Even though research is still going on, the available data show that Hypericum extract is clinically effective as an anti-depressant drug and that it probably works by biochemical mechanisms not so much different from the mechanisms of action of the tricyclics or the SSRIs. We feel that these findings are important enough to be communicated and interesting enough to stimulate further research.
Walter E. Muller, Frankfurt Siegfried Rasper, Vienna 1997
The modern era of research into St John’s Wort was ushered in by the German Health Department, which set up Commission E to investigate the many herbal remedies in general use in Germany and to find out for which of these there was reasonable evidence of efficacy. Commission E came out with its report in 1984 and identified approximately 300 herbs for which such evidence existed. Shortly after this, certain German pharmaceutical companies targeted some of these herbs as worthy of particular research attention; St John’s Wort was one of these herbs.
Research into a new treatment, such as St John’s Wort for depression, usually develops in predictable ways. One needs to establish whether the treatment actually works, who benefits most from it, what dosages are appropriate and for how long treatment should be continued. Side-effects need to be documented. Only once a treatment is regarded as safe and effective does attention usually turn to how the treatment actually works. Research in St John’s Wort is ongoing, but so far it has taken these expected directions. In this chapter I summarize the state of the art of research on the herbal anti-depressant.
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Maurice, aged thirty-seven, found it difficult to establish a normal sleeping pattern after frequent business trips to America. Mogadon was prescribed and he found the jet-lag easier to cope with. After three months he was not travelling so much and felt he did not need the tablets. His insomnia became worse than he had ever known it. He had palpitations and a tight feeling in his chest, and also had digestive problems.
His doctor was kind and sympathetic but said he did not think Maurice had been on the tablets long enough for dependence to have developed. The doctor suggested going back on the full dose to see what happened.
Maurice’s symptoms were much improved when he visited the surgery a week later. His doctor said that he had discussed the case with his partner who had two patients who had experienced similar problems, although they had taken the tablets over a longer period.
Complete withdrawal took six weeks. For the following three weeks Maurice felt ‘off colour’ but did not have any dramatic symptoms. After that he was back to normal.
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Skin Problems
These should always be investigated in case there is another cause. The ones most commonly reported are: dryness, itching, a dry scaly rash (often on the hands or over the bridge of the nose and on to the cheeks), spontaneous bruising and skin breaking easily. Minor cuts often take a long time to heal. Many people notice a change in skin colour. It can have a slightly jaundiced or pale brown appearance. Often a dramatic improvement can be seen in the condition of the skin even in the early days of withdrawal.
Dental Problems
The high incidence of premature tooth loss (apart from extractions because of the jaw pain) in people who have been on tranquillizers for years is another pointer to inadequate nutrition. (The same may be said for split nails.)
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You may feel delighted that you have managed to cut down or stop taking your pills, but be puzzled by how down you feel. This is another temporary state to endure. It will improve or disappear altogether when you are through withdrawal. Many people who have loving families and no financial worries, or stress of any kind, feel guilty about being so down.
Withdrawal blues do not single out people with life problems, many people have a temporary ‘down’. Sometimes the depressive symptoms are delayed and appear when the sufferers feel they are coping well. Try not to get discouraged if this happens—it will pass. If it gets too much for you to cope with, your doctor may want to give you an anti-depressant for a short time. Many find this a help, but realize it is a temporary measure. Gradual reduction from these drugs is advisable.
Depression may manifest itself in ways other than extreme sadness. Here are some of them: sighing; sluggishness; headaches; nausea; constipation; heavy limbs; feeling bloated; needing more sleep; time passing slowly; losing interest in people; feeling that people do not want to see you; isolating yourself; losing interest in appearance; loss of appetite; compulsive eating (particularly sweet foods); being annoyed out of proportion to the situation; feeling a black cloud or shape over your head or on your shoulders; finding mornings are worse and having to force yourself from the oblivion of sleep; people you love seeming far away—you know you love them but cannot feel it—you feel guilty and worry about this; the smallest task seems beyond you; you feel worthless—how could anyone love you; you feel a burden.
Many people are slow to accept the physical symptoms they have as depressive symptoms. That is not to say that it is ‘all in the mind’—far from it. It usually starts in the mind and then affects the body.
Suppressed emotions such as fear, anger, hurt and jealousy, actually cause chemical changes to take place. It is the altered body chemistry that is responsible for the physical changes. It can happen the other way too. A physical change can cause depression. Influenza, anaemia, bad nutrition, food allergies, certain glandular disorders, and hormonal changes such as at puberty, the menopause, and after childbirth, are all common causes of altered emotional states.
So often the sufferer will say ‘If I did not feel exhausted, sick, heavy-limbed, etc. I would not be depressed.’ In fact, it is often the other way around. If they were not depressed, they would not have the physical symptoms. So until you recognize that you are depressed, you cannot do anything about it.
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It will take time for the body’s normal chemicals to be produced again. When you understand that there is a definite physiological reason why you may feel more anxious during withdrawal, this will give you the confidence to ignore the ‘pull yourself together’ brigade. This point is also illustrated by the large numbers of people who are prescribed these drugs for a physical reason who also have anxiety symptoms on withdrawal.
When you have a major problem or upset in life, it is often necessary to relieve anxiety for a short time, but it is a great mistake to carry on for months or years. Not only does the user run the risk of dependence, but also because the emotions are dulled, he or she is unable to adjust to the loss or altered situation. This is particularly so in bereavement. The user has to face the grief again when medication ceases, and may feel severe guilt about not grieving at the appropriate time. Because the suppressed emotions of years come to the surface in withdrawal, many people are able to face old conflicts and traumas, and in doing so, lose some of their fears, and gain self-respect.
To illustrate how many (although it is agreed not all) of the withdrawal symptoms are due to rebound anxiety, here are anxiety symptoms listed under ‘Anxiety Neurosis’ from the Oxford Textbook of Psychiatry (1983), Ed. Gelder, Gath and Mayou. Some people have found this section rather technical, others were finally convinced (because the source was beyond dispute) that they were not suffering from some serious physical illness.
Anxiety neuroses have psychological and physical symptoms. The psychological symptoms are the familiar feeling of fearful anticipation that gives the condition its name, irritability, difficulty in concentration, sensitivity to noise, and a feeling of restlessness.
Patients often complain of poor memory when they are really experiencing the effects of failure to concentrate.
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