NATURE'S PROZAC?

By J. MADELEINE NASH

To dispel the dark moods that dogged her through life, Truen Bergen tried every antidepressant imaginable. But she hated the side effects, which ranged from a sharp prickling sensation to mild hypertension. Then she heard about St. John's wort, a medicinal herb that has been used for centuries in teas and tinctures. "I figured it couldn't be any worse than the medication I was already taking," says Bergen, 49, an airline purser from San Diego, Calif. "Then, after two or three weeks, it dawned on me. I felt balanced and good. I felt happy."

A folk remedy? You bet. But St. John's wort--or Hypericum perforatum, as scientists call it--is not just another weed. It has attracted a huge following in Europe, and is now catching on in the U.S. According to Dr. Harold Bloomfield, author of Hypericum & Depression (Prelude Press; $7.95), this pretty yellow-flowered plant is nature's own antidepressant--almost as potent as the prescription drug Prozac but without Prozac's troubling side effects. St. John's wort may not work for everyone, acknowledges Bloomfield, a psychiatrist in Del Mar, Calif. "But to those for whom it does work, it's like a godsend!"

Suddenly St. John's wort is hot--especially with the media. Barbara Walters spoke on ABC's 20/20 about the "simple herb that could change the lives of millions of Americans who suffer from depression," and last week the New York Times ran two stories in as many days calling St. John's wort "a gentle remedy" and "a rival to Prozac." Pills and potions containing extracts of hypericum are selling briskly in supermarkets and health-store chains from New York to California. "We are stunned and pleased," says Karl-Heinz Siewert, managing director of Lichtwer Pharma, a Berlin-based company that markets hypericum under the brands Kira and Jarsin.

The hoopla over hypericum began in Germany, where Jarsin, not Prozac, is the No. 1 antidepressant. This isn't as surprising as it may sound. German physicians are far more willing than their American counterparts to recommend herbal medications to patients. And a string of studies by German scientists, many of them sponsored by Lichtwer, have built a tantalizing if tentative case for hypericum's effectiveness as a treatment for mild and moderate depression. The result: so many German psychiatrists and general practitioners now recommend hypericum preparations that sales have soared from $23 million in 1994 to $66 million last year.

But does the evidence of hypericum's efficacy have real scientific validity? To some extent it does. Last year, for example, the British Medical Journal published a review of 23 clinical trials that attempted to measure the compound's therapeutic potential. Many of these trials indicated that patients on hypericum showed more improvement than patients treated with placebos. The studies, however, were small (most involved only a few dozen patients) and relatively short term (the longest lasted no more than eight weeks).

Over the coming years, nagging questions about hypericum's effectiveness and safety may finally be settled. The National Institutes of Health is laying plans for a large clinical trial that will directly compare hypericum with the best antidepressants. But until the results are in, there is reason to be cautious. Like all plants, hypericum contains a wide variety of compounds, including one that is known to cause sun sensitivity. Hypericum's effects in combination with other drugs are also cause for concern. Psychiatrists worry about the so-called serotonin syndrome, a kind of biochemical overload brought on by combining several antidepressants. Among the symptoms: nausea, slurred speech and muscle spasms.

Still, the German experience suggests that St. John's wort is relatively harmless. "Millions of people have taken, or are now taking, hypericum," observes Jerry Cott, a Maryland-based pharmacologist, "and none of the side effects reported have been anything like those we've seen with drugs like Prozac. That's kind of exciting." Indeed, just as aspirin (whose active ingredient was first isolated from the bark of the willow tree) has spurred the development of a new generation of anti-inflammatories, so hypericum may eventually stimulate the creation of safer, more powerful, antidepressant drugs.

Biochemically, hypericum has some interesting properties. For starters, says University of Frankfurt psychopharmacologist Walter Muller, it appears to affect the brain in the same way Prozac does--by prolonging the activity of the mood-enhancing brain chemical serotonin. This is the same neurotransmitter acted on by the controversial diet pills fen-phen and Redux (see following story). But hypericum has much broader activity. In rats and mice, at least, it extends the action of at least two other powerful brain chemicals that are thought to play a role in depression: dopamine and norepinephrine. In each case, hypericum appears to work not by stimulating the release of the neurotransmitters, but by preventing their reabsorption by nearby nerve fibers.

Despite its promise, experts agree that hypericum should not be viewed as an off-the-shelf solution for depression, especially severe depression that prompts suicidal thoughts. Nor should it be casually ingested in hopes of relieving a milder state of the blues. As Dr. Stephen Barrett, a co-author of the American Medical Association's Reader's Guide to Alternative Health Methods, observes, "Most people with mild depression will do better with psychotherapy than with drugs. Therapy is generally more effective for these people in the long run than taking a pill--even if the pill works."

--Reported by Dan Cray/Los Angeles, Alice Park/New York and Ursula Sautter/Bonn

With reporting by DAN CRAY/LOS ANGELES, ALICE PARK/NEW YORK AND URSULA SAUTTER/BONN