), those receiving 240 mg/day of the ginkgo extract (EGb 761) had greater improvements in depression, fatigue, anger and SDS self-rated depression scale. The effect of ginkgo biloba on healthy elderly subjects Cieza A, Maier P, Poppel E. Ludwig-Maximilians-Universitat Munchen. Fortschr Med Orig. 2003;121(1):5-10. Ed: This study is very hard to believe. To draw such conclusions from such a short study with only 33 subjects taking ginkgo is simply irresponsible.  Such studies are often funded by the manufacturer.

L. Angustifolia Not as Good as Imipramine But Combination Best: In a small DB 4 weeks study of 45 MDD patients with HAM-D>17. Imipramine 100mg/d vs lavandula tincture (1:5 in 50% alcohol ) 60 drops/day or both. U Tehran, Comparison of Lavandula angustifolia Mill. tincture and imipramine in the treatment of mild to moderate depression: a double-blind, randomized trial. Akhondzadeh S, Kashani L, Fotouhi A, Jarvandi S, Mobaseri M, Moin M, Khani M, Jamshidi AH, Baghalian K, Taghizadeh M. Prog Neuropsychopharmacol Biol Psychiatry 2003 Feb;27(1):123-7

Melatonin Levels Normal But Late in Onset and Offset: In this study of 14 major depressive inpatients, compared to 14 matched controls, the results suggest that the melatonin production is phase-shifted in major depression. Serum melatonin and urinary 6-sulfatoxymelatonin in major depression. Crasson M, Kjiri S, et al. Universite de Liege, Belgium. Psychoneuroendocrinology. 2004 Jan;29(1):1-12

Melatonin: Some Help for Mild Seasonal Affective Disorder: In a DB PC 3-week study of 58 adults with subsyndromal seasonal affective disorder (s-SAD) and/or the negative or positive type of weather-associated syndrome (WAS), melatonin 2 mg at night improved the quality of sleep (P=0.03) and vitality (P=0.02) in the subjects with s-SAD, but did not help individuals with WAS, positive type. Effect of controlled-release melatonin on sleep quality, mood, and quality of life in subjects with seasonal or weather-associated changes in mood and behaviour. Leppamaki S, Partonen T, et al. National Public Health Institute,  Helsinki, Finland. Eur Neuropsychopharmacol. 2003 May;13(3):137-45.

Melatonin: No Extra Benefit from Melatonin added to Fluoxetine After ECT: DB 12 weeks after ECT. 28.5% relapse in both fluoxetine and fluoxetine + melatonin groups. Coadministration of melatonin and fluoxetine does not improve the 3-month outcome following ECT. Israel: Grunhaus L, Hirschman S, Dolberg OT, Schreiber S, Dannon PN., J ECT 2001 Jun;17(2):124-8

Melatonin May Have Helped Older Women in DB: Women over age 43 in Italy in a DB PC study took melatonin 3 mg at bedtime or placebo. Although the women not clinically depressed, the study found most reported a decrease in depressive symptoms while on melatonin. Exp Gerontol 2001 Feb;36(2):297-310. Ed: Melatonin is great for older individuals for sleep and probably for Alzheimer's prevention and stroke treatment as well.  However, I doubt that it is of much benefit for anxiety or depression. For more, see Melatonin.

Rhodiola Rosea No Depression Research But Promoted: From Russia and Scandinavian folk culture. Promoted for depression and memory. Newsweek 2/3/03 mentions Phytomedicine article 3/03 by Georg Wikman of Swedish Herbal Institute. 180 Russian cadets before and after night duty. Rhodiola DB PC reportedly helped do better on 4 abstract thought and memory tests. Richard Brown of Columbia Univ (SAMe promoter "Stop Depression Now" psychiatrist, no research of any type found on PubMed by him) has given to rhodiola to 300 patients for depression and other disorders. Another DB PC crossover of 56 physicians given 2 weeks each in Yerevan reportedly found decreased mental fatigue on overnight work during the first two week period. Abstract didn’t mention what happened during second two week period. Rhodiola rosea in stress induced fatigue--a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Darbinyan V, Kteyan A, Panossian A, Gabrielian E, Wikman G, Wagner H. Phytomedicine 2000 Oct;7(5):365-71; Another study in Volgograd with foreign students for 20 days DB PC reported less mental and physical fatigue. A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen. Spasov AA, Wikman GK, Mandrikov VB, Mironova IA, Neumoin VV. Phytomedicine 2000 Apr;7(2):85-9;

Saffron Might Help Depression: Saffron is used for depression in Persian traditional medicine. In a 6-week DB PC study of 40 adults with mild to moderate depression, a hydro-alcoholic extract of Crocus sativus (stigma) 30 mg/day did as well as fluoxetine 20 mg/day (BD). Hydro-alcoholic extract of Crocus sativus L. versus fluoxetine in the treatment of mild to moderate depression: a double-blind, randomized pilot trial. Noorbala AA, Akhondzadeh S, et al. Tehran University, Tehran, Iran. J Ethnopharmacol. 2005 Feb 28;97(2):281-4. Ed: Unfortunately, in such a small study without a control group, it is hard to tell if either group would have done better than placebo. 

Thomas E. Radecki, M.D., J.D.

 modern-psychiatry.com