The truth about: Nature's Prozac?

Is there a gentle treatment for depression? Herbalists say St John's wort fits the bill. By Cherrill Hicks

Prozac, the "Happy Pill", is in the headlines again, with its makers, Eli Lilly, being criticised for going over doctors' heads and directly targeting depressed Americans with a big advertising campaign. Two-page colour ads, depicting a dark rain cloud followed by a bright sun, will appear in the US next week in 20 consumer magazines, including Newsweek, Cosmo, Time and Marie Claire, aimed at getting patients to diagnose themselves as depressed and then ask their doctor for the drug by name. In Britain, advertising drugs directly to patients is illegal.

Opponents say that Prozac, the market leader in antidepressants since it was launched in 1987, is already being used by the wrong types: not the clinically depressed, but those who are shy, anxious or maybe just miserable. Although it is said to be non-addictive, and does not have the same side effects as the previous generation of antidepressants, it has been blamed for violent mood swings and suicidal behaviour, and has faced a number of legal actions in the US.

Is there a safer, more gentle alternative to standard anti-depressants? The herbalists say there is: hypericum perforatum, or St John's wort, instantly recognisable at this time of year by its yellow flowers, used in the Middle Ages to dispel evil spirits (which is why the insane were forced to drink its infusions) and by The Knights of St John to treat wounds on Crusade battlefields.

Hypericum extract is already big in Germany, where it is used extensively for depression and anxiety; both prescribed by orthodox doctors and bought over the counter, it outsells Prozac by 7:1. A new study from Berlin claims hypericum is especially beneficial to menopausal women, alleviating symptoms such as night sweats and hot flushes, raising self-esteem and flagging libidos. Dr Barbara Grube, who directed the study involving 111 patients, says extract of hypericum improves a woman's confidence, enabling her to "take the initiative in sex".

So could it work for English melancholics? On its own, the Berlin study is unconvincing: it was small, and did not include a control group taking a placebo. But there is, in fact, good evidence that hypericum extract is as effective as standard antidepressant drugs. Scientists from Germany and the US analysed 23 clinical trials involving 1,757 patients with mild or moderate depression who were treated with either St John's wort extracts, a combination of this and other plants, a placebo, or drug treatment.

Their report, published in the British Medical Journal, found St John's wort to be "significantly superior" to a placebo and equally effective as standard antidepressants. Side effects occurred in less than 20 per cent of patients taking the herb, compared with 53 per cent of those on standard drugs. Scientists believe that more research is needed both to test its effectiveness in cases of severe depression, and its safety - although there has not been a single report from Germany of serious drug interaction or toxicity.

How does hypericum lift the spirits? The plant contains at least 10 bioactive substances that may contribute to its effectiveness, including hypericin, which is thought to inhibit an important enzyme in the brain that has an effect on neurotransmitters, which relay messages between brain cells, such as serotonin, noradrenaline and dopamine.

In Britain, however, hypericum is not licensed as a drug, although its makers, Lichtwer Pharma, have submitted an application to the Committee on the Safety of Medicines. A lower strength version, called Kira and sold as a food supplement, claims to be able to "beat the blues" and help people "look on the bright side"; as with Prozac, it shouldn't be relied on to sort out life's misfortunes. Anyone who is seriously depressed would be wise to avoid self-medication and visit their doctor instead.