The preponderance of the outcome research at this time has supported the view that chemical treatment of depression, (even the use of powerful pharmacological agents, much less herbals) is no better than basic cognitive-behavioral support or even just finding a good friend to talk to. Except in the darkest and most severe and intractable of major depressions, where it appears we need something to jolt us out of the hopelessness trap, whether it might be drugs, ECT, or even surgery.

For a striking and unexpected perspective on why people do sometimes get exceptional and unexpected results from antidepressants, refer to the current debate on the American Psychological Association's web page. There, they discuss the recent research by Irving Kirsch and colleagues purporting that most of the effects of even Prozac may actually be attributable to "placebo" or expectation effects (http://www.apa.org/releases/debate.html).

There are many things that respond usefully to placebo effects, and to generally sound nutrition, but depression seems to be one of the most responsive, especially if it is not too severe. Whatever the actual effectiveness of St. John's Wort (which is not really well established yet, but is probably "non-zero"), it is unlikely to be nearly as effective as a good human support system, proper balance of foods, and a few simple changes from pessimistic to optimistic thinking habits (for example, see University of Pennsylvania psychologist Martin Selligman's "Learned Optimism."). There is a wealth of research data supporting this so far, except, as I mentioned, in the case of very severe chronic depression.

If there are supplements that do aid in treating depression, they would probably include not only Hypericium, but also various stimulants and bioenergetics that help give some feeling of energy to lift a depressed person out of their inactivity. Sometimes, as with PMS, there are some more specific nutritional approaches, concentrated use of serotonin precursors and well-timed carbohydrates to alter hormone balance just enough to give the sufferer a feeling of energy and control, giving her more biological freedom to change her mind set and thinking patterns during that difficult time.

Just as an aside, I think most of the use of supplements adheres to this principle to some degree. Most don't really work reliably at all, and they few that do can probably attribute much of their effectiveness to other changes being made at the same time in more basic things like stress reduction, changes in bad habits, activity levels, and nutrition. One of the most important and least acknowledged principles is that any effect at all, or even just successfully adhering to a plan, tends to give people the feeling that they have more control than they previously expected.

For example, just realizing that you have the power to stop and think a half an hour before eating, take a few pills and a glass of water, and then eat more sensibly that you ordinarily would. That gives many of us a tremendous new sense of power, even if the pills turn out to have no active function in the body. Or, to borrow a trick from a famous hypnotist, getting people to change at all, even in the "wrong" direction, gets them to realize that they have the power to change themselves by their actions. Many of the bodybuilding supplements can attribute some positive effect to this increased sense of being able to control or influence some aspect of our training.

These comments are my own, and do not reflect the views of my consulting client, SmithKline Beecham Pharmaceuticals Research and Development, who graciously provide me with computer resources for my research.

Would you say that insulin is a placebo effect? Aspirin? - which is derived from an herb like most medications. Everyone's body is different. Different things are going to work for different people and some people will not experience results. Until we can actually come up with some kind of blood test or brain scan that tells us how our brains are working chemically and what and how much of a substance they need to reduce depression/anxiety, then we are pretty much in the dark with solutions except for the tedious individual "trial and error".

Though I do not get results from St. John's Wort, my sister finds it very effective for her PMS mood swings. One more point, the anti-psychotic drugs keep people from being delusional who have that mental disorder. Is this a placebo effect? I don't think so. It saddens me to hear people criticize the use of medications or herbal substances, because people who are suffering and who might truly benefit from these substances might be dissuaded from even trying them. Although it is being done unwittingly, it is still a very cruel thing to do. Have you ever read Dr. Julian Whitaker's newsletter or Vitamin Research's Nutritional News or the host of other periodicals reporting on the research and getting people healthful solutions to physiological problems that don't bring a host of side effects?