Herbal antidepressant

Huff see Inhalants Hug drug see Ecstasy Humibid DM see Dextromethorphan Hydrochlorothiazide (HCT) see Diuretics Hydroflumethiazide see Diuretics Hydrostat see Hydromorphone Hypericum perforatum see Antidepressants Herbal drugs... 

St. John s wort see Antidepressants Herbal drugs Stardust see Cocaine... 

Hypericum perforatum (St John s wort) (Hypericaceae) widely used as antidepressant herbal medicine... 

Aromatic natural products of polyketide origin are less prevalent in plants compared with microorganisms. The majority of the plant constituents that contain aromatic stmctures are known to arise from the shikimate pathway (see below). Unlike those derived from the shikimate pathway, aromatic products of the polyketide pathway invariably contain a meta oxygenation pattern because of their origin from the cyclization of polyketides. Phenolic compounds such as chrysophanol-anthrone (Bl), and emodin-anthrone (B2), and the anthraquinones, aloe-emodin (B3) and emodin (B4) (Fig. 2), are products of the polyketide pathway and are found to occur in some plants of the genera Cassia (Leguminosae) (21), Rhamnus (Rhamnaceae) (22), and Aloe (Liliaceae) (23). The dimer of emodin-anthrone (B2), namely hypericin, (B5) is a constituent of the antidepressant herbal supplement, St. John s wort (Hypericumperforatum, Hy-pericaceae) (24). 

Melatonin receptor agonists Antihistamines Antidepressants Herbal preparations... 

A number of non-hormonal therapies have been studied for symptomatic management of vasomotor symptoms, including antidepressants [e.g., selective serotonin reuptake inhibitors (SSRIs) and venlafaxine], herbal products (e.g., soy, black cohosh, and dong quai), and a group of miscellaneous agents (e.g., gabapentin, clonidine, and megestrol). The choice of therapy depends on the patient s concomitant disease states, such as depression and hypertension, and the risk for potential adverse effects. 

St John s wort is a yellow flowering plant that was first used medicinally by the ancient Greeks as a diuretic and a treatment for wounds and menstrual disorders. This herbal remedy is widely prescribed in Germany, where it has been studied extensively in clinical trials as a treatment for depression. In most countries, including the UK, it is available over the counter. In Ireland it is available only by prescription. Recently, a team of German scientists led by Klaus Linde at the University of Munich published a comprehensive review of 29 clinical trials of St John s wort, involving more than 5,000 depressed patients. They concluded that it is more effective than placebos and as effective as standard antidepressants in the treatment of major depression. 

In addition to this serious diet-drug interaction, irreversible MAOIs also potentiate the effects of sympathomimetic drugs like ephedrine found in over-the-counter cold remedies and recreational stimulants like amphetamine. The MAOIs also interact with drugs that increase synaptic concentrations of 5-HT, such as the tricyclic antidepressant clomipramine and the herbal SSRI antidepressant St John s wort (Hypericum spp.). The resulting serotonin syndrome is characterised by hyperthermia and muscle rigidity. While devoid of these side effects the reversible MAO-A inhibitor moclobemide has yet to establish itself as a first-line alternative to the SSRIs. 

St. John s wort, an herbal nonprescription medication containing hyperi-cum, may be effective for mild to moderate depression, but it is associated with several drug-drug interactions. Its potency, purity, and manufacture are not regulated by the FDA. As depression is a potentially life-threatening disease, all antidepressant treatments should be overseen by a trained healthcare professional. 

Herbal Antidepressants and Anxiolytics Saint-John s- Wort History and Botany... 

Ernst E, Rand JI, Barnes J, Stevinson C. (1998). Adverse effects profile of the herbal antidepressant St. John s wort (Hypericum perforatum L.). EurJ Clin Pharmacol. 54(8) 589-94. 

Herbal antidepressants - St John s Wort (Hypericum officinalis)... 

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. 

Wentworth, J.M., Agostini, M., Love, J., Schwabe, J.W., and Chat-terjee, V.K. (2000) St John s wort, a herbal antidepressant, activates the steroid X receptor./ Endocrinol 166 R11—R16. 

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). 

Lobelia inflata, mentat, Morinda citrifolia and officinalis, and Rhazya stricta have all been suggested to have antidepressant properties. There are no controlled studies, however, with any of these herbal products to support these claims. Moreover, these products are not innocuous. 

Nahrstedt A. Antidepressant constituents of Hypericum perforatum. In Chrubasik S, Roufogalis BD, eds. Herbal Medicinal Products for the Treatment of Pain. Lismore Southern Cross University Press, 2000 144—153. 

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. 

---