Excerpts from the book by Hyla Cass, M.D.
http://www.cassmd.com

• One Powerful Herb
• The Benefits of St. John's Wort
• Depression - A Very Common Problem
• Standard Medical Treatments
• St. John's Wort to the Rescue
  

Chapter One: One Powerful Herb

One such powerful herb is St. John's wort (wort is Old English for plant). Known botanically by its Latin name, Hypericum perforatum, for it's seemingly perforated leaves, it may have gotten its common name because it blooms around June 24, the Feast of St. John. It is native to many parts of the world, including the United States. The ancient Greeks utilized this herb for everything from the healing of wounds to the treatment of melancholy. St. John's wort is one of many herbs used by natural or holistic physicians for years as a prime example of the healing power of nature.

In this chapter, I'll first discuss the benefits and uses of St. John's wort as a part of a natural approach to psychiatry, followed by an overview of depression and its various treatments.

The Benefits of St. John's Wort
Contemporary herbalists have focused most of their attention on St. John's wort's ability to alleviate depression. For a fraction of the cost, this herb can be as effective as the prescription antidepressants and without the numerous side effects that often accompany these drugs. Dozens of clinical studies have demonstrated St. John's wort's remarkable ability to alleviate mild to moderate depression, as well as seasonal affective disorder (SAD), which is depression brought on by the absence of sunlight. In Germany, where much of this research has taken place, prescriptions for St. John's wort now outnumber those for Prozac (fluoxetine hydrochloride) by a ratio of at least 4 to 1, and possibly greater than that. As word has spread across the Atlantic, millions of Americans are switching from drugs such as Prozac and Zoloft (sertraline hydrochloride) to St. John's wort.

"I can't believe it! I feel normal for the first time in a long, long time - maybe ever."

— Cindy, a 35-year-old working mother

This powerful herb has a number of other medical uses, too. It can help the body fight off disease through its strong antiviral and antibacterial properties. Scientists have also confirmed the herb's value for such historical uses as wound healing, insomnia relief, and even treatment of premenstrual syndrome (PMS) and menstrual cramps (see Chapter 4).

Making The Natural Choice
Sometimes, choosing a natural therapy such as St. John's wort means going against a doctor's advice, as Nancy did.

It was 9 p.m., and I was still working at my computer when the phone rang. I was surprised to hear my childhood friend Nancy who generally calls only to announce births, deaths, and engagements - at the other end of the line. Her urgent tone concerned me. "What do you think about St. John's wort?" she blurted out. "I know you use herbal medicines in your practice, and I have a professional question to ask you about my dad. He's been getting more and more depressed of late, so I took him to see his doctor, who recommended an antidepressant-on top of Dad's heart and blood pressure medications. I wasn't comfortable with this approach."

Earlier that week, a friend had told Nancy about St. John's wort and depression. She was intrigued by this natural alternative to antidepressant drugs and wanted to know more. Asked about his opinion of this herb, her father's doctor said that he'd never heard of it, then laughed off her question with comments about quackery, gullibility, and snake oil. Still worried about her father and unwilling to blindly follow the doctor's prescription, she went home and dialed my number. From somewhere firmly in the middle of the medical mainstream, Nancy was reaching out for help. I told her how perfect it was that she had called. I have incorporated the use of natural substances into my psychiatric practice, reading available literature, and mutually sharing information with my colleagues to keep up with the growing field. Nancy seemed relieved that she had finally found somewhere to turn. Her questions tumbled out: "Does it really work?" "What do you think his doctor will say?" "Is it safe for him to take it with his other medications?"

She was asking all the right questions. I told her that St. John's wort would likely help her dad, but his medications were still an issue. Not a straightforward case, his use of St. John's wort would require close medical supervision by a knowledgeable doctor.

For many years I have practiced holistic psychiatry, an approach that treats the mind, body, and spirit as an indivisible whole. One aspect of this approach is referred to as orthomolecular psychiatry, which uses natural substances rather than pharmaceutically manufactured products whenever possible.

The term orthomolecular, coined by Nobel Prize-winning scientist Linus Pauling, means "the right molecule in the right place," and orthomolecular psychiatry relies on the use of molecules that occur naturally in the human body. I am familiar with the array of medications available, and even prescribe them at times. However, I have found the natural approach far more effective. Less invasive and with longer-lasting results, rather than just treating symptoms it addresses the root cause of illness. Since we are a part of nature, it makes perfect sense that natural products are more compatible with our biochemistry and thus less likely to cause harm. Nature's pharmacy has become a mainstay of my practice. Disease reflects an imbalance at some level, and I often turn to herbs to help restore inner balance. For more information on the nutritional approach to psychiatry, see Chapter 8.

Depression - A Very Common Problem
It has been estimated that 18 million Americans suffer from depression at one time or another in their lives. Clinical depression is not the brief fluctuation in mood that comes from a bad day at the office or a fight with one's spouse. Rather, it is an on-going medical illness that can consume the lives of those who are afflicted with it. Abraham Lincoln, one of many prominent people who have suffered from depression, wrote, "If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth."

For most of us, depression is a transitory feeling that passes in time, part of the ups and downs that accompany all of our lives. Clinically depressed people, on the other hand, often feel fatigued, drained of energy, empty, and hopeless. They may lose interest in the things that normally provide pleasure, even sexual activity. They may isolate themselves socially and feel quite alone. However, with proper diagnosis and treatment, including the correct use of St. John's wort where indicated, depression can often be alleviated.

There are actually several different types of depression, which we will look at more closely in Chapter 2. No individual fits any one category exactly, since depression is as variable as the persons who have it. These classifications do serve, however, as a convenient shorthand, describing symptoms, prognosis, and treatments. Those of us who practice natural medicine have found that depression can be treated with appropriate nutritional supplements and, in some cases, without any medication at all. In the absence of treatment, on the other hand, clinically depressed individuals can become immersed in a self-perpetuating negative spiral. Let's look at both the conventional approach to depression and an approach that emphasizes the use of St. John's wort.

Standard Medical Treatments
The mainstays of traditional psychiatric treatment have been psychotherapy and medication. Beginning with the psychological approach, to people who have experienced depression for their entire lives, reality feels depressing. Their mistaken beliefs and resulting b ehaviors tend only to reinforce their misperceptions. The goal of psychotherapy is to help patients come to terms with the world around them. It helps them to break dysfunctional patterns, and eventually to see things in a more positive light in order to achieve happier and more productive lives. More than simply a form of re-educating the patient, psychotherapy also involves "re-parenting" the patient, with the therapist providing a safe and nurturing context in which the patient can grow as an individual.

While psychotherapy was once the traditional domain of psychiatrists, times have changed. The availability of many well-trained non-medical psychotherapists, combined with the economic realities of reductions in insurance reimbursement and the higher fees of psy-chiatrists as compared with those of psychotherapists, often dictates a split in patient care. Therapists, including psychologists, marriage and family counselors, and social workers, are trained to know when a problem is beyond their field of expertise, and will refer the patient for psychiatric consultation when appropriate. Thus, psychiatrists often treat only the more seriously ill individuals, or act as medication consultants rather than as primary therapists. In many of these cases, psychiatrists treat depression with antidepressant medications in an attempt to counteract the chemical imbalances in the brain. We will look at the biochemical causes of depression in Chapter 3.

Over years of laboratory research, the existing antidepressant drugs have been developed to have a very specific effect. Some of them have been in use since the 1950s, and drug therapy remains a useful tool in the treatment of psychiatric illness. We will explore the characteristics of these medications in Chapter 7.

However, the antidepressants have their drawbacks. While they may be effective 60 to 80 percent of the time in treating depression, they can exact a stiff price. Many patients stop taking them because of side effects. Common side effects of Prozac include nausea, headaches, anxiety, insomnia, drowsiness, diarrhea, dry mouth, loss of appetite, sweating, tremors, short-term memory loss, and rashes. As if all of this weren't bad enough, most antidepressants also reduce your sex drive. Studies that looked specifically at sexual dysfunction found that 30 to 40 percent of all men and women taking antidepressants suffered a drop in libido.

So what is the solution? Many effective answers to depression can be found in readily available natural substances.

St. John's Wort to the Rescue
Some of the most potent therapeutic agents are herbs (see Chapter 5). Actually concentrated foods, herbs supply our bodies with essential nourishment not found in our usual diets. They promote balance by supporting the body's basic functions, helping it to regulate and heal itself. Unlike the sledgehammer approach taken by many modern drugs, herbs work to fine-tune the body into the precision instrument that it can be.

In the treatment of various types of depression, one herb stands above all the rest: St. John's wort. I have had many opportunities to see the effects of this remarkable plant. Cindy is a good example.

A 35-year-old secretary and mother of two, Cindy had been depressed on and off for years, her intermittent attempts at psychotherapy providing only temporary relief. Her family doctor, surmising correctly that there might be a biochemical component to her depression, referred her to a psychiatrist, who prescribed Prozac.

Despite some misgivings about being dependent on a drug, Cindy accepted the recommendation out of desperation. After a few weeks, the medication began to work. Her energy level increased, and she felt better about life and herself for the first time in years. She experienced renewed interest in her husband and children. Even her job, which she had come to resent, became more enjoyable, more of a positive challenge than a burden. However, after another couple of weeks, she began to notice some troubling symptoms.

During her deepest depression, Cindy had lost all interest in sex. As she began to feel better, she expected her libido to increase as well. Instead, it declined even more. Even when she did have sex, she was unable to reach an orgasm. Both sexual problems are common side effects of Prozac and drugs of that type. In addition, she felt irritable and had trouble both falling and staying asleep. Despite her exhaustion and need for sleep, she began to dread bedtime, for more reasons than one. It didn't seem fair that she was paying so high a price for her positive change in mood!

Cindy felt betrayed, angry at herself and the world in general. While her husband, Phil, had been very supportive during her days of darkness, he was now losing his patience. He took her lack of sexual interest personally, not understanding that it wasn't her fault. She stopped taking Prozac to see if that would help, but after a few weeks, the depression began to return. Cindy's doctor offered to prescribe a different medication, but she was afraid that she would just have other problems. Fortunately, a sympathetic coworker, Joan, noticed Cindy's mood swings. Joan told Cindy about her own success with a more natural approach to psychiatry.

Cindy sat across from me relating her story. Though she was an attractive, well-dressed woman, with stylishly cut black hair and large brown eyes, there was something missing. The lack of shine in her downcast eyes, the drooping corners of her mouth, and her discouraged tone gave her away. "Doctor, I've had it. My psychiatrist wanted me to try another drug, but I just can't go through that again."

Cindy's initially promising response to Prozac confirmed that her brain chemistry was indeed out of balance. She had stopped taking Prozac six weeks earlier. But instead of giving her a synthetic chemical, I prescribed St. John's wort. I told her to take three 300-milligram capsules of the dried herb daily. A little doubtful, she asked, "How can an herb that's available without a prescription be as strong as a drug and not have side effects, either?" I explained that unlike drugs, which harshly manipulate the body's chemistry, St. John's wort works with the body to gently improve mood. Somewhat reassured, she looked up at me with a hint of her former spirit. "I know you helped Joan, so I'm willing to give it a try."

I saw Cindy four weeks later, and she was looking much better. There was now a sparkle in her eyes, and she looked directly at me instead of at the floor. "I can't believe it! I feel normal for the first time in a long, long time-maybe ever." "After two weeks, I felt like I did during the early stages of Prozac, but with none of the side effects. I can think more clearly now, too. My relationship with my husband is improving daily, and," she added with a smile, "nightly, as well."

Cindy continued to take St. John's wort, reached a plateau of positive feeling and functioning, and got on with her life. She comes to see me periodically and, after more than a year, continues to do well. Her depression is behind her. We have discussed the possibility of decreasing the dose or even discontinuing it, but for now, she would rather let this herbal extract brighten her life than take a chance on having a relapse.

After years of popularity in Europe, St. John's wort has now been recognized in the United States as a valuable tool for treating depression. Inexpensive and available without a prescription, it offers new hope to millions of people. (We will look in detail at how you can use St. John's wort in Chapter 5.)

Dozens of clinical studies have been conducted on St. John's wort (see Chapter 6). More than 5,000 patients have taken part in these investigations, including more than 2,000 in controlled, double-blind studies-experiments in which neither the subject nor the researcher knows who is receiving the actual substance being tested. Time and again, the studies have shown that an average of 70 percent of depressed patients have a significant decrease in symptoms and an increase in feelings of well-being when treated with St. John's wort. This is the same average success rate achieved with the prescription antidepressants, but without the side effects.

The scientific evidence has led to the widespread use of St. John's wort in Germany, where it now accounts for half of all the prescriptions written for depression. Prozac, on the other hand, has only 2 percent of the German market.

St. John's wort's powers are derived from a number of active ingredients. Although initially considered the main active ingredient, current research indicates that the chemical hypericin does not provide the major antidepressant activity of St. John's wort. The hypericin content, however, is used as a convenient reference point when creating standardized extracts. For more information on hypericin and standardized extracts, see Chapter 5.

Bear in mind that depression can be a serious illness that requires medical attention. If you are frequently depressed, you should talk to your family physician or consult a psychiatrist about possible treatment options. This is true even if you are able to function normally at home or at work. You don't have to be bedridden or seriously depressed to need medical help. The secret to successfully treating depression is to uncover and treat both the biochemical and psychological factors that may be keeping you out of balance, so that your natural energy, initiative, and joy can shine forth. We will look at lifestyle and depression in Chapter 9.

St. John's wort is rapidly becoming the most frequently used antidepressant medication in the world. This safe and effective herb is taken by more than 20 million Germans on a daily basis, and it is recommended by psychiatrists throughout Europe. Now, Americans have awakened to its enormous potential.

Knowledge is vital to establishing control and positive direction in your life. In the following pages, you'll learn about the various psychological, nutritional, and medical factors that are involved in treating depression, and the role of St. John's wort in such treatment. You will receive detailed information on the proper dosages to take, and you will find out about the studies that have confirmed the herb's effectiveness around the world. You'll also see how St. John's wort fares when compared with the prescription antidepressants.

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