St. John’s Worts vs. SSRI for depression

St. John’s Wort or SSRI’s for depression? This is a common question posed by patient’s but there is often misunderstanding behind these natural supplements. Some people are more willing to trying “natural” products such as supplements and are not willing to take pharmaceutical products which on the surface is understandable. I learned however over time that the supplement market is so poorly regulated that there is often problems with the more natural products. Putting the regulation aside and assuming one gets a high quality form of St. John’s wort, which one is better?

The bottom line is there is very little difference if the potency of each is taken into account. The fact is St. John’s Wort effects the neuronal circuits in very similar ways to an SSRI and whether it is natural or not makes no difference to your body. St. John’s Wort is a potent serotonin re-uptake inhibitor that also effects many other protein pathways just like SSRI’s do. The benefit of using an SSRI over St. John’s wort is the much more standardized and predictable dosing. Different brands of St. John’s Wort, different potencies, different batches; all create so many variables that it becomes difficult to predictably know the dose one is getting or know that they are getting a consistent dose.

So while I work with patients if they prefer to use a product like St. John’s Wort, I educate them about the downsides and that the ultimate effect on your brain is same. So natural or not, the brain knows no difference and the side-effects are the same, the medication interactions are the same and ultimately all one gets is the inconsistency in dosing and potency when choosing a supplement.

Psychiatrists no longer receive any motivation from drug companies to prescribe medications and this is often also misunderstood by the public. The motivation to prescribe medication has really disappeared from modern medication, especially in a practice such as mine where I provide psychotherapy, integrative care and often no medication.

Michael Yasinski MD