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Arguably, one of the most popular herbal medications on the market now is St. John's Wort (Hypericum perforatum). This herbal product is available in any drug or health store and is marketed for improving mood and sense of well-being.

Hypericum perforatum is a low-growing perennial plant found throughout the Americas, Europe and Asia. Its star-shaped yellow flowers and the plant tops are used to extract the medicinal herb known as St. John's Wort. Use of this plant as medicine is ancient.
St. John's Wort was approved for treatment of depression in Germany in 1984. Its use is controlled by prescription there and a modest level of relief from depression symptoms have been reported with short-term use of the drug. The popularity of St. John's Wort in the U.S. began to accelerate in the mid 90's with sales reaching a reported $45 million in 1997.

St. John's Wort appears to work by restricting the ability of nerve cells to reabsorb serotonin. Serotonin is a neurotransmitter associated with elevated mood. When serotonin is not reabsorbed in nerve cells, a higher concentration of the chemical remains in the bloodstream. St. John's Wort has been called "Nature's Prozac" for this reason; it acts on the body in much the same way as Prozac and other Standard Serotonin Reuptake Inhibitors (SSRI's).

The problems with St. John's Wort are several. In the U.S., St. John's Wort is considered a dietary supplement and not a drug. The 1994 Dietary Supplement Health and Education Act allows this and many other herbal products to be produced, marketed and sold with little or no regulation. Proponents of the Act argue that this gives American's the freedom to make choices about their health care; allowing for alternative medical answers. However, it also means that the commercially available products are not regulated in terms of controlled dose, labeling or marketing claims.

Given this information and the fact that the herbal supplements comprise a multi-billion dollar industry, the potential for fraud and abuse arises. Controlled dosing is one of the first concerns. As a natural product, it's difficult to control the potency of hypericum extract. Concentrations of the active agent vary from plant to plant and from season to season. This variance creates a product with no stable concentration of the active ingredient; a situation that would be completely intolerable in the pharmaceutical industry. Stable dosing using products purchased over the counter cannot be achieved.
Since little or no regulation exists for labeling of herbal supplements, potential side effects and drug interactions are often not found on the packaging of the products. St. John's Wort is generally purchased to help alleviate the symptoms of depression; a medical condition. So, the product is purchased to be used as medicine. Without the ability to regulate dose and without warnings of complications, side effects and interactions, the potential for serious complications now exists.
The problem of diagnosis is another concern. Clinical depression is a potentially serious illness. Self-diagnosis and treatment may not be wise. Treating the symptoms of illness without determining the cause only opens up the possibility of relapse or masking of the illness. Once treatment is stopped, could not the symptoms reappear more profound than at first? And, with clinical depression as the underlying illness, the potential for suicide always exists. Proper diagnosis should be made by a licensed health professional before treatments with any medicine begin.
Serious side effects and drug interactions are possible with St. John's Wort. Pregnant or nursing women should not take St. John's Wort. Photosensitivity can occur with this drug. St. John's Wort should not be combined with any other antidepressant, unless recommended by a physician, as overdosing may occur. Allergic reactions can occur; persons using this medicine should be alert to this possibility. If rash, itching, shortness of breath or difficulty breathing, swelling of the throat or face occur, discontinue use immediately and consult a physician.

Stomach upset and nausea are possible. Restlessness, irritability, sleeplessness or sluggish feeling, and headaches may occur. Avoid foods containing concentrated amounts of tyramine; aged cheeses, smoked, pickled or cured meats, beer, wine and hard liquor. Consult a physician for complete list of foods to avoid. St. John's Wort may interact with tyramine causing severe headache, rise in blood pressure or irregular heartbeat.

Serious interactions have been reported between hypericum and the drugs indinavir and cyclosporine. Changes in drug effects can occur when medications such as cyclosporine, digoxin and warfarin are taken with St. John’s Wort.

There is empirical evidence that St. John's Wort is more effective than placebo in the treatment of mild to moderate depression and significant anecdotal evidence also suggests that St. John's Wort can be an effective treatment of mild to moderate depression.
Things to remember:
· St. John's Wort is a drug.
· This drug has the potential to cause side effects, allergic reactions and to interact with other medications.
· Standardized dosing is difficult to achieve with over the counter products.
· Depression is a serious illness and should be diagnosed by a physician. Drug therapy of any kind should be discussed with a physician.