Herbal Treatment Outdoes Paxil (St. John's Wort Slightly More Effective)

[VolcanoJen]

http://story.news.yahoo.com/news?tmpl=story&cid=97&ncid=97&e=6&u=/hsn/20050211/hl_hsn/herbaltreatmentoutdoespaxil

Well, what do you know? Pharmaceutical companies will be quick to rip this study apart... they start to do just that further into the article.

Excerpt:

FRIDAY, Feb. 11 (HealthDay News) -- An extract of the herb St. John's wort was found to be slightly more effective than the widely prescribed antidepressant Paxil for people with moderate to severe depression, a short-term German study found.

The results fly in the face of a large-scale, carefully controlled U.S. trial, reported in 2002, that found a St. John's wort extract was no more effective than a placebo for people with moderately severe depression. The earlier study found statistically significant improvement in patients who took the antidepressant Zoloft, compared to those who took a placebo.

The German results were strikingly different. The study included 251 people with a score of 22 or higher on the Hamilton Depression Scale, a widely accepted measure of the condition. The Hamilton score decreased by 14.4 points for patients who took three daily doses of the St. John's wort extract for six weeks, compared to a reduction of 11.4 points for patients who took Paxil. There were also fewer adverse side effects in the St. John's wort group than in the Paxil group.

[Liberal Veteran]

1. While I think this is a good thing...I do have a negative to say about it.

Be VERY careful about taking St. John's Wort when you are taking other medications. It is known to interact with a number of drugs including:

Digoxin.
Oral Birth Control
Warfarin
Theophylline
Protease Inhibitors for HIV
Reserpine
Loperimide.

Natural doesn't always mean perfectly safe.

[VegasWolf]

3. Yes, one should always be careful about interactions, but Paxil

has serious interactions also. Cocaine, heroin and tobbaco are
all natural.

[candy]

7. Thanks for that caveat,we all need that kind of information.

--Is there a good website where you can find out the dangers of the natural supplements,which I prefer?

[Liberty Belle]

50. Intellihealth is a Harvard website. I think they may list this, also

the National Center for Complementary and Alternative Medicine (part of the NIH) has an online compendium of herbs and other supplements.

To check out specific brands, try consumerlab.com. They pull products off shelves and test to be sure contents are what's on the label. They only list the ones that pass. For a fee, you you can get the ones that don't.

Any questions, I may be able to help. I'm an editor for a nutrition industry publication.

[Book Lover]

11. I'd also like to point out that

plants vary in their biological makeup (like every living being). One plant will contain such-and-such percentage of an active compound, and the plant growing in the ground right next to it will have another. Not may, *will*. There may be somewhat accurate predictors, and ag techniques can minimize this difference, but herbal suppliers are not required to engage in these.

[KittyWampus]

18. The Ones That Do, Advertise It. You're Right Though... Just Read Labels

[Lindacooks]

28. Yep, you're right, and there's no way to know if what a label says

is accurate with so called 'natural medications'. When the supplement industry fought off FDA regulations, they also lost credibility. There are varied amounts in supplements because there's no oversight.

There could be as little as 0% concentration of an ingredient in a supplement, or more than is safe, plus there can be other ingredients not on the label. This is according to Consumer Reports and other consumer watchdogs.

No matter how much you hate the FDA, I do NOT trust corporations to do the right thing with any consumer product. Regulation and oversight is needed.

"Recently, ConsumerLab.com tested the herb Valerian, used to promote sleep, for its active ingredient, valerenic acid. The researchers bought 17 different products containing Valerian, both as extracts and as powders. Some contained the single herb, while others were in combination with various herbs. Only nine of the supplements passed their test, and half of these contained no valerenic acid. The other half that failed contained half of the valerenic acid."


http://static.highbeam.com/w/womenshealthletter/september012001/moresupplementproblemsthenutritiondetectivequality/

[BuddhaGirl]

36. I would take ConsumerLab.com's test results with a big grain of salt

they are a for-profit company, companies have to pay big bucks to have their products tested. Also, companies can pay to have their competitor's products tested. I don't trust them.

[Lindacooks]

56. I couldn't post Consumer Report's results because they are

subscription-only. And I trust them and they say the same thing.

[HuckleB]

40. Light sensitivity is another issue for many people.

I've had folks diagnosed with SAD who were on a prescribed light therapy regimen begin taking St. John's Wort on their own, with some very negative effects on the skin. I've also had patients report burning quite quickly compared to their usual history when out in the sun, after starting to take St. John's Wort.

[Eloriel]

51. Also contraindicated if you have high blood pressure, IIRC n/t

[VegasWolf]

2. Gotta give the big pharmas a pass on this one. How can they make

billions and trillions in profits competing with an herb
that you can grow in your backyard. The poor darlins.

[BigBearJohn]

4. Can anyone suggest where I could buy this herb? which is the best?

[IronLionZion]

6. Vitamin World has it

and GNC, some grocery stores,

[BuddhaGirl]

38. buy St. John's Wort in a good natural health store

Gaia Herbs, Herb Pharm and Enzymatic Therapy are reputable companies that make very good quality products.

[OneMoreDemocrat]

52. Solgar makes (in my humble opinion) the best St. John's Wort.....

supplement...as well as most other herbal supplements.


www.solgar.com

[BigBearJohn]

57. Thanks! for all the suggestions!

:)

[Ian David]

5. The company funding the study has been fined for fraud

Nature's Way has been fined and cited for fraud several times by the Federal Trade Commission.

Considering the INCREDIBLY broad leeway that supplements have, you almost have to TRY to get spanked by the FTC.

And one of their products was deemed "unsafe" by the FDA.

Again, with supplements you almost have to TRY to get pulled off the market.

The research was financed by the company that markets the extract.
<snip>
The extract used in the German trial is marketed in European countries under the brand name Neuroplant VO, said Dr. Jochen Muehlhoff, marketing information manager for the company. It is sold in the United States as a dietary supplement by Nature's Way products under the brand name Perika, "for promoting a positive mood, rather than a drug for the treatment of depression," he said.

More:
http://story.news.yahoo.com/news?tmpl=story&cid=97&ncid=97&e=6&u=/hsn/20050211/hl_hsn/herbaltreatmentoutdoespaxil


See also:
The cabbage soup diet recipe site explains that Answers 03/18/1992 FDA ORDERS NATURE'S WAY GUAR GUM DIET PILLS OFF MARKET T92-14 Sharon Snider March 18, 1992 [phone] FDA ORDERS NATURE'S WAY GUAR GUM DIET PILLS OFF MARKET FDA has received numerous inquiries about action taken recently by 10 states and the FDA against diet drug products containing guar gum. The following may help in responding to questions. In a nationally coordinated effort, FDA and 10 states moved to stop the sale of a weight control drug product containing guar gum, an ingredient determined by FDA to be unsafe for weight control. FDA warned Nature's Way Products, Inc., of Springville, Utah, to stop distributing its East Indian Guar Gum capsules and to remove them from the market immediately. Acting in concert with FDA, attorneys general in 10 states ordered General Nutrition Centers, the major distributor of the capsules nationwide, to stop selling them. They also ordered General Nutrition Centers to recall and destroy all other diet products containing guar gum. Failure to do so could result in civil penalties. The nationally coordinated action by FDA and the state attorneys general is the first of what are expected to be more joint enforcement actions against health fraud, deceptive practices and other violations of federal and state food and drug laws. FDA banned the use of guar gum in nonprescription diet drug products after numerous reports that the ingredient presents a health hazard. The -MORE- Page 2, T92-14, Guar Gum agency also banned 110 other weight control ingredients in these products because none had proven effective. Guar gum was found to be neither safe nor effective. Guar gum is a complex sugar that swells when it becomes wet and is purported to create a sense of fullness when ingested. Diet drug products containing guar gum have caused numerous cases of esophageal, gastric and intestinal obstruction. Many people affected required hospitalization, and one eventually died as an indirect result of esophageal obstruction. Although the ingredient is banned in weight loss drug products, it is approved for use in small amounts in foods such as cheese, salad dressings and ice creams. This use is not a health concern. In a letter to Nature's Way, FDA cited both use of a banned ingredient and claims on the label that make the product a new drug, requiring FDA approval before it can be legally marketed. East Indian Guar Gum capsules claim to promote weight control, regularity and digestion, and to control glucose and reduce cholesterol. Marketing a new drug without FDA approval is a violation of the Federal Food, Drug, and Cosmetic Act. FDA gave Nature's Way five days to advise the agency how it plans to comply with the law. Failure to do so could result in further regulatory action, such as seizure or injunction. FDA has moved against 14 manufacturers of guar gum diet drug products in the past couple of years. In July 1990, the agency told the marketer of Cal-Ban 3000 diet tablets and capsules to stop distributing those products and ordered distributors to recall supplies. U.S. Marshals subsequently seized more than 350,000 bottles of Cal-Ban 3000. In September 1991, a federal judge condemned the seized Cal-Ban 3000 as an unapproved new drug and ordered it destroyed.

More:
http://www.thejacastaproject.co.uk/natural-pain-killer.html
http://www.fda.gov/bbs/topics/ANSWERS/ANS00386.html



See also:

http://www.ftc.gov/opa/predawn/F93/cantrol.htm

FOR IMMEDIATE RELEASE: January 26, 1990

FTC CHARGES NATURE'S WAY PRODUCTS' ADS FOR "CANTROL"
WERE FALSE AND UNSUBSTANTIATED; COMPANY TO PAY
$30,000 FOR MEDICAL RESEARCH, UNDER CONSENT AGREEMENT

The Federal Trade Commission has charged Nature's Way Products
with making unsubstantiated claims in advertising that "Cantrol"
capsules fight yeast infections. Under a consent agreement
announced today for public comment, the company agreed not to make
unsubstantiated claims about certain nutritional supplements in the
future and also agreed to pay $30,000 to the National Institutes
of Health to support research in candidiasis or the effects of
yeast on health.

The complaint charges that the company advertised Cantrol with
a 14-question, diagnostic "yeast test," with such questions as "Do
you feel tired most of the time?" and "Do you suffer from swing
moods or depression?" The ad claimed that "If you answered 6 or
more questions with a 'yes,' the probability is high to very high
that you, like so many others, have a yeast infection." These ads
were carried in national magazines such as American Health, Shape,
and Let's Live.

The ads claimed that yeast (candida albicans) "can sometimes
grow rapidly due to a variety of conditions," but that "Cantrol's
high potency formula helps keep yeast colonies from overpopulating
in the intestines where they grow."

The complaint charges that the "yeast test" does not demon-
strate that a person is likely to have a yeast infection. It also
charges that Nature's Way did not have a reasonable basis for its
claim that consumption of Cantrol controls adverse effects on
health commonly caused by excessive levels of yeast in the intes-
tines and controls vaginal yeast infections.

Under the consent agreement, Nature's Way agreed not to
misrepresent, in advertising for any food supplements, any self-
diagnostic test concerning yeast conditions. In addition, the
company must not make any representation concerning any food
supplement's ability to control yeast conditions, unless it can
substantiate the claim. It also agreed not to represent that
Cantrol or any other food supplement containing certain ingredients
can cure, treat, prevent, or reduce the risk of developing any
disease, unless the company can substantiate the representation.
Those ingredients are acidophilus, Evening Primrose Oil (EPO), Pau
D'Arco, linseed oil, caprylic acid and vitamin E.

In lieu of redress, Nature's Way agreed to pay $30,000 to the
National Institutes of Health, to fund research into yeast condi-
tions.

The complaint and agreement name Nature's Way Products Inc.,
its management company Murdock International Corp., and Kenneth
Murdock, the president of both companies. They are all based in
Springville, Utah.

The Commission vote to accept the consent agreement for public
comment was 4-1, with Commissioner Andrew J. Strenio, Jr., dissent-
ing. In a separate statement, Strenio said that, "Since the prima
facie case is so strong and involves public health considerations,
the Commission should not settle for so little." He said that he
felt the injunctive relief requiring substantiation for any disease
prevention claims should cover all dietary, food, or nutritional
supplements rather than be limited to the ingredients found in
Cantrol. He also indicated that the $30,000 payment to NIH was too
low, saying "consumer spending for Cantrol purchases during the
time in question was roughly $6,000,000. Thus, although the
$30,000 figure might have been tolerable if taken together with
sweetened injunctive relief, the public ought not be forced to
swallow it here."

The consent agreement will appear in the Federal Register and
be subject to public comment for 60 days, after which the
Commission will decide whether to make it final.

Comments should be addressed to the Office of the Secretary,
FTC, 6th St. and Pennsylvania Ave. N.W., Washington, D.C. 20580.

A consent agreement is for settlement purposes only and does
not constitute admission of a law violation. When the Commission
issues a consent order on a final basis, it carries the force of
law with respect to future actions. Each violation of such an
order may result in a civil penalty of up to $10,000.

Copies of the agreement, the complaint, and an analysis of
the agreement are available from the FTC's Public Reference Branch,
Room 130, 6th St. and Pennsylvania Ave. N.W., Washington, D.C.
20580; 202-326-2222; TTY 1-866-653-4261.

# # #

MEDIA CONTACT: Susan Ticknor, Office of Public Affairs,
202-326-2181

STAFF CONTACT: Robert C. Cheek, Bureau of Consumer Protection,
202-326-3045
(File No. 862 3073)
(Cantrol)

See also:
www.ftc.gov/os/closings/staff/natureswayclose.htm

[VegasWolf]

9. The american gov stepping in to protect the profits of the big

pharmaceutical corporations. At this point, I almost have more
confidence in the independence of european journals.

[Ian David]

10. Alt. Medicine is un-regulated for the same reason Nutrasweet is

Orin Hatch was bought-off by lobbyists in both cases.

[VegasWolf]

13. I know, it is a total joke! I think legalizing an innocent herb like

marijuana would provide even better relief for mild
depression than wort.

[Karenina]

30. It lowers my BP significantly

where the pills I was prescribed do NOTHING. St. John's Wort helped my depressive symptoms greatly but exacerbated the light sensitivity of my skin. :shrug:

[HuckleB]

35. You got some repeated, peer-reviewed studies to show that?

In my experience, marijuana actually exacerbates depression and anxiety over time. But I'm all ears if you can show otherwise.

[MakeItSo]

44. Marijuana is not a good long-term solution for depression

Marijuana is a depressant. I've tried that game myself. People say it's a cure for depression and for ADHD. Short-term, sure. But long-term, it CAUSES depression and ADHD.

It causes depression by gradually robbing you of a long-term vision of your life. It causes you to enjoy the now, live the now, be the now. But if you're always being the now, how are you ever going to plan for your vision of the future? Short-term it may help some people focus. But long-term, how organized can you possibly be if you're stoned all the time?

I've tried pot for depression and ADHD and I've tried a combination of St. John's Wort and DMAE for depression and ADHD. I've also focused on a long-term, positive vision of where I want to be with my life in 5 years. It's working. Pot didn't.

[David__77]

8. From personal experience, I say otherwise...

...St. John's Wort may be acceptable for mild--stress, mild--depression unaccompanied by anxiety or other symptoms, but Paxil indeed is more effective, in the short and mid-term for depression accompanied by anxiety. The major drawback of Paxil, which is not a minor thing, is not that it is ineffective, but rather that it is VERY difficult to get off of! The withdrawal symptoms are serious indeed, and care must be exercised when slowly withdrawing.

[smirkymonkey]

24. Tell me about it...

I went off Paxil 3 months ago and it was a total nightmare. I am just now starting to feel better.

It's one of the worst SSRI's to detox from.

[zann725]

27. St. John's Wort is EXCELLENT for depression. No "numbing", distorted

feeling when taking it (which occurs with pharmaceutical drugs).

And it's NOT addictive. It tends to "level out" one's "downs" so much that you only have to take it occasionally...for a few weeks or days at a time...and then not again for months. Amazing stuff.

[HuckleB]

39. Depends on the individual.

I've had a number of patients who felt "numbed" by St. John's Wort, and I know when I've found the right medication whenever a patient is back to base but doesn't feel like he or she is taking medication. And that has happened very frequently with Lexapro, as well as with Celexa, Zoloft and even Prozac and Welbutrin now and then. As for your comment about addictiveness, neither are SSRIs. But one who takes St. John's Wort at an amount that is effective who wants to come off should reduce the dosages slowly over time, just like with an SSRI.

[MakeItSo]

41. Withdrawal from SSRIs is much more severe

Unless tapered off very gradually, several of the SSRIs may cause fairly significant withdrawal symptoms, such as electric shock sensations, that St. John's Wort doesn't cause -- even if you don't come off of it gradually. Sexual side effects are the norm for SSRIs but are uncommon with St. John's Wort.

[HuckleB]

42. Not necessarily true.

Again, individuals vary. I've even had folks decide to stop taking Paxil after years (not presrcribed by me, mind you) without noticing any difference at all. I have also had people come off St. John's Wort, reporting every type of side effect known in regard to the nasty SSRIs (Paxil) and SNRIs (Effexor). Never generalize such things. People have a way of responding that tosses generalization out the window.

[MakeItSo]

46. Sounds like you know what you're talking about

Good point. I'm feeling pretty excited about my experience with St. John's Wort (and generally outraged at the pharma industry, based on the near-daily news reports of clinical cover-ups) so please forgive my bias.

[HuckleB]

48. Hey, it works wonderfully for many people.

And I have no hesitation recommending it to many patients. The hardest part about it is keeping up on the best and most standard suppliers. Luckily I've got some good contacts in the naturopath and herbal remedy world, and they keep me in the know on what brands to recommend.

Another great road to try, in my experience (to avoid paying the pharma piper), is acupuncture. I've had good results recommending patients with high anxiety and sleep disorders, as well as fair results recommending it for folks with mild to moderate depression.

Best to you.

Salud.

[98geoduck]

55. Maybe they'll put Shrub on it, and he'll realize what an Idiot he is.

[kineneb]

33. St.John's Wort fine for very mild depression

But I am on Paxil (40mg/day) long term for major depression, panic and OCD symptoms. Without it I would not be able to function at all. Four years ago I had an almost total breakdown- full-blown clinical depression, thoughts of suicide and 2 week-long panic attack! I was taking 20mg at that time and it just kept me from going completely over the edge...Dr. then up it to 45mg. Not ever having been "normal" I guess I don't notice the side effects as much. Sure beats being crazy.

[satya]

12. My .02--also be very careful with this if you have high blood pressure.

Best to work with an alternative health care provider rather than trying to self medicate.

[VegasWolf]

15. Just talk to your doctor. Many modern doctors are way up on

herbal supplements and advocate them.

[Eloriel]

53. And if they're not, there's an Herbal PDR now -- really

I was delighted to learn about that. My M.D. even says his office has one, tho he didn't know where it was when I was in there the other day.

[crispini]

14. I always thought Paxil was an anti-anxiety drug,

not an anti-depressant? :shrug:

[VegasWolf]

16. Paxil manufacture's claim both.

http://www.paxilcr.com/index.jsp

[reprobate]

45. The two are VERY closely related.

In my case the anxiety seemed to trigger the depression bouts.

[Undercover Owl]

17. St Johns Wort grows in the USA

It is a pretty yellow flowering plant, commonly used as a groundcover. Hypericum is the scientific name.

[stevedeshazer]

23. Goatweed

It's a weed.

[Undercover Owl]

26. well, maybe.

Some may consider it a weed, but some people purposely plant it as a groundcover. Besides, there are many species of Hypericum.

That's how common this stuff is. St John's Wort grows in abundance.

[Eloriel]

54. Many if not most medicinal herbs are weeds

or wildflowers if they're herbaceous (as opposed to woody). Dandelion, comfrey, milk thistle, on and on.

[Piperay]

19. I take St John's Wort

for panic attacks and it has really helped me. :thumbsup:

[Fridays Child]

20. I liked it a lot but it really increased my appetite. Seems like...

...I snacked constantly.

[VegasWolf]

25. Yes, Paxil does that also, some people put on 30 pounds or more.

[depakid]

21. St. Johnswort is a mild MAO inhibitor

Meaning that you'd be wise to follow the appropriate dietary restrictions if you're inclined to take the stuff in therapuetic amounts.

http://www.dr-bob.org/tips/maoi.html#Saklad

[MakeItSo]

22. Not true -- not an MAO inhibitor

There are no known food or beverage interactions with St. Johns Wort. Science hasn't been able to determine exactly how it works, but it's thought to work more like an SSRI, without the side effects.

I've suffered from depression on and off for years. I've used Zoloft in the past. A week and a half ago I was in the midst of a bout of fairly intense depression and I thought I'd give
St. Johns Wort a try.

I've been taking Vitamin Shoppe brand standardized extract, 300 mg. 3 times a day.

After taking St. John's Wort, I felt better within several days. I've been more productive at work, less anxious, less down on myself, and generally more satisfied with life.

Unlike Zoloft, I have not noticed any sexual side effects.

If you want to try St. Johns Wort make sure you buy an extract, standardized to 0.3% Hypericin. I'm not a shill for Vitamin Shoppe but I have been impressed with their quality.

The only downside is that you need to remember to take 3 doses a day. Also, it's said to make people more sensitive to the sun, but it's the middle of winter so I can't tell yet whether that'll be a problem for me.

This is big pharma's biggest nightmare. Of course they're going to fight it tooth and nail. You can buy a bottle of 4 month supply of quality St. John's Wort extract for $11.95. Compare that to nearly $300 for an SSRI.

BTW, if it's a placebo effect and not the herb itself I could give a shit. It's working for me. The placebo effect is vastly underrated.

[Undercover Owl]

29. No, it is a MAOI

It is a monoamine oxidase inhibitor (MAOI).
It should not be mixed with an SSRI like zoloft, prozac, etc.

[MakeItSo]

34. NOT TRUE -- SJW IS NOT AN MAO INHIBITOR

This is simply NOT TRUE, and has been known NOT to be true for quite a few years. No need to scare people unecessarily (unless you're a big pharma company looking to lose billions in SSRI sales that is)

This is from McLean Hospital/Harvard Medical School:

An early study suggested hypericum may inhibit the enzyme monoamine oxidase (MAO). Later investigations have failed to confirm significant MAO inhibition and it is unlikely that MAO inhibition contributes to the clinical effects of St. John’s wort. Recent studies in vitro demonstrate inhibition of serotonin reuptake by hypericum. One study suggests an inhibiting effect on norepinephrine reuptake. Hypericum also inhibits the enzyme dopamine-b-hydroxylase in vitro. A novel proposal is that hypericum reduces cytokine expression (interleukin-6); interleukins have been hypothesized to provoke depression in susceptible individuals.

http://www.mclean.harvard.edu/psychupdate/psyup1998_06.htm

[depakid]

32. I have no problem with placebo effects

insofar as they help people heal and lift their depression- I'm all for it.

They are very real and frequently beneficial, which is why subjects are "blinded" in clinical studies- and with respect to clinical studies of depression- this takes on even greater importance, because what you're looking for is efficacy of the particular drug not an overall healing effect.

With respect to inhibition of monoamine-oxidase, I suggest you run a search on google scholar using the key words "hypericum" and "MAO."

[HuckleB]

37. Indeed. Thanks for the thoughtful post.

:hi:

[Blue_Tires]

31. wow

and i took paxil for 2 long years (no complaints, though)

[kiraboo]

43. I had fairly severe depression w/suicidal thoughts,

OCD, and panic attacks. After using Elavil for a year, I made my own ticture of St. John's Wort from the homegrown plant, and I used it instead of the amitryptiline (sp?). I found that it worked very well and I used it for another year before weaning myself from all medication. Several years later I had another, milder episode which I treated with St. John's Wort. Same beneficial effect. I never had any side effects that I noticed though I spend a lot of time in the garden and have read about the possibility of skin sensitivity. I'd recommend the Wort!

[haele]

47. As with all herbs, unless there's a standard to measure by...

one's mileage will vary.
I'm glad to see both a US and a European study on St. John's wort vs Paxil, but I'm a little leery of the reporters here; the test period was rather short (6 weeks? - should be at least 6 months for a good test on the effectiveness on body chemistry) there's no mention as to whether or not the patients in the test also had chemical evaluations along with the could be somewhat subjective Hamilton Depression Scale evaluation.
The caveat to this study can be that not only is clinical depression an uncertain state to diagnose, people can often "self induce" a better or worse test result over an initial period of time depending on purely subjective attitude towards the treatment or environmental surroundings.

As quoted in the article states:

The difference between the German and U.S. results could be explained by a difference in the severity of the condition among participants in the two trials, said Kirstin Stolp, a pharmacist with Dr. Willmar Schwabe Pharmaceuticals, the maker of the extract used in the new study.
Patients in their study had a more chronic condition, with the duration of their current episodes of depression much longer than in ours," she said. "Also, patients in the American trial in large part had not responded to several previous attempts at treatment. Our trial included only patients who had only one treatment without response."
...........
While he called the results of the German trial "quite impressive," Halbreich said there are practical difficulties in the use of St. John's wort, particularly for persons who take an extract on their own.
"If you go to a drug store or vitamin or supplement store, you find a lot of brands, and they are different from each other," he said. "Even with a very reputable German manufacturer, there are differences in activity."

Still, a very interesting study and strongly indicates the value of taking any sort of medication, natural or otherwise, while under the treatment of a trained, experienced physician. I'm thinking that Paxil is over-prescribed anyway; and for many people, standardized quality SJW or similar medication is a much better match for their problems.
My main concern would be that someone with a major depression problem may turn to "Walmart's special" jumbo-sized bottle of SJW to self-medicate because they think it's cheaper than going to a real doctor and getting a good quality, standardized medication to go along with therapy. I've seen it happen too many times with friends on the fringe who drop their therapist because they think they know better and the product they are taking is "natural" - even though they don't know anything about the process or quality of the product they are treating themselves with.
Self-medication for major depression, bipolar syndromes - or any other major psychological/physiological problem - never ends happily.

Haele

[mitchum]

49. But neither hold a candle to valium

God, I miss the old days