St. John's wort and depression

Q: I have been depressed for over five years now, and I have tried different medications for it, like Prozac and Celexa. They didn't seem to work very well, so I stopped. I read about St. John's wort for depression, and I was going to try it. What are your thoughts about it?

A: St. John's wort is an herb that is well known for treating depression. You may also see it called Hypericum perforatum, which is its Latin name. European studies on specific, standardized St. John's wort extracts have shown that it is beneficial for people with mild to moderate depression. Some of the extracts that have been studied include Kira, Remotiv and Movana, which are available here in the United States.

Based on your question, though, I'm not convinced that you fit in the category of mild to moderate depression. In that case, St. John's wort may not be the right choice for you.

And based on the fact that you have tried two medications, and they have not worked, you may need to explore more than just a pill — regardless of whether it is a supplement or a prescription — to achieve results. Remember that for people with recurrent symptoms, or depression for more than two years, it definitely helps to go for counseling in addition to using medication. Also, even if the two medications above didn't work, you may still benefit from using one from a slightly different class, so I think it is worth talking about it with your doctor.

Some people I see worry about using prescription medication to treat depression. They are nervous that medication doesn't address the underlying problems, and that if they take away the symptoms of depression, they won't have any incentive to deal with those issues.

I think the answer here depends on where you are. It is certainly true that a pill doesn't take away your problems. On the other hand, sometimes people are so impaired by their feelings of sadness, guilt, etc., that they simply can't function. If that is the case, sometimes people need medication to start moving again.

Ultimately, depression always requires more than just a prescription. Like all illness, depression is an opportunity to stop and pay attention to our lives. If we ignore that opportunity, it will show up again in another way, and often more seriously. So I generally recommend counseling, and other types of emotional and mental processing, for everyone I see with depression.

Dr. Astrid Pujari is a Seattle M.D. with an additional degree as a medical herbalist; she practices at the Pujari Center and teaches as part of the residency programs at Virginia Mason and Swedish/Cherry Hill hospitals. Send questions to apujari@seattletimes.com for possible use in future columns. All information is intended for education and not a substitute for medical advice. Consult your doctor before following any suggestions given here.