St. John's Wort Depression
St. John's Wort Depression (Hypericum)
At least one out of every 20 Americans gets depressed each
year, and many rely on anti-depressants to help them cope.
A new study shows the herb St. John's Wort might be just as
effective, and with fewer side effects.
The August 3, 1996 issue of the British Medical Journal contains
an analysis of approximately 25 studies that suggest that
St. John's Wort (Hypericum perforatum) is just as helpful
as commonly used drugs, without side effects such as headaches
or vomiting. Dr. Cynthia Mulrow, one of the study's authors,
says the findings are not surprising. "Some of the commonly
used medicines have a basis on herbs or have a basis in plants,
and some of the ones were developed using plants."
Although not well known in the United States until recently,
researchers in Europe have been studying it for decades. Doctors
in Germany have been prescribing it for depression and insurance
companies have been paying for it. It has available in herb
shops in Europe and the United States, but recently has been
increasingly selling out as word has been getting around about
it effectiveness. It comes in liquid, capsule and dried form.
Clinical Studies
Not long ago, experiments were done where mice infected with
viruses similar to HIV were given St. John's Wort extract.
The virus' progress was halted. This led to testing on human
HIV and AIDS patients. The results are inconclusive, though
anecdotal information reports a significant improvement in
some patients.
St. John's Wort contains hypericin that inhibits monoamine
oxidase, a bodily chemical associated with depression. It
appears that hypericin does not act alone. Like many herbal
medicines, St. John's Wort relies on the complex interplay
of many constituents for its antidepressant actions. Patients
suffering from depression received relief, increased appetite,
more interest in life, greater self-esteem and restoration
of normal sleeping patterns.
St. John's Wort is available as tea, tincture, decoction,
oil, and in capsule form. Teas should be made with 1-2 cups
of flowers per 1 cup of boiling water. This tea can be drunk
three times daily. The dosage of the tincture is 1/4 to 1
teaspoon up to three times daily.
Perhaps most notable regarding St. John's Wort extract for
depression has been favorable comparisons to standard prescription
antidepressive drugs. These include maprotiline hydrochloride
and imipramine.
In a multicenter trial, 135 patients with depression were
given either St. John's Wort (900 mg/day) or imipramine (75
mg/day) for six weeks. Therapeutic success was determined
using the HAMD, Clinical Global Impression (CGI), and Depression
Scale according to Zerssen. HAMD score improved by 56% in
the St. John's Wort group versus 45% for the imipramine group.
Differences on the CGI and Zerssen scales were slightly better
for St. John's Wort although not significantly different.
Adverse reactions were reported in 16% of patients taking
imipramine while only 12% of those taking St. John's Wort
experienced side effects.
Precautions
Dr. Donald Brown of Bastyr University recommends that persons
with fair skin avoid exposure to strong sunlight and other
sources of ultraviolet light when taking St. John's Wort because
of some cases of photosensitivity that have been reported.
He also advises avoiding foods that contain tyramine, alcoholic
beverages, and medications such as tyrosine, narcotics, amphetamines,
and over-the-counter cold and flu remedies while taking St.
John's Wort. St. John's Wort should not be taken while also
taking prescription antidepressants. It is also Dr. Brown's
opinion that St. John's Wort should not be used during pregnancy
or lactation.
According to Jonathan Zuess, MD (author of The Natural Prozac
Program), tyramine seems to primarily be a problem if a person
has high blood pressure. This is due to St. John's Wort working
in a similar way to drugs that are monoamine oxidase inhibitors
(MAOIs).
However, studies done in the 1990's have shown that the MAOI-like
effect of St. John's Wort is negligible when it's used in
normal doses. So it is unlikely that it would react with tyramine.
In Germany, where doctors have had the most experience with
St. John's Wort, it is considered safe to use in patients
with high blood pressure.
Nonetheless, if you have high blood pressure, and your doctor
agrees to your use of St. John's Wort for depression, the
following precautions should be taken:
- Have your blood pressure checked at least weekly for the
first six weeks, and at least monthly thereafter.
- Do not eat foods containing tyramine.
Even if you do not have high blood pressure, do not take
St. John's Wort with amino acid supplements (especially phenylalanine
and tyrosine). Amino acids are a form of monoamines, which
can pose a danger when mixed with St. John's Wort. The monoamines
that you get in your diet (such as the amino acids in meat)
are less concentrated and are not a hazard
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