Antidepressant herb

Interaction with drug metabolism liquorices, which are the most commonly used herbs in TCM can increase metabolites (e.g., nortriptyline, desipramine, and norclomipramine) of tricyclic antidepressants (TCAs) and may produce more side effects (such as dry mouth, constipation, palpitation, etc.) (Xu, 2004 Zhu Huang, 2004). 

For example, if one were studying an herb to treat depression, one would want to control as many factors as possible that could influence the outcome. People already taking an antidepressant drug would have to be excluded. One might also balance the subjects in different groups for severity of depression, psychotherapy treatment, or even levels of physical exercise. Certainly, the subject groups should be balanced for number of males and females, because sex differences in depression could contaminate the results. 

As will be discussed in detail here, these herbs may create several effects, due to multiple neuropharmacological actions or even due to a single action. For the sake of convenience, the herbs have been broadly classified here into antidepressant/anxiolytic and antipsychotic categories due to their frequently overlapping effects. 

Although several putative anxiolytic herbs are discussed in chapter 6, a select few are discussed here because of their similarity to antidepressant medications in terms of neuropharmacological activity, and because of the close relationship between depression, anxiety, and their pharmacological treatment in general. Whereas the anxiolytic herbs discussed previously have anxiolytic effects through more-general CNS depressant actions, the ones discussed here seem to have more-specific actions, particularly on serotonin. 

Saint-John s-wort was used in ancient Greece and medieval Europe, where it was believed to ward off evil spirits. Its name derives from wort, the Old English word for herb, and the fact that it was harvested in Europe on the eve of St. John s day (June 24th) and burned to purify the air (Fleiligenstein and Guenther 1998). Traditional uses include treatment of depression, insomnia, enuresis, and anxiety. Modern use has focused on its antidepressant effects and possible antiviral effects for treatment of the human immunodeficiency virus (FIIV) (Fleiligenstein et al. 1998) (table 7.3). There has been some interest in its antiglioma effects as well (Couldwell et al. 1993). 

Flavonoids in the diet have been widely promoted as important antioxidant contributors. Their neuroprotective properties, because of this effect, have been demonstrated by several workers. However, they have also been demonstrated to have MAOI activity and this has been proposed as part of the explanation of the use of the common herb, St Johns Wort, Hypericum perforatum L., as an antidepressant. This dual role has now been proposed for a variety of flavonoids, such as kaempferol (22) from the leaves of Ginkgo biloba L., a widely used herbal product which has been suggested as a preventative agent against neurodegeneration. Quercetin (23), similarly, has also shown to inhibit MAO-B " and reverse the effects of induced catalepsy, which mimics the bradykinesia associated with PD. Tangeretin (24) also inhibits MAO-B and crosses the blood brain barrier in a rat model. 

Elisabetsky, E., W. Figueiredo, and G. Oliveria. Traditional Amazonian nerve tonics as antidepressant agents Chaunochiton kappleri a case study. J Herbs Spices Med Plants 1992 1(1/2) 125-162. 

Soni, K. B., A. Rajan, and R. Kuttan. Inhibition of aflatoxin-induced liver damage in ducklings by food additives. Mycotoxin Res 1993 9(1) 22-27. Elisabetsky, E., W. Figueiredo, and G. Oliveria. Traditional Amazonian nerve tonics as antidepressant agents Chaunochiton kappleri a case study. J Herbs Spices Med Plants 1992 1(1/ 2) 125-162. 

Hypericum perforatum, more commonly known as Hypericum or St. John s wort, is used widely because of the perception that it is a safer, natural antidepressant. In Germany, Hypericum is used more extensively than conventional antidepressants for treating depression. Because St. John s wort has been attracting increasing media attention worldwide, consumption of this herb is likely to become more prevalent. 

The use of herbs has also been fueled by the increased awareness of clinical depression and its treatment as a result of the marketing efforts of major pharmaceutical companies. That effort has transformed prescription antidepressants into one of the largest dollar sales category in pharmaceuticals such that the sales for a block buster antidepressant can be more than 2 billion dollars per year. Not surprisingly, then, herbal remedies or phytomedicine has also become a multibillion dollar industry in the United States with an estimated one in ten Americans having used herbal agents within the past year, with or without their physician s knowledge. 

This herbal product has the most data available to support its usefulness as an antidepressant. Nevertheless, only minimal information is available about its pharmacology and its relative risk-benefit ratio. At least seven different biologically active chemicals have been isolated from crude extracts of hypericum. Several are ubiquitous in the plant kingdom. The exceptions are hypericin and pseudohypericin, which have been assumed to be responsible for any antidepressant activity of this product. Nevertheless, there is the potential for one or more of these seven compounds and their metabolites to mediate desired or undesired effects, particularly when used in combination with other medications (i.e., herb-drug interactions). 

If patients are on antidepressants or antipsychotics which are considered to slow down the movement of Qi, herbal formulas containing sweet, astringent and sour herbs that stabilize and bind the Qi, fluid and blood, and that suppress the Qi movement should be used with caution. 

Stentorin. A protein with a bound chromophore called stentorin mediates the light-avoidance response of the protozoan Stentor. Stentorin,610 which is found in pigment granules in the cell surface, is a derivative of hypericin, a plant compound with antidepressant activity and the active ingredient in the herb St. John s wort. 

Folklore The oil has insect repellent properties. The herb is used in cooking to impart a lemon flavour to the food. It is an ingredient of a melissa cordial made by Carmelite nuns as well as being included in other liqueurs such as benedic-tine and chartreuse. Traditionally the herb was seen as an antidepressive. (Bown, 2003 British Herbal Medicine Association, 1983 Graenwald et al., 2002 Tierra, 1998). 

As far back in history as the Greek physicians Hippocrates, Pliny, and Galen, through to present time, the herb St. John s wort has been used for its antidepressant effect. It is believed to influence the neurotransmitters in the brain. Although some research has shown it to be effective in cases of mild to moderate depression, many questions remain as to its safety and effectiveness. 

In Germany, St. John s wort is approved for use in depression and anxiety. It is the most common antidepressant used and is usually sold by prescription. However, in the United States it is sold only as an herb and without prescription. It is frequently used by people with self-diagnosed depression. Preparations of St. John s wort will vary in potency according to manufacturer. Although extensive studies have been conducted on the... 

The herb St. John s wort (Hypericum perforatum) has a number of constituent parts, including hyperforin, which is currently being studied as the responsible constituent for the antidepressant action. The herb contains at least ten compounds that can have an unpredictable effect on the consumer. 

Falsely believing that a herb is safer than a prescribed drug, many people either take St. John s wort in place of, or in addition to, their prescription antidepressants. These are dangerous practices because of the serious side effects of the combinations and the serious consequences that may result when someone stops taking their antidepressant without the guidance of a physician. 

St. John s wort. The dried buds and flowers of this plant are used to treat mild to moderate depression and anxiety. More than 30 well-designed studies involving thousands of patients show the herb works about as well as conventional antidepressants for treating mild to moderate depression. 

How has deregulation worked A meta-analysis of the herb St John s wort (Hypericum perforatum) for mild and moderately severe depression, published in 1996 by German and American physicians, concluded that it was more effective than a placebo and was as effective as standard antidepressants but with fewer side effects. However, the authors of the analysis raised questions about the methods employed and cautioned about its efficacy in seriously depressed patients. The active chemical in the herb, they claimed, was not appropriately standardized. Furthermore, the study only compared St John s wort with antidepressant drugs that were given at or below their lowest level of efficacy. And, finally, patients were treated for only 6 weeks. An accompanying editorial concluded that longer term studies are needed before it can be recommended in major depression. ... 

St. John s wort. The St. John s wort plant (Hypericum perforatum Figure 6.4) is an increasingly popular herbal supplement that proponents claim has the ability to cure a vast array of ailments. St. John s wort appears to boost the release of the neurotransmitter serotonin in the brain, which may be the reason it is able to treat anxiety and depression. The herb contains numerous substances, two of which, hypericin and hyperforin, maybe key active ingredients. St. John s wort appears to be effective in relieving the muscle pain associated with fibromyalgia and the tissue pain associated with hemorrhoids. The herb comes in tablet, capsule, cream, and ointment forms and must be taken for several weeks before it takes full effect. St. John s wort should not be taken with antidepressants such as... 

Diazepam is better indicated if insomnia is associated with daytime anxiety. Other benzodiazepines prescribed for insomnia include nitrazepam, flur-azepam, loprazolam, lormetazepam and temazepam. The non-benzodiazepine hypnotics zaleplon, zolpidem and zopiclone are not licensed for long-term use. The sedative antipsychotic promethazine hydrochloride is sometimes used to facilitate sleep, with a 25-50 mg recommended dose. Melatonin has proved effective for some clients, mostly in regulating the sleep/waking cycle. Although evidence of efficacy is limited, some clients use herbs such as valerian and chamomile. If Mr AB will finally be diagnosed with depression, a trial with an antidepressant will be indicated. 

Women use herbal and dietary supplements at higher rates than men do. This rise in use of alternative therapies places women at increased risk of significant drug interactions, specifically drug-herb and drug-nutrient interactions (83 9). For instance, St. John s wort, a popular antidepressant, contains at least seven groups of chemical compounds. These include naphthodianthrons (hypericin and pseudohypericin), flavonoids (quercetin, hyperoside, and rutin). 

This herb is also known as St. Joan s wort, klamath weed, and goatweed. It has historically been used for many purposes, but most recently it is marketed as an antidepressant. In fact, it outsells all conventional antidepressants in Germany. The active constituent is hypericin that seems to act as a weak monoamine oxidase MAO inhibitor and a selective serotonin reuptake inhibitor (SSRI). Dopamine and norepinephrine uptakes are also mildly inhibited. St. John s wort is available in many forms, as a tablet, tea, tincture, and the raw dried herb. For best results, a tablet standardized to contain 0.3% hypericin should be taken Kira by Lichtwer Pharma is the most extensively studied. Randomized, placebo-controlled trials using 300 mg of St. John s Wort three times daily have found it to be superior to placebo in mild to moderate depression. Response rates are generally regarded as inferior to conventional antidepressants, including... 

Most of the research regarding the antidepressant action of St. John s wort has focused on the hypericins (Wagner and Bladt, 1994). Research has been done to examine the possibility of monoamine oxidase (MAO) or catechol -O-methyltransferase (COMT) inhibition, and inhibition of serotonin and norepinephrine reuptake (Perovic and Muller, 1995 Raffa, 1998). In one study, the effects of hypericum total extract, hypericum fractions, and hypericin on MAO and COMT activity were examined in vitro (Thiede and Walper, 1994). It was concluded that the in vitro concentrations of these preparations required to inhibit MAO were in excess of that attained through ingestion, and thus MAO inhibition could not be an explanation of the herb s antidepressant activity. In addition, COMT inhibition appeared to be associated with flavonols and xanthones rather than hypericins. Another study (Cott, 1997) showed that pure hypericin did not bind to MAO, and confirmed that concentrations of the crude extract required for MAO inhibition exceeded those attained after oral administration. 

The botanical name of St. John s wort is Hypericum perforatum. Derived from Greek, hypericum means over the apparition, which refers to the ancient belief that the fumes of this herb could drive evil spirits away. Indeed, St. John s wort maybe considered the original antidepressant. Its use dates back to ancient Greek times, where... 

One way to confirm whether St. John s wort can help with depressive symptoms is to analyze its pharmacological action in the brain. With this information, we can then assess whether the herb may be acting in ways similar to other antidepressants. For many years, scientists believed that the active ingredient of St. John s wort was a substance called hypericin, thus St. John s wort remedies were often standardized by their hypericin content. However, recently other components of the herb s flowers and leaves have also been shown to produce pharmacological action in the brain, such as flavonoids (substances reputed to have anti-depressant and anti-anxiety actions). Thus it is most likely that several chemicals in St. John s wort work in conjunction to bring about therapeutic changes. 

Saint-John s-wort is one example of a natural herbal remedy for depression that has recently gained in popularity and prevalence across the United States. In Europe, it is reportedly outselling the prescription medication Prozac. Saint-John s-wort (Hypericum perforatum) is a lush green herb with bright yellow flowers that has traditionally been used to heal wounds and as a tea to soothe nerves and relieve melancholy. The natural antidepressant effect that results enhances the neurochemical serotonin, norepinephrine, and dopamine with few side effects (Lemonick, 1997). 

The herb is native to Europe, western Asia, and northern Africa and is available at many health stores in the states without a prescription. It costs much less than prescription antidepressant medications. 

---