Health: The suddenly fashionable wort

ACCORDING TO the self-help charity Depression Alliance, around four million people in Britain suffer from depression at any one time. Add to that the fact that the cost of depression to the United Kingdom is pounds 8 billion a year - of which pounds 500 million goes on medication - and it comes as no surprise that so much attention is focused on any new treatment which arrives on the market.

The current vogue is for hypericum, or St John's wort, a rather unassuming little plant which is confounding the medical profession with its efficacy both as an anti-depressant and for its lack of side effects. Hypericum has been used for centuries in folk medicine for everything from diarrhoea to sleep disorders, but it is now being hailed as the "alternative Prozac", an effective treatment for depression, insomnia, seasonal affective disorder and pre-menstrual syndrome. But does it really work?

The best clinical trials have taken place in Germany and all of them show very good results. Indeed, in Germany St John's wort is licensed as a prescription drug and out-sells Prozac by seven to one.

In his book St John's Wort, Dr Norman Rosenthal from the National Institute of Mental Health in the US says there is no reason why the same results should not be achieved in Britain. "To date there have been over two dozen studies of the efficacy of St John's wort as an anti-depressant and the simple conclusion is that the herb works," he says.

It seems there are even added benefits to taking the herb. "Many of my patients report that their sex lives improve, they get better sleep at night, and for women it can take the edge off their PMT," says Dr Rosenthal.

This comes as no surprise to medical herbalists like Dr Ann Walker, who has known about hypericum for years. "Now that the clinical trials are proving the efficacy of hypericum - something we have known all along - suddenly the medical profession is sitting up and taking notice," she says.

"Hypericum has a wide therapeutic profile but most herbalists use it for more than depression. In fact, in my practice the most common use for hypericum is in the treatment of symptoms of the menopause," she says. "Hypericum supports the nervous system which, during the menopause, is often a bit shattered because of the rapid changes in the hormones."

"It has extremely strong antiviral properties, which is why it has been widely used for fevers, coughs and colds," she says. "It was also used to treat urinary tract infections and can generally raise vitality levels."

Some experts are adopting a "wait-and-see" approach. Professor Stuart Montgomery, emeritus professor of psychiatry at Imperial College London says: "St John's wort is a very useful addition to our current armoury but there is not enough data for us to believe it is equivalent to the mainstream selective serotonin re-uptake inhibitors (SSRIs)."

The most recent evidence shows that St John's wort actually works in a similar way to the mainstream SSRIs, influencing one or other of the three important neurotransmitters in the brain, - serotonin, norepinephrine and dopamine.

A recent report published in the British Medical Journal analysed 23 clinical trials of the plant and found it to be "significantly superior" to a placebo and just as effective as standard antidepressants.

Dr David Wheatley is a consultant psychiatrist with a private London practice. "I started to use it [hypericum] in my own practice and found that it works very well in mild or moderate cases of depression," he says.

Dr Wheatley believes there is a case for both SSRIs and hypericum. "It is really a question of matching the treatment to the individual."

Melinda Holt is in no doubt about the efficacy of St John's wort. She has suffered from more than 18 years of depression. Her mother had depression for the last 10 years of her life and ended up committing suicide.

Melinda is very aware of what depression is and what it can do. "In the past when I have had depressive episodes I have always refused antidepressants. I didn't want to get caught in the same trap as my mother," she says.

Last year, after losing both her parents within a fortnight, Melinda found she couldn't drag herself out of the depths of despair. She was put on Prozac but says she was "like a zombie" for weeks. "I couldn't co-ordinate my right arm and my left leg, and vice versa, and I felt very unsafe, particularly as I had to drive a car."

After the short burst on Prozac, a friend recommended St John's wort and she gave it a try. "Initially, from feeling so bad I couldn't get out of bed in the morning, my mood started to lift. Suddenly I felt able to communicate with people and within a few weeks I had started visiting friends again.

"I don't believe St John's wort is a magic cure but it has helped me cope."