St. John's Wort for Depression
St.John's Wort for DepressionMental illness strikes more Canadians every year than all other disease combined - including cancer and heart disease. According to the Canadian Mental Health Association, 1 in 3 people will experience mental health disorders in their life. Depression is one of the most common emotional illnesses. It can be caused by a combination of chemical, physical, social, psychological, genetic, or biological factors. (Canadian Mental Health Association). The most common form of treatment in Canada and the USA are anti-depressant drugs. However in parts of Europe, scientists have been studying the herb "Hypericum perforatum, better known as St. John's wort.
Extracts of St. John's wort are licensed in Germany for the treatment of anxiety, depression and sleep disorders. Nearly three million prescriptions for St. John's wort were written by M.D.'s in Germany in 1993 alone. Studies, mostly conducted in Germany have found that St. John's wort reduces feelings of depression, anxiety, apathy and worthlessness. Researchers are not totally sure how St. John's wort chemically acts on the brain as a treatment for depression, but they believe that components of the herb such as hypercin, xanthones and flavonoids may have an effect. Recent studies demonstrate that St. John's wort can inhibit the serotonin reuptake, thereby increasing one's mood. For example the study published in Arzneimittelforschung found that St. John's wort caused a 50% inhibition of serotonin uptake by postsynaptic receptors. (Perovic, S.)
St. John's wort appears to be most effective for mild to moderate depression, rather than for severe depression. A recent double-blind trial by Dr. Vorbach and colleagues from the Psychiatric Clinic, Elizabeth Hospital in Darmstadt, Germany, has compared the effectiveness of St. John's wort as an anti-depressant with the medication Imipramine. ( Tofranil). One hundred and thirty-five patients with a history of depression were given either 300 mg of a standardized extract of St. John's wort, or 25 mg of Imipramine three times a day for six weeks. Patients were evaluated using a battery of psychological tests. At the end of the study, the test scores improved by 56% in the St. John's wort group and by 45% in those taking the Imipramine. In short, St. John's wort was as effective as imipramine in treating mild to moderate cases of depression.(Vorbach EU)
In 1996, The British Medical Journal published an overview of 23 clinical studies in Europe and found that the herb may be useful in cases of mild to moderate depression. The study was entitled " St. John's wort for depression -- an overview and meta-analysis of randomized clinical trials." The object of the researchers was to investigate whether or not St. John's wort was more effective that the placebo in the treatment of depression and if it was as effective as standard anti-depressive treatment, and had fewer side effects. Overall, 1757 patients with mainly mild to moderate depression were tested. The conclusions showed that St. John's wort was significantly superior to the placebo and it was as effective as a pharmaceutical anti-depressant--and with much fewer side effects. In fact, more than half of the patients on prescription anti-depressant drugs reported side effects while less than 20% of those on the herb did so. (Linde K)
The herb's success rate as an effective anti-depressant is between 60-80%, a rate equal to that of prescription drugs such as Prozac, with far fewer side effects. A drug monitoring study published in 1994 looked at the experiences of 3,250 patients who were treated with St. John's wort. It was found that only 2.4% of the these patients reported any side effects at all. This finding is significant especially since Prozac produces side effects at least ten times more frequently. ( Woelk,G)
Safety of St. John's wort
The side effects of St. John's wort have been few and so mild as to be considered negligible in findings so far. Researchers are still studying the herb. The only side effect usually listed, as a caution for St. John's wort is photosensitivity, that is, some people find their skin more subject to sunburn when taking very large amounts of this herb. In 1994 British Medical journal study found a few, mild cases of skin sensitivity to sunlight, gastrointestinal symptoms, and fatigue. However, these side effects appear to be rare.
St. John's wort has no known interactions with other drugs. However, it is discouraged to take it with full doses of anti-depressants because a combined effect could be too great.
Dosage
The standard dosage used around the world for St. John's wort is the same as that used in most of the trials in the British Medical Journal. Three 300 mg doses per day of a preparation that contains St. John's wort extract, standardized to.3% hypericin, normally taken over a period of weeks, months or often much longer.
Small children should take a total of 300 mg of hypericum daily, while larger children should take 600 mg per day. Adolescents can take the adult dose recommended.
Effectiveness
Hypericum's effectiveness in treating depression should not be evaluated until at least six weeks of a 900 mg daily anti-depressant dose. As with prescription anti-depressants, the effect of hypericum takes place gradually. Studies generally indicate that hypericum takes longer to reach full effectiveness than do prescription anti-depressants.
Long Term Study
The National Institutes of Health (NIH) has launched the first US clinical trial of St. John's wort. It is a three year study that was started in October, 1997. Three hundred and thirty-six patients with major depression are being tested and assessed to determine whether or not St. John's wort has a therapeutic effect in the treatment of depression. A standardized preparation containing 900 mg daily dose of St. John's wort is being compared with a placebo and a group of anti-depressant drugs such as Prozac, Paxil, Zoloft and others. Patients will be followed for a two to six month period depending on their response to medication.. The goal of the follow-up is to determine if patients given St. John's wort have fewer relapses than patients with placebos.
Based on the current evidence, St. John's wort has proven to be effective in treating patients with mild to moderate depression. Its efficacy in treating severely depressed patients has not been fully evaluated. Millions of people are using this herb for depression. Some people who are attracted to natural remedies or who don't want to take chemicals or experience the side effects from anti-depressive medications, may find St. John's wort a simpler alternative to their prescription pharmaceuticals.
References
1. Canadian Mental Health Association
2. Perovic S, Muller W. "Pharmacological profileof Hypericum Extract. Effect of Serotonin Uptake by Postsynaptic Receptors." Arzneimittelforschung. 45911):11:45-1148 (1995)
3. Vorbach EU, Arnoldt KH, Hubner WD. Pharmacopsychiatry 1997 Sep;30 suppl 2:81-5. Efficacy and tolerability of St. John's wort extract L1 160 versus imipramine in patients with severe depressive episodes according to ICD-10.
4. Linde K, et al. "St John's Wort for Depression-an Overview and Meta-Analysis of Randomized Clinical Trials." British Medical Journal. 313(7052):253-258 (1996)
5. St. John's Wellness Newsletter. October, 1999
6. Curr Med Res Opinion 1998; 14(3): 171-84
7. Mol Psychiatry 1999 Jul;494):333-338. The experimental and clinical pharmacology of St John's Wort (Hypericum perforatum L.)
8. Int J Clin Pharmacol Ther 1999 Mar;37(30:111-9. St John's wort: a new alternative for depression?
9. JAMA Vol.281 No 19, May 19, 1999. Treating Depression: New Pharmacotherapies: Summary(AHCPR publication 99-E013)
10. Woelk,G.; Burkard,G; and Gruenwald,S. Benefits and Risks of the hypericum extract L160: Drug Monitoring Study with 3,250 patients. Journal of Geriatric Psychiatry and Neurology. 7(suppl):S34-S38, 1994.
