Bottom Line/HEALTH: One in 10 Americans take antidepressants. If you’re in your 40s or 50s, that number goes to one in four women are taking antidepressants. And a major 2013 study found that there was an enormous, enormous level of overdiagnosis of depression. So what do you really need to be doing, and what’s a far safer alternative to antidepressants? Let’s talk to our expert.

I’m Sarah Hiner, president of Bottom Line Publications, and this is our Conversation With the Experts, where we get the answers to your tough questions from our leading experts.

Today I’m talking to Dr. Andrew Rubman, a leading naturopathic physician and the medical director of Southbury Clinic in Southbury, Connecticut. Dr. Rubman is also a longtime contributing medical editor to Bottom Line. So welcome, Andy.

Dr. Andrew Rubman: Hi, Sarah.

Bottom Line: Really frightening statistics. One in four women in their 40s and 50s are getting antidepressants. There’s got to be a better way, so let’s talk about St. John’s wort, which has been around for a very long time.

Dr. Rubman: Well, yeah, since John the Baptist. A very long time.

Bottom Line: Is that who it’s named after?

Dr. Rubman: Yeah, really. St. John.

Bottom Line: All right. Is St. John’s wort really a safer, more effective option for many people?

Dr. Rubman: Yes, a more effective option, but remember, it’s still using a natural substance in a druglike fashion.

Bottom Line: It is using a natural substance in a druglike fashion, but is it safer, because there are so many side effects of antidepressants?

Dr. Rubman: Absolutely. It really is. St. John’s wort is extracted from the root of the plant and is not a single substance, the way that the antidepressant would be. So you have a material that acts the way the antidepressant does, by helping to block the reabsorption of serotonin, a so-called SSRI. But along with that are certain cofactors that allow it to be better-tolerated by the body and have less of a long-lasting negative effect.

Bottom Line: Is St. John’s wort actually the plant that most of the antidepressants are derived from?

Dr. Rubman: In general, yes.

Bottom Line: Is St. John’s wort appropriate for anybody with depression or actually more likely just mild to moderate? So all these women that are being given antidepressants because they go in to their doctor and say, “Well, life’s kind of hard and I’m kind of sad,” and they offer a prescription—who is best for St. John’s wort?

Dr. Rubman: People with mild-to-moderate depression. People who are trying to work with their diet, with their nutrition, who realize that the creation of serotonin in the brain is dependent on adequate calcium, adequate estrogen and other factors, and those are being addressed, who, rather than going to an SSRI, would like to try a natural intervention. Then they have the supporting structure to allow the SSRI to work.

If someone has a terrible diet, is under a great deal of stress and wants to grab something that’s going to work, probably neither will work well.

Bottom Line: You talked about the dietary component. Is there an important dietary component for SSRIs or for St. John’s wort? Is there something that they need to be doing?

Dr. Rubman: Calcium and magnesium. Adequate stomach acid. Good digestion. Getting it in. Adequate protein, because calcium needs to ride on a protein conveyance from the liver to the tissue to get going. And then getting into the tissue requires an adequate estrogenic effect for men and women. That’s where it gets a little bit complicated.

Bottom Line: Is it good for all levels of depression or only certain levels?

Dr. Rubman: Better with mild and moderate. Not so much with severe, because there are other confounding factors that will not only make the St. John’s wort work less well but also the SSRI work less well.

Bottom Line: All these women that are going to the doctor and being given a prescription, even though they’re being misdiagnosed or overdiagnosed as being depressed, is this something that somebody can take on their own when they’re feeling a little bit moody, a little gloomy, without having to get into a prescription?

Dr. Rubman: Sure. It has a very low potential of addiction, and it conflicts with virtually no known drugs. The only effect that it may have is that it may increase the effects of warfarin or other anticoagulants, and so some people may notice that they have more of a bleeding tendency, but it’s not usually severe.

So yes, but be aware of the fact that there are many different St. John’s wort preparations, and some are better than others. So some degree of guidance is always going to be good in using the material.

Bottom Line: For some reason, the doctor is giving them these prescriptions to start with. Is there anything that they can do in terms of their diet or their lifestyle that is creating a mood disorder for them?

Dr. Rubman: Oh sure, yeah. A lot of it has to do with their level of physical activity. A lot of it has to do with their eating frequency. A lot of it has to do with even doing something as simple as drinking enough water. Sometimes these things can create imbalances, not only in the body, but also in the brain. That’s why the idea of mind and body is a concept that has been a long time coming, but certainly makes a lot of sense.

Bottom Line: What is it about St. John’s wort that makes it more effective than the prescription medications?

Dr. Rubman: It has cofactors in it that helps it to work sometimes for a longer period of time. It helps the body to take better use of it in the short period of time. And it also tends to habituate the individual less to it. In other words, there are secondary and tertiary changes that can come from taking the drug that one doesn’t see as often with the St. John’s wort.

Bottom Line: You mentioned before that there are different varieties of St. John’s wort. What’s the best variety of the St. John’s wort?

Dr. Rubman: Number one, you want to get St. John’s wort, w-o-r-t. There’s a little bump or a tubercle on the root of the plant, so a whole-plant extract is not going to have much of the good stuff that you want.

Bottom Line: So just from the root-derived.

Dr. Rubman: Yeah, it’ll say root-derived material. Probably the best generally available form is a tincture of the material. You want to look at the tincture—it should be in a dark brown or a blue glass bottle. When you draw it up into the dropper and look at it in the light, it should have a ruby red color. If it’s darkened or brownish, it means it has oxidized and it’s not going to be as valuable. That’s one of the things that excited the early Christians, was the ruby red color of the material.

Bottom Line: Does it need to be refrigerated?

Dr. Rubman: No. Just protected from light.

Bottom Line: If somebody is currently taking an antidepressant, can they take St. John’s wort as well…or switch to St. John’s wort?

Dr. Rubman: The answer is yes on both, but they need to be aware of the fact that the effects may be additive. So they may get a lot more of a drug effect than they anticipated. And anytime that they’re doing that, they’re taking a substance, they should talk to their prescriber first and say, “I’d like to do this. Do you have any concerns because of my particular medical situation?” That’s only fair.

Bottom Line: Are there any risks to taking it otherwise, assuming an overall healthy person?

Dr. Rubman: There tends to be in some people an increased tendency toward bleeding, and so if you’re on an anticoagulant like warfarin or something, you should mention to your physician that you want to try that.

Bottom Line: All right. Thank you, Dr. Andy. The bottom line on St. John’s wort? If you’re taking a prescriptive antidepressant, you may want to think about St. John’s wort. It’s got fewer side effects and works more naturally with your body. Be sure that you get St. John’s wort that’s derived from the root of the plant and not from the whole plant. Make sure that it’s bright red in color. If it is not, then it may have oxidized and gone bad.

If you’re taking a prescriptive antidepressant already, make sure you talk to your doctor. You can switch to St. John’s wort, but you want to do it under a doctor’s guidance. And if you’re on a blood thinner, then you definitely need to watch out and talk to your doctor and use St. John’s wort carefully. This is Sarah Hiner with Bottom Line on Your Health.