So you’ve heard all about this stuff called St. John’s wort.
It’s been trumpeted as a totally natural elixir for the blues–but you wonder: Does it really work? And is it safe?
Now, for the first time, medical school researchers in Miami and across the nation will use the tools of traditional medicine to assess the worthiness of a pill from a realm once dismissed with cackles as “alternative” medicine.
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For health care in America, it is a seminal moment, the traditional and the alternative united in a shotgun marriage that’s a product of scientific curiosity and economics. As more and more patients inform their physicians that they rely on a hodgepodge of herbs and minerals to lift them up and bring them down, doctors increasingly are eager to unlock the secrets that sit bottled on the shelves of health-food stores.
“People have been using it right and left without knowing how it works, without knowing anything about its safety,” says Dr. Paul J. Goodnick, the University of Miami psychiatrist who’s presiding over the South Florida portion of a national study of St. John’s wort. “But they keep using it because it’s available, and it requires no doctor’s appointment, and it’s relatively affordable, and nobody has to know you’re taking it.
“In a sense, by studying something like St. John’s, we, in medicine, are just coming back to where we started from.”
The University of Miami is among 10 research centers investigating the strength and safety of St. John’s wort. They want to study people who suffer more than the occasional down-in-the-dumps: They want to evaluate the herb’s effects in people with the kind of depression that leaves them feeling forlorn most of the day, that causes them to sleep too much or too little, eat too much or too little, the kind of depression that prompts thoughts of suicide.
St. John’s wort supplements have soared in popularity in the past couple of years. That’s since an analysis of 23 European medical studies documented that the herb seemed to ease mild to moderate depression and had only mild side effects.
The American researchers want to hold the herb to a more rigorous standard, using the kind of measures applied to experimental drugs for cancer and heart disease and other medical conditions.
In all, 20 people will be studied at the University of Miami. They will be divided evenly, with half getting St. John’s wort for eight weeks, half getting a placebo, or dummy pill, containing none of the herb. A battery of diagnostic tests will be used by psychiatrists–and by the patients themselves–to determine the status of their depression throughout the study. The drug company Pfizer, which makes anti-depressants but does not produce St. John’s wort, is underwriting the research.
At 42, Heather Rockcastle has already had both hips replaced, survived 17 operations for a variety of ailments–and watched a successful career as an orthopedic nurse wither.
“I had moments I was feeling so depressed,” says Rockcastle, who lives in Coral Gables. “I thought, if I could just put that gas pedal to the metal and run into that tree, I would just do it. I’d never tried St. John’s, and I wondered: Is this hocus-pocus, or is it great?”
So she enrolled in the University of Miami study. As the weeks passed, she felt better and better.
In the eighth week, patient and scientist–neither knew whether she was getting the real thing or a placebo–broke the seal that told them the truth. Rockcastle, it turned out, had been downing placebo pills.
“The mind,” Rockcastle says, “is a great thing.”
Even a result such as this is useful to scientists because it tells them something about the value of the interaction she had with researchers during the study. It’s the kind of result that fascinates Murali Doraiswamy, director of clinical trials in the department of psychiatry at Duke University.
Duke is headquarters of a separate St. John’s wort study paid for by the National Center for Complementary and Alternative Medicine, a branch of the National Institutes of Health. It’s similar to the work being done at UM, but differs in one critical way: It splits patients among three groups, with one-third getting St. John’s, one-third getting a placebo and one-third getting the anti-depressant drug Zoloft.
Like the researchers involved in the other study, the scientists at Duke and the 11 other medical schools participating in the NIH investigation–including the University of South Florida in Tampa–hope their work on St. John’s can serve as a model for investigating other herbs and minerals.
“I grew up in India, exposed quite a bit to herbal remedies and naturalistic treatment and lifestyle change as part of the overall medical treatment of a patient,” Doraiswamy says. “So when someone comes into my office and tells me they’re taking St. John’s wort, my first reaction is not that you’re stupid or you’re wasting your money, but I go through the literature with them and tell them I think the jury’s still out.
“But I hope we’re getting closer to a verdict.”