St. John’s Wort is as effective as Citalopram in treating mild to moderate depression but has significantly fewer side effects. Why doctors still so often prescribe Citalopram is explained in this blog post by the Institute for Modern Psychotherapy in Berlin.
Overview of All Topics
The Consequential Serotonin Hypothesis
You’ve probably heard before that a lack of serotonin is responsible for the onset of depression. This neurotransmitter, along with norepinephrine, is believed to play a significant role in signal transmission in the brain. According to widely accepted theories, serotonin, put simply, is essential for proper communication between nerve cells in the brain. A deficiency in this neurotransmitter, therefore, hinders effective communication between nerve cells. The result of this chemical imbalance is that we feel fatigued, low-energy, and unmotivated. In other words, we become depressed or anxious.
Today, this so-called “serotonin hypothesis” is particularly promoted and disseminated by pharmaceutical companies. Their antidepressants, especially Citalopram, which is very popular in Germany, primarily aim to increase serotonin levels.
These medications are clearly classified as selective serotonin reuptake inhibitors (SSRI).
The Myth of Serotonin Deficiency
It all sounds scientifically grounded—and gives those affected hope for a quick improvement through medication. If only there wasn’t one problem: the serotonin hypothesis is simply wrong. Currently, there’s no evidence that people with depression have any issues with their serotonin levels. Let that sink in for a moment. Although the serotonin hypothesis has dominated antidepressant research for decades, it has never been empirically confirmed. In fact, the opposite has been observed. Attempts to induce depressive symptoms in healthy people by lowering their serotonin levels through medication surprisingly led to an improvement in mental well-being. Paradoxically, based on this experiment, the antidepressant Tianeptine was developed, which doesn’t act as a serotonin reuptake inhibitor but rather as a serotonin reuptake enhancer.
In summary, a serotonin deficiency seems to play little or no role in the development of depression. Accordingly, medications developed based on this erroneous assumption should be viewed with skepticism.
But could this really be true? That a demonstrably flawed hypothesis, once introduced, could be accepted and perpetuated by both experts and the media alike? Unfortunately, yes. Just think of spinach. You’ve likely heard that spinach is a true powerhouse of iron. No surprise there, since this view was promoted for decades by nutrition scientists and the media. And the famous cartoon character Popeye, who gains strength from the “iron miracle” spinach, only helped cement this belief. However, today we know that spinach doesn’t actually contain that much iron.
The origin of this myth was a misplaced decimal point in an old nutritional table, turning 3.5 milligrams into an impressive 35 milligrams of iron per 100 grams.
How Effective Are Citalopram and Other Antidepressants?
The implausibility of the serotonin hypothesis doesn’t bode well for the effectiveness of antidepressants. Indeed, the success of these medications is quite limited. For mild, moderate, and not overly severe depression, they are no more effective than a placebo. On average, only 14 percent of people taking them experience an improvement in depressive symptoms.
Therefore, they are recommended only for very severe cases of depression. In such cases, it has been observed that after a few weeks, patients may regain enough energy to begin working with psychotherapy. Even then, however, these medications should ideally be tapered off as soon as possible.
Various studies have confirmed that antidepressants are either ineffective or only slightly more effective than placebos. The same conclusion was reached in a meta-study published in the summer of 2019 by the reputable Danish Nordic Cochrane Centre. Notably, this center is funded by the Danish government and is legally prohibited from receiving funds from pharmaceutical companies.
And that’s a good thing, since the latter have increasingly diverged from current research findings in their advertisements for antidepressants in recent years.
Citalopram: A Dangerous Placebo
Given the limited effectiveness of antidepressants, it’s all the more important to focus on potential side effects. This is especially true for Citalopram, one of the most prescribed antidepressants worldwide. In fact, taking this serotonin reuptake inhibitor can lead to a range of serious consequences.
Prescribing it solely for its—albeit positive—placebo effect seems questionable in this context.
Side Effects of Citalopram You Should Know:
The list of possible side effects from Citalopram is long. Drowsiness, sweating, nausea, dry mouth, and insomnia are among the milder side effects, though they occur very frequently, with a likelihood of over 10%.
Additionally, common side effects (1–10% probability) include:
- Fatigue
- Exhaustion
- Weakness
- Muscle pain
- Dizziness
- Headaches
- Tremors
- Increased salivation
- Diarrhea
- Vomiting
- Heart palpitations
- Stomach pain
- Skin rash
- Nervousness
- Concentration problems
- Anxiety
This list could go on much longer. Particularly notable: sexual dysfunction is also listed with a probability of 1–10%. However, according to an article in Ärzte Zeitung, these occur much more frequently than reported.
Sexual Dysfunction: A Common Long-Term Effect of Citalopram
Around 60 percent of patients taking antidepressants suffer from sexual dysfunction, which significantly impacts their quality of life. While some of this may be due to the depression itself, in many cases, the medications alone are responsible. This is especially true for SSRIs, including Citalopram. These drugs can impair sexual function even years after stopping them.
The fact that sexual dysfunction is classified as only a “common” rather than a “very common” side effect of Citalopram may be partly due to patients’ reluctance to discuss these issues out of embarrassment.
If you suspect that taking Citalopram has caused sexual dysfunction for you, it might be worth discussing discontinuing the medication with your doctor.
A word of caution: Citalopram must be discontinued gradually—a process known as “tapering off.” Stopping the medication abruptly can lead to serious withdrawal symptoms.
Citalopram: Discontinuation Can Lead to Withdrawal Symptoms
Antidepressants are often taken for months, sometimes even years. The problem: Over time, dependency can develop, particularly with SSRIs, leading to withdrawal symptoms, known as SSRI discontinuation syndrome. Symptoms range from diarrhea and nausea to headaches and flu-like symptoms, and even numbness.
St. John’s Wort: The Well-Tolerated Alternative to Citalopram
Limited effectiveness, unpleasant side effects, harmful long-term consequences, and withdrawal syndrome: I can only recommend Citalopram in absolute exceptional cases (namely, only for truly severe depression). You may rightly ask, “Is there an alternative?” Yes, there is—St. John’s Wort, a plant-based remedy. Unlike Citalopram, this natural treatment, which has been used successfully against depressive moods since ancient times, has almost no side effects. The lists of “very common” (more than 10%) and “common” (1–10%) side effects remain completely empty.
In terms of effectiveness, St. John’s Wort can indeed hold its own against Citalopram. A randomized, placebo-controlled double-blind study in 2006 concluded that St. John’s Wort is similarly effective as Citalopram for moderate depression.
At the same time, and unsurprisingly, it is much better tolerated.
Eliminating Depression and Anxiety: The Value of Finding the Cause
As tempting as it may be to attribute depression or anxiety simply to a disturbed brain chemistry, the reality is different. Both disorders have not one but many possible triggers—physical and psychological. It’s no wonder, then, that antidepressants only help about 14% of those affected. This also highlights the limitations of St. John’s Wort.
The fact is: only those who know the cause(s) of their depression or anxiety can treat it effectively. I have discussed common triggers in detail in my books, which I’ve linked at the end of this article. For depression, these include:
- Negative thinking and pessimism
- A lack of BDNF proteins, caused by insufficient physical activity
- Side effects from poorly combined medications
- Food intolerances
- Deficiency in minerals, trace elements, and vitamins
- Chronic inflammation
- Changes in social behavior due to social media and smartphones
- Unrecognized or improperly treated anxiety disorders
- Sleep disturbances and poor sleep habits
- Traumatic experiences and repressed grief
Once the trigger is identified, even a seemingly stubborn depression or longstanding anxiety disorder can be resolved. Whatever problem you may be struggling with, there are now effective ways to quickly return to a life without anxiety and depression—no medication needed.
By guiding your thoughts in a positive direction through targeted mental training, you actively control your brain’s neuroplasticity. This builds new neural structures linked to positive emotions during the day. These positive thoughts are consolidated during the night, leaving no room for nightmares. What sounds complex is actually simple and is based on the latest neuroscience.
Incidentally, my patient, who was pursued by a dark shadow in her nightmares, was able to sleep through the night again and enjoy her rest thanks to the Bernhardt Method. This work had an additional benefit for her—she suddenly received many compliments on her radiant appearance. She realized how much her daily life had been subconsciously impacted by her nocturnal struggles. Once she finally overcame these issues, it had a lasting positive effect on her aura and daily life.
Troy A.
Tampa, Florida