
DATE: Saturday, August 2, 1997              TAG: 9708020041

SECTION: DAILY BREAK             PAGE: E1   EDITION: FINAL 

SOURCE: BY PAT DOOLEY, STAFF WRITER 

                                            LENGTH:  196 lines

HERBAL TREATMENT FOR DEPRESSION AREA SHOPPERS SCOOP UP BOTTLES OF ST. JOHN'S WORT.

ABOUT TWO years ago, Ed Atkinson would awaken every morning and pray for the strength to get out of bed.

A recovering alcoholic, Atkinson was in the early days of abstinence after a 15-year battle with drinking.

``I was very depressed for about the first six months of sobriety,'' said Atkinson, who lives in Virginia Beach.

With the help of a therapist, Alcoholics Anonymous and a psychiatrist who prescribed the antidepressants Zoloft and, later, Paxil, Atkinson made it through the dark days of early recovery.

The antidepressants helped stabilize his moods, but he didn't like the side effects, which can include fatigue, irritability and sexual dysfunction.

Then a friend told him about an ancient herb known for its antidepressant powers and few, if any, negative effects. Called St. John's wort, or Hypericum perforatum, it was available in health-food stores, cost a few cents a day and did not require a prescription.

Atkinson liked the idea of taking ``something more natural,'' and asked his psychiatrist about the herb. Soon, he began ``phasing off Paxil and phasing onto St. John's wort.''

To Atkinson's delight, it seemed to ease the grayness that was his depression.

Back then, Atkinson and his doctor were among a small number of people in the United States turning to Hypericum, a yellow flowering herb native to Europe, western Asia and northern Africa.

But these days, they are far from alone.

In late June, television's ``20/20'' aired a segment about the herb and the work of Dr. Harold H. Bloomfield, a Yale University-trained psychiatrist and author who uses St. John's wort to treat depression.

Since then, people in Hampton Roads and elsewhere have been asking their doctors about the herb. Consumers also have been scooping up copies of ``Hypericum & Depression,'' which Bloomfield co-wrote last year, and emptying health-food-store shelves of bottles of the grayish-brown, vitamin pill-size capsules.

Some say it's just one sign of a growing movement toward unconventional therapies in the United States, where an estimated 18 million people suffer from depression.

At the Heritage Store in Virginia Beach, for example, shoppers bought five dozen bottles of St. John's wort during one recent weekend, said herb buyer Tina Griffin.

Although the store long has stocked Hypericum, sales ``really exploded since the television show,'' Griffin said. ``We've gone through hundreds, if not thousands, of bottles in a couple of weeks.''

Local health professionals, too, say patients are curious about the herb, in turn leading physicians to learn more about it themselves.

Dr. Barry Lubin, a Norfolk internist who treats many patients for depression, says that ``there has been a tremendous amount of interest'' in St. John's wort.

Like other doctors, Lubin has seen many patients benefit from synthetic antidepressant medicines. Side effects generally are minimal with the newest class of drugs, including Prozac, Zoloft and Paxil. Older classes of antidepressants are as effective but often produce more potent, but unwanted, effects.

Some people are looking for alternatives, Lubin said. In the past couple of months, about 10 patients have asked him about Hypericum.

Across the United States, consumers are eager for information about nontraditional therapies. According to a report in the July 15 issue of Patient Care, alternative therapies were used by one in three adults in 1990.

Nearly 60 million Americans use herbs to treat colds, burns, headaches, depression and other ailments, resulting in a $3.2 billion market for botanically based products, according to a February survey by Prevention magazine.

For doctors practicing conventional medicine, the public's growing interest poses a question of how - or whether - to incorporate alternative therapies, many of which have not been been extensively tested in the United States.

St. John's wort, for example, has been widely studied and used in Western Europe. It is the No. 1 antidepressant in Germany - outselling even Prozac, the most-prescribed antidepressant in the United States.

In August 1996, the British Medical Journal published an overview of 23 clinical studies involving more than 1,700 patients abroad. It concluded that Hypericum has antidepressive properties in cases of mild to moderate depression but requires long-term study.

In this country, where the herb is classified as a dietary supplement, it has received little scrutiny. Manufacturers of supplements are not required to meet the same standards for safety and efficacy as are the makers of over-the-counter and prescription drugs.

Lubin believes St. John's wort holds promise. He does not recommend it for people with severe depression, but for others using Prozac or Prozac-type drugs who want something more natural, he believes the herb may be worth a try.

A few patients are using it, he says, but it's too early to tell if they'll benefit. Like other antidepressants, St. John's wort takes up to six weeks to become effective.

Dr. Cynthia Galumbeck, a Virginia Beach psychiatrist, believes the herb probably isn't harmful and, like several local doctors interviewed for this story, says she would be comfortable letting some patients try it with supervision.

But she and some other doctors say valuable treatment time may be lost if the herb has no effect. About 20 antidepressants on the market nationally have been proven safe and effective for about 80 percent of patients.

Just because a product is popular - or labeled ``herbal'' - doesn't mean it works, says Dr. Suzanne E. Dundon, a Virginia Beach psychiatrist, who discourages patients from using St. John's wort.

Such products are chemicals that have not been thoroughly tested, she says. They may not do anything, she says, or may even be harmful.

Anyone who believes he is depressed should seek a professional's help, she says, adding, ``Talk to a doctor or a psychiatrist rather than trying to wing it.''

Bloomfield, author of the Hypericum best seller, admits more substantial information on the herb is needed, especially in this country.

In June, the National Institutes of Health announced it will launch a study into the safety and effectiveness of Hypericum, spurred in part by growing public interest.

In the past four years, Bloomfield has treated more than 400 patients with Hypericum.

About 80 percent of patients get relief, mostly from mild to moderate depression. But Bloomfield says he also has successfully treated some severely depressed patients.

``Many people experience the depression lifting and a boost in energy,'' he says, adding that Hypericum is not stimulating or addictive. It works similarly to Prozac, inhibiting reabsorption of the brain chemical serotonin and producing feelings of well-being.

Bloomfield generally recommends a daily divided dosage of three 300-milligram capsules containing 0.3 percent hypericin extract. That is the amount used for most research, but is not always what's bottled and sold in stores.

``There's junk out there,'' he says, and suggests consumers read the label. He also warns them that abruptly discontinuing their synthetic antidepressants can cause rebound depression.

He sometimes weans patients from their antidepressants while starting them on Hypericum. Others benefit from a combination of Prozac-type antidepressants and St. John's wort.

Side effects are rare but can include gastrointestinal upset and sensitivity to sun or bright lights.

Bloomfield says Hypericum is more than this month's hot item at the health-food store. He welcomes the studies, which he believes will prove him right.

``We by no means know everything about Hypericum,'' he says, ``but the word was too good not to get the word out.''

At the Whole Foods Co-op in Norfolk, which has had trouble keeping the herb in stock, clerk Heidi Grass decided to try it herself.

Grass had been severely depressed earlier this year, after the antiques shop she worked in closed and she lost her job, and her husband said he wanted a divorce.

``I was in tears all the time,'' she says.

A psychiatrist prescribed Zoloft, which eased Grass's depression but made her jittery. Then she heard about Hypericum.

``If I can find an alternative to medication, I'm there,'' she says.

Her doctor didn't recommend she try it, but she went against his advice, cut back on Zoloft and started taking St. John's wort.

She says it's too soon to know if it's working, but like Ed Atkinson, Grass believes Hypericum is right for her.

``I know it's OK,'' she says.

As for Atkinson, he occasionally stops taking the herb - as a kind of test. But he always comes back to it.

``The St. John's wort tends to keep my emotions on an even keel,'' says Atkinson, a self-employed heating and air conditioning repairman, who lost nearly everything to his drinking.

Still active in Alcoholics Anonymous, he's gradually pulling his life back together.

``I'm not walking around in some kind of stupor,'' he says, describing the herb's mild antidepressant effect.

``It's keeping me on track so I can function effectively in my life.'' ILLUSTRATION: Color Photo

Martin Smith-Rodden

Ed Atkinson...

STAFF FILE PHOTO

[bottle of St. John's Wort]

Graphic

ABOUT ST. JOHN'S WORT

St. John's wort, or Hypericum perforatum, is a yellow flowering

herb native to Europe, western Asia and northern Africa.

Pliny and Hippocrates used the herb to treat many illnesses. It