St. John’s Wort

The National Institute of Mental Health may be wasting $4 million in the projected study of St. John’s wort for minor depression (Psychiatric News, April 18). Depressions that are not even severe enough to meet the elastic criteria for dysthymia are doubtful candidates to qualify as clinical disorders. They are likely to include states of sadness, sorrow, unhappiness, and the “blues” derived from and altering with the various and universal contingencies that complicate the fate of being human. As long as the diagnosis of depression depends on interviews and symptom checklists and cannot call upon the objective testing available to other branches of medicine, such a diagnosis is bound to be unreliable, especially when depressions are “minor.” The effort to find a medical rationale for the use of this herb as treatment is an example of the unfortunate effort by psychiatry to medicalize the human condition.

I predict that if the study is conducted with scientific rigor, there will be insignificant differences in treatment results for the three treatment conditions. I further predict that this second research defeat will not convince the herbal advocates that when St. John’s wort is helpful, it is because of psychological reasons or because time has passed and the patient’s life has changed.