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6. SEVERE DEPRESSION
Despite conflicting clinical evidence, Mischoulon and Rosenbaum express hope that
St. John’s wort may eventually be found effective in moderate to severe depression.
But this hope is not shared by the other sources. Berkeley Wellness Reports is more
pessimistic, stating flatly that studies do not support the use of St. John’s wort for
severe depression, depression of long duration, or bipolar disorder. The Natural
Standard describes the scientific evidence for use of St. John’s wort for moderate to
severe depression as “unclear” and “speculative,” and the Mayo Clinic focuses on the
negative studies, counseling the use of stronger medications. Even Consumer Reports
limits its endorsement to “some forms” of depression, presumably excluding moderate
to severe symptoms.
2002 NIMH/NCCAM HYPERICUM DEPRESSION STUDY. The most important reasons why
it is so difficult to evaluate the effectiveness of St. John’s in severe depression is that
preparations of the drug are not standardized and severe depression is notoriously
subject to spontaneous remission, as illustrated by the high placebo response (32%) in
the landmark 2002 NIMH/NCCAM Hypericum Depression study, which compared to a
24% remission rate for St. John’s wort and sertraline (Zoloft ) and thus cast doubt on
the efficacy of St. John’s wort in moderate to severe depression.^12
With regard to the 2002 NIMH/NCCAM Hypericum Depression study, Mischoulon and
Rosenbaum point out that a 32% placebo remission rate is, in and of itself, a statistical
anomaly, and that the occasional high spontaneous remission rate of depressive
symptoms, especially in people with moderate to severe depression, makes it difficult
to assess the efficacy of mental health interventions. Thus, according to Mischoulon,
the emphasis in the 2002 study should have been on the significant finding of
equivalency of efficacy between St. John’s wort and sertraline (Zoloft), a well-
recognized antidepressant, more than on the difference between both and the high
placebo remission rate found in the study. However, the 2002 study had a negative
effect on public perception, casting doubt on all depression medications, herbal and
