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Health food shops failing the depressed

A recent survey has found that only one of the 12 preparations suggested as a treatment for depression by health food shop staff - St John's Wort - is supported by evidence that it works.

Other treatments recommended included multivitamins, ginseng, cat's claw, gingko biloba and royal jelly.

Studies have shown that a significant number of people with a psychiatric disorder turn to complementary and alternative medicine. This survey, published in the October 2006 issue of the Psychiatric Bulletin, set out to assess the appropriateness of treatments recommended by health food shop staff for symptoms of mild-to-moderate depression.

Members of staff from each of 10 health food shops offering herbal remedies within a 3-mile radius of Leeds city centre took part in the study, although they were not aware that they were participants.

The researcher approached staff as a customer, complaining of a standard set of symptoms that commonly occur in mild-to-moderate depression. In all 10 interviews the same transcript was used. Health food shop employees were given an opportunity to ask questions to elicit further information.

Additional symptoms described by the researcher were all those of depression. The majority of staff did ask additional questions before making recommendations. This appeared to be in order to rule out a medically treatable condition, such as anaemia, or to decide on appropriate preparations.

Only two employees asked if a GP had been consulted, and three specifically asked if there was a depression of mood. One explained that she was not medically trained and that it would be wise to see the GP first.

Staff made no response when the researcher explained that she was currently prescribed the oral contraceptive pill, despite evidence that St John's Wort can decrease the effectiveness of oral contraceptives.

Twelve different preparations were suggested, with multivitamins being the most popular. Staff also made a number of suggestions for changes in diet and lifestyle.

The results suggested that treatments were recommended according to individual symptoms, rather than taking an overview of them all, as a healthcare professional would in order to make a diagnosis. St John's Wort, a specific mood-lifting treatment, was recommended only when depression was suspected.

The authors of the study comment that it raises concerns about the separation and independence of complementary and alternative medicine services from the NHS and pharmacies. There is a clear need for better communication between patient, medical practitioner and herbal agencies such as health food shops to ensure patient choice, safety and therapeutic benefit in the treatment of depression.

Reed JE, Trigwell P. Treatments recommended by health shops for symptoms of depression. Psychiatr Bull 2006;30:365-8.