Paula Gardiner, MD, is research associate at the Center for Holistic Pediatric Education and
Research, The Children's Hospital, Boston, and is on the faculty at Tufts University Family Practice Residency, Boston, Mass.
When parents ask about supplements and other so-called natural remedies for depression, what do you tell them? This review of what is known about herbal and dietary treatments for depression in pediatric patients will help you provide an informed response.
Few studies have evaluated the safety or effectiveness of herbs and dietary supplements in children with depression or other mental health disorders. The federal Dietary Supplemental Health and Education Act of 1994 allows herbal products and dietary supplements to be marketed without proven safety and efficacy, leaving American consumers without protection against poor manufacturing practices and fraudulent advertising. Resources for information on herbs and dietary supplements are listed.
Most families use herbs and dietary supplements on the basis of their own personal experience, cultural background, historical usage, and popular media portrayals. As with any medication, there are risks to children using dietary supplements: incorrect dosing, side effects unique to the child's developmental stage, drug interactions, and severe allergic reactions.
St. John's wort
Still the most popular herbal remedy for depression, St. John's wort (SJW), or Hypericum perforatum, was traditionally hung from windows and doorways to drive away evil spirits. In folk medicine, an oil extract of the herb's flowers was used to treat nervous conditions such as depression, anxiety, insomnia, restlessness, irritability, and menstrual cramps. Most preparations are standardized to hypericin content, which was presumed to be the active component. However, recent data indicate other active ingredients as well, including hyperforin. The postulated mechanism of action is the selective inhibition of serotonin, γ-aminobutyrate, norepinephrine, and dopamine reuptake in the central nervous system.4
Results of efficacy studies in adults have been variable, partly because of variations in the quality of the preparation used. However, in some studies using standardized preparations, SJW appears to be as effective as selective serotonin reuptake inhibitors (SSRIs) in treating mild or moderate depression in adults.5 Few studies have evaluated SJW's effectiveness in children, and most have been open label trials. In open label trials in children lasting from four to eight weeks, using doses of 150 mg TID to 600mg TID, response rates have ranged from 35% (9/26) to 75% (25/33) on standardized scales and up to 97% positive response on parent and clinician global assessments.1,6,7