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Herbal Remedy Works for Depression -- but Only in Germany

October 08, 2008 6:30 AM

By Michelle Schlief, ABC News Medical Unit

I hope you'll trust me that I've had enough personal experience with depression, including supporting and helping friends and family who suffer from the disorder, to say that I don't find it to be a laughing matter.

But I find myself really wondering about this new study that looks at St. John's wort, a popular herbal remedy for depression. The good news is that according to this new analysis, it appears to work just as well as some prescription drugs for major depression (the most serious form); the bad news (for most of us) is that you apparently need to be German to experience the effect.

No fooling.

According to Klaus Linde of the Technical University in Munich, and the lead author of the analysis, "Trials from German-speaking countries have clearly more positive effects, both compared to placebo and standard antidepressants, than trials from elsewhere." The remedy's effectiveness in other countries remains uncertain, he said.

Holy glockenspiel, Batman!

Immediately, I'm wondering if my descendants can reap any benefit out of my one-quarter German-ness. Maybe I'm finally finding the real perks of having that surname that nobody ever gets quite right.

But I'm getting way ahead of myself. This analysis that I'm talking about is actually a meta-analysis from the Cochrane Collaboration, an international group that evaluates health-related research.

Meta-analyses examine the results of multiple studies that have set out to address similar questions. You might, for instance, want to see the results of a meta-analysis when you have several smallish studies with results that aren’t significant and seem to contradict one other, or have otherwise proved inconclusive. By pooling the data, meta-analyses allow you to come to more accurate conclusions based on all of the data.

But I know what you're thinking -- and yes, the classic problem with meta-analyses is the old garbage in, garbage out. A good meta-analysis of badly designed studies will still result in bad statistics. And although the Cochrane Collaboration is well respected and discriminating in its analysis, I still have my questions.

Is this due to a placebo effect -- and if so, why are Germans more susceptible?

Research supports the idea that the placebo effect is real. And recent data suggests that beliefs can affect the strength of the effect -- for instance, volunteers had greater placebo-based pain relief when they believed that their (sugar) pills were expensive. Their bodies seemed to really think that they were getting what they’d paid for. So perhaps the way these studies are conducted in German-speaking countries lends itself to stronger beliefs about the effects of pills?    

Or is this a heritable effect based on having German ancestors -- for instance something genetic or epigenetic?

Different people respond to different medications and treatments for depression -- this is almost certainly because what we call depression is actually a collection of different disorders with different underlying psychological and biological mechanisms.

And more than a few diseases have been linked specifically back to our ancestors. Sickle cell anemia is more common in those whose ancestors lived in Africa, the Mediterranean and the Arabian Peninsula; heart attack risk due to a particular genetic variant more common in African-Americans than in European Americans; and Parkinson’s disease is twice as likely to develop in a subset of people whose ancestors are from China. Interestingly, it's believed that most of those with the mutation are descendants of a common ancestor.

Or maybe this is an artifact of German culture -- it's unlikely, but could they be using a different standard of normality?

If my melancholy is your business as usual, then I can see how a discrepancy could emerge.

Or perhaps there is a systematic design flaw in either the German or the non-German studies?

The authors have tried to control for all variables reported among experiments, but there could easily be something besides living in a German-speaking country that everyone is overlooking.

The bottom line for me is that St. John's wort has already been shown to be effective in treating mild and moderate depression, regardless of where your ancestors called home. I'm not, however, convinced that it's the perfect therapy for everyone with major depression. But if St. John's wort helps anyone who can't or won't or who just isn't interested in taking prescription medication for depression -- if it serves as a first step or even the only necessary step for anyone who isn't comfortable or able to talk with a mental health professional -- then I'm for it.

But as with any major lifestyle change, it's critical to consult your doctor before proceeding.

And like other dietary supplements, St. Johns wort isn’t regulated by the FDA. The daily dose of extract tested in the analyzed trials was between 500 and 1,200 milligrams. And as you know, there can be huge differences between different brands. 

Finally, keep in mind that what works for somebody else may not work for you. Many other options exist including talk therapy.

What do you think?

October 8, 2008 | Permalink | User Comments (4)

User Comments

Posted by: Ted | Oct 8, 2008 8:04:55 PM

Posted by: Austin Lee | Oct 8, 2008 9:37:20 PM

Posted by: Andrew | Oct 14, 2008 4:58:13 PM

Posted by: xfnlcsjpi ndhktj | Mar 20, 2009 4:08:27 AM

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