Herb Research Foundation

At this year's American Psychiatric Association Meeting, which took place May 30 through June 4, 1998 in Toronto, St. John's wort was on the minds of over 2,000 psychiatrists. After years of watching this sunny plant uplift millions of people worldwide, the mental health world has elevated the plant's own status. Drawing from over 25 European clinical studies, many psychiatrists agreed that St. John's wort may have a major role to play in treating mild-to-moderate depression.

During the six-day meeting, several hundred presentations were given on standard therapies. Although only three focused on herbal alternatives, the enthusiastic response surprised even the presenters. HRF President Rob McCaleb, who served as moderator for a three-hour herb talk, noted that crowds of psychiatrists were spilling into the hallway during the presentation and eagerly buying the cassette tape before the meeting even began.

Until now, the long-standing debate between psychiatrists and psychologists has revolved around this question: who should be allowed to prescribe antianxiety and antidepressant drugs like Xanax® and Prozac®. With the current evidence about St. John's wort, kava, valerian, and other herbs, the debate has suddenly widened. For the first time, the field of psychiatry is considering the importance of herbs in mental health and the public's role in self-care. One participant at the conference, Dr. Michael Evans, staff physician at the Toronto Hospital and the University of Toronto Department of Family and Community Medicine, says he recommends St. John's wort to patients who don't meet the criteria for major depression or who refuse to take traditional antidepressants. Now, more psychiatrists like Dr. Evans are beginning to learn about and teach about herbs in their practices.

In the next five years, herbal therapies for mental health may be standard therapy, according to Rob McCaleb. Clinical evidence has already shown St. John's wort to be effective in 75% to 85% of people. Clinically tested herbs also have limited support from the FDA in the area of mental health. The government agency receives many complaints about the side effects of standard psychotherapeutic drugs. For example, the common anti-depressant drug Prozac® is associated with adverse effects such as anxiety, insomnia, nausea, weight gain, possible liver/kidney damage, and hypertension. Xanax® has been linked to dizziness, irritability, difficulty concentrating, memory impairment, seizures, jaundice, incontinence, and changes in libido. By contrast, St. John's wort rarely causes side effects. Since around 40% of depressed patients respond to placebo and up to 80% to St. Johns' wort, synthetic antidepressants should be considered a last resort, used only if safe, natural therapies fail.

At the conference, Dr. Jacques Bradwejn, psychiatrist at the Royal Ottawa Hospital, announced a new clinical study that will evaluate St. John's wort's effects on major depression. The three-year study will test St. John's wort against a standard serotonin reuptake inhibitor (SSRI) antidepressant and placebo in hundreds of patients. More than 50 of the nation's top psychiatrists competed for the 12 positions in the National Institute of Mental Health-sponsored study that began in July. Dr. Bradwejn commented, "We're very excited about this study because it will provide answers that can be integrated into mainstream mental health treatment."

Information on St. John's wort was presented at the conference by Jerry M. Cott, PhD. The other two speakers on alternative health included Michael W. Smith, MD, speaking on the overall subject of herbs in psychiatry and Dennis McKenna, PhD, presenting the latest news on kava. Charles S. Grob, MD spoke about plants and entheogens as medicine. HRF President Rob McCaleb added some study results on valerian and ginkgo and led the panel discussion on this important subject. Charles Grob also gave a presentation on the potential use of hallucinogenic plants in psychiatric practice. Discussion focused on Iboga (Tabernanthe iboga), a West African plant used in treating substance abuse, and ayahuasca or "vine of the souls," a South American plant traditionally used in religious practice. Due to overwhelming demand, organizers of the meeting decided to greatly increase the program and discussion on natural therapies next year.