The subject of mental health unwellness in children and young people has been prominent in the New Zealand media in recent weeks, with huge cause.

Globally suicide is one of the top three causes of death in young people aged 15-19, globally⁽¹⁾. New Zealand has the highest suicide rate for 10-14 and 15-19 year olds out of 19 developed countries. These alarming figures were revealed in February this year through a study by the British healthcare think tank Nuffield Trust which compared UK’s record on adolescent health and wellbeing to 18 other developed, wealthy countries^(2,3).

A 2017 University of Auckland study published in the Australian and New Zealand Journal of Psychiatry, found nearly one in 20 high school students (4.5%) reported attempted suicide, while 7.9% had repeatedly self-harmed over a 12 month period. Students from poor families were nearly three times more likely to try to take their own lives⁽⁴⁾. Rates in rainbow youth, and young Māori men, are also higher than for others^(5,6).

Reasons for these alarming statistics are multiple, but the fact that millennials and increasingly younger people are living a significant part of their lives online particularly on social networking and gaming, is undoubtedly contributory⁽⁷⁾.

We live in a country where our culture and attitudes to depression, have historically been based too much on the ‘buck up and get on with it’ approach. However, these statistics and also the ‘Blam Blam Blam’ song of the same name released in 1981, demonstrate that the comment by former Prime Minister Robert Muldoon ‘There is no Depression in New Zealand’, has long been disproven.

The government is currently looking at how it can improve suicide prevention, and the increased media coverage of this issue is welcome. Early recognition and diagnosis, adults being more open to talking to young people about suicide and depression, and fostering a society where more of a sense of purpose can be gained by young people along their journey through youthhood and into adulthood, are critical needs.

Antidepressant drugs have saved countless lives since their inception in the late 1950s, despite some limitations. They don’t always work; adverse effects can be unpleasant and contribute to a very low compliance rate, and without addressing contributory factors, their long-term efficacy is often limited.

Herbal medicines have been used by different cultures for depression since time immemorial, although different terminologies were and still are often applied to this, and a definitive diagnosis according to DSM criteria obviously wasn’t made!

St John’s Wort (Hypericum perforatum) is of course the herb best known to western medical herbalists as an antidepressant, and there are now more than 2,000 peer-reviewed publications on this herb, including more than 30 clinical trials showing it to be as effective as antidepressant drugs for the treatment of mild to moderate depression⁽⁸⁾. Its use increased dramatically from 1996 following publication of a favourable meta-analysis of clinical trials published in the British Medical Journal, and while usage reduced at least for a time from 2000 following reports of drug interactions and safety concerns, St John’s wort preparations are widely available ‘over the counter’ in New Zealand and Australia.

While this herb has certainly helped herbal medicine to be taken more seriously by English speaking populations, the self-medication of St John’s Wort in major depression is not necessarily the best approach. There are many more herbs that can also be useful in young people prone to depression, where the complexities of the condition are best suited to an overarching treatment plan overseen by suitably trained health practitioners. This is particularly so given New Zealand’s woeful record in preventing teenage suicide.

Depression frequently coexists with intense anxiety, in addition to those confounding socio-economic and cultural factors, such as poverty and too much online time. The pressure to succeed and worries about the environment and future contribute to an unhealthily high level and type of stress in young people. These factors can manifest as generalised anxiety disorder, sleep issues and over time result in feelings of low self-esteem and depression.

Herbal medicine has much more than St John’s wort to offer for young people with, or prone to, depression. As anxiolytics (anti-anxiety agents), they are much safer interventions than drugs such as benzodiazepines, and there are many herbal adaptogens (stress protectors) that can additionally help insulate young minds against the effects of prolonged or acute stress⁽⁹⁾.

An example of how a herbal practitioner-directed treatment approach can help, was shown through a clinical trial undertaken in China between 2009 and 2013. This investigated the effects of individualised treatments with herbal medicine in a group of 146 severely depressed patients admitted to hospital⁽¹⁰⁾. All patients continued to receive treatment with a range of antidepressant and other psychotropic drugs, and half of them took various additional herbal medicines that were individualised to their situation by traditional Chinese medicine practitioners.

Patients who received adjunctive herbal medicines during their average 28 day hospital stay, were 2.1 times more likely to achieve a clinical response (according to the validated Hamilton Rating Scale for Depression), & 5.8 times more likely to achieve remission, than those who received drug treatment only⁽¹⁰⁾. Concomitant Herbal medicine use was also associated with fewer incidences of physical tiredness, headache, palpitation, dry mouth and constipation, although digestive discomfort was more often reported.

Against the background of alarming figures about mental health and particularly teenage suicide, governments should take a serious look at the potential for Herbal Medicine practitioners to help reduce these statistics and save lives. A plethora of natural health products aimed at the management of anxiety and depression are now directly available through pharmacies and health food stores. However, young people experiencing mental health challenges and who are clearly at an unacceptable risk of suicide, warrant a much more personal, integrative and professional approach to their particular situation. Given the seriousness of this issue facing so many of our young people, the need for regulatory and funding systems that support the provision of much greater access to the personalised interventions and individualised treatments that well-trained medical herbalists can provide, is now urgently needed.

 

Refs:

1. World Health Organization (2014a) ‘Adolescent health epidemiology’.www.who.int/maternal_child_adolescent/epidemiology/adolescence/en.

2. NZ Herald, Feb 26, 2019, NZ Ranks bottom of developed countries on youth mortality rates.
3. https://www.nuffieldtrust.org.uk/news-item/sound-the-alarm-we-must-improve-our-young-people-s-health-services.
4. Chan S et al, Aust N Z J Psychiatry. 2018 Apr;52(4):349-356
5. https://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-mana-hauora-tutohu-health-status-indicators/suicide-and-intentional-self-harm.
6. NZ Herald, 2 Aug, 2017, Break the silence: Rainbow suicide rate five times higher than mainstream.
7. NZ Herald, Aug 17, 2019. Anxious millennials reach out for help.
8. Rasmussen PL, Feb 2018. St Johns Wort: Safety concerns in clinical practice. Practitioner Webinar, Phytomed Medicinal Herbs Ltd, Auckland, NZ.
9. Rasmussen PL, Feb 3, 2017. Why Herbs should be the first choice of treatment for acute anxiety. http://www.herbblurb.com
10. Liu LY et al, J Affect Disord 2015; 170:71-77.