(Doctor Dale Guyer discusses alternative medicine in the treatment of depression)

Guest physician Dr. Dale Guyer combines traditional and alternative methods in the treatment of common health problems.

Editor's Note: In 1997, the Post featured a series of TV health shows exploring the growing field of complementary medicine. Response from TV viewers was overwhelming. We invited Dr. Guyer back to share his knowledge from clinical work in both the traditional and complementary fields of medicine.

Q. Could you please tell us about St. John's Wort?

A. St. John's Wort is an extract from a common plant that is used in hedgerows in Europe and seems to be useful in the treatment of depression and certain types of anxiety disorders. In some clinical studies, it has been shown to have potential as an immune-boosting agent that can be of help for patients in treating infections. Certain injectable extracts of the plant may have efficacy in treating HIV disease. Of course, this is a pure, pharmaceutical-grade extract of the plant, so it would not be something that a person could get the same results from by using homegrown herbal decoctions. The standardized herbal extracts that are used as prescription medicines in Europe for the treatment of depression are subject, to very high quality purification processes. You may not get the same physiological effect by taking an over-the-counter herbal preparation. They are very different substances.

Q. Is it called St. John's Wort in Germany?

A. Hypericum is another name that is often used. The concept of St. John's Wort often creates a lot of interest. The word "wort" in our culture has a different visual picture. It is actually an old word for "root."

Q. It's more popular right now in Europe than it is in the United States, is that right?

A. That's true. It relates to an interesting enigma. In our culture, the FDA gives us permission to use certain medications, but it has fairly stringent criteria for bringing a new drug to the marketplace. In Europe, particularly in Germany, there are separate regulatory agencies for natural compounds. Despite the fact that there exists a lot of data to support the use of St. John's Wort, most of it is published in Europe and oftentimes not in the English language, so a lot of the information tends to be unavailable to physicians who practice in this country. The unfortunate part is that this information gap puts physicians at a disadvantage because they just don't have the information or background to know how to prescribe the herb, nor do they have the confidence gained from clinical experience. An interesting observation I've noted is that oftentimes in our country, the medical consumer has a better source of information and education as it relates to natural products than do most physicians.

Q. Physicians would be concerned about the quality of the product.

A. True, product reliability is a major concern regarding many of the natural substances. There have been several studies where products are bought off the shelves, then assayed by an independent lab in order to determine how much of the active ingredient of a compound is actually in, for example, a capsule. The range is pretty dramatic to the point that certain herbal extracts might not even have the same herb that is advertised on the label; they might not have the same type of extract, or might not have the active components present. All these problems are improving. We have a lot of good companies and quality products out there. We also have many high-quality health- food stores. And many of the people who run these establishments are very well educated and can effectively direct a client or customer to the best-quality supplements.

Q. What should the consumer look for in buying St. John's Wort?

A. When you are looking at any herbal medicine like St. John's Wort, make sure it is a standardized extract. It will usually be stated on the label. For example, HyperiMed is a product made by PhytoPharmica. It clearly says on the label: St. John's Wort 300 mg, standardized to contain 0.3% hypericins, which is thought to be the active ingredient in the herbal product. It will have some sort of verification. In some cases, it will state that it is verified by a high-pressure liquid chromatography (HPLC), which is one way to standardize the active chemical constituents. There should also be an expiration date and some assurance of quality. For a consumer who might have questions, it is very reasonable to call a company and ask for verification that a product has been independently assayed: request the source of the extracts, and so forth. Any good, reputable company can supply that information. This way, you have a lot more assurance that you are getting a quality product.

Q. The reason that many people take St. John's Wort is that they are not afraid of its side effects, but they are afraid of the side effects of prescription drugs.

A. Side-effect profile is certainly an interesting concept. There is a book that I once read called Life Extension by Sandy Shaw and Durk Pearson. One of my favorite chapters in the book was titled, "Is there anything in the world that is absolutely safe?" The only word in the chapter was "No."

There is an assumption in the mind of the consumer that because something is natural, it is absolutely safe. Of course, we know that this is not quite accurate: many of the most toxic compounds in the world are natural compounds--arsenic, lead, mercury, etc. However, many natural substances tend to have, less propensity to have side effects than many of our standard prescription drugs. In my clinical experience, I have found that maybe 80 to 85 percent of the time, if not more, many of these very simple approaches work better and are better tolerated by most individuals than prescription medications. That is not to exclude the fact that we really need prescription medications in acute and crisis care. But three elements often missing from conventional medical care are an understanding of, information about, and experience in using some of the less-invasive therapies.