Depression St. John’s wort

Answer Two months ago, Mr. R. began taking St. John s wort to counteract depression. St. John s wort is a potent inducer of intestinal and hepatic CYP3A4. Saquinavir undergoes extensive first-pass metabolism by intestinal CYP3A4 and is metabolized in the liver by CYP3A4. The use of St. John s wort is contraindicated for individuals taking pro-... 

St. John s wort has been used to treat a wide range of ailments for more than 2000 years, and is said to have been prescribed by Hippocrates himself. Apart from depression, St. John s wort is being promoted or used as a treatment for attention-deficit hyperactivity disorder (ADHD), anxiety, stress, obsessive-compulsive disorder, sleep problems, nocturnal enuresis, bacterial and viral infections such as HIV-AIDS, respiratory conditions, peptic ulceration, inflammatory arthritis, cancer, and skin wounds (Rey and Walter, 1998 Walter et ah, 2000). It is also said to increase libido, an application dating from the Middle Ages (Fletcher, 1996). No empirical evidence is currently available to support any of these uses. 

APREPITANT ANTI DEPRESSANTS-ST JOHN S WORT t aprepitant levels Inhibition of CYP3A4-mediated metabolism of aprepitant Avoid co-administration (manufacturers recommendation)... 

Depression St. John s Wort naturopathic several controlled studies demonstrate efficacy for mild to moderate depression... 

Maprotiline, Moclobemide, Mianserin, Fluoxetine (Prozac), Paroxetine, Sertraline, Fluvoxamine, Citalopram, Venlafaxin (generic IR formulation and the brand Venlafaxine XR), Mirtazapine, Flupentixol-melitracen (Deanxit), Tianeptine, Extract of St. John s Wort, Buspirone Depression and anxiety... 

Lecrubier, Y., Clerc, G., Didi, R. Kieser, M. (2002). Efficacy of St. John s Wort extract WS 5570 in major depression a double-blind, placebo-controlled trial. Am. J. Psychiatry, 159, 1361-6. 

Schrader, E. (2000). Equivalence of St John s Wort extract (Ze 117) and fluoxetine a randomized, controlled study in mild-moderate depression. Int. Clin. Psychopharmacol., 15, 61-8. 

St. John s wort, which has become very popular for the treatment of depression, has been shown to induce intestinal P-gp and intestinal and hepatic CYP3A4 in humans [140]. That mechanism explains the significant reduction in cyclosporin and anti-aids (e.g., indinavir) plasma concentrations. It is likely that similar effects will be noted with the compounds listed in Table 8 (although the effects noted in Table 8 are in the opposite direction of those seen in the presence of St. John s wort). 

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. 

I am not a great fan of St John s wort. For lasting control of depression, psychological treatment produces the best results, and medication does not add much - if anything - to it. Nevertheless, if a depressed patient wants medication, or if available alternative treatments are not sufficiently effective, this herbal remedy, taken under medical guidance, may be worth considering. 

Hudson, Christopher G., Socioeconomic Status and Mental Illness Tests of the Social Causation and Selection Hypotheses , American Journal of Orthopsychiatry 75, no. 1 (2005) 3-18 The Humble Humbug , The Lancet 2 (1954) 321 Hunter, Aimee M., Andrew F. Leuchter, Melinda L. Morgan and Ian A. Cook, Changes in Brain Function (Quantitative EEG Cordance) During Placebo Lead-in and Treatment Outcomes in Clinical Trials for Major Depression , American Journal of Psychiatry 163, no. 8 (2006) 1426-32 Hyland, Michael E., Do Person Variables Exist in Different Ways , American Psychologist 40 (1985) 1003-10 Hypericum Depression Trial Study Group, Effect of Hypericum Perforatum (St John s Wort) in Major Depressive Disorder A Randomized Controlled Trial , Journal of the American Medical Association 287 (2002) 1807-14... 

Hypericum An extract of Hypericum perforatum (St John s wort) used in the phytotherapy of depression. 

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. 

Gordon JB. (1998). SSRIs and St. John s Wort possible toxicity Am Fam Physician. 57(5) 950-51. Gorman JM. (1996-97). Comorbid depression and anxiety spectrum disorders. Depression Anxiety. 4(4) 160-68. 

Kerb R, Brockmoiier J, Staffeldt B, Ploch M, Roots I. (1996). Single-dose and steady-state pharmacokinetics of hypericin and pseudohypericin. Antimicrob Agents Chemother. 40(9) 2087-93. Kim HL, Streltzer J, Goebert D. (1999). St. John s wort for depression a meta-analysis of well-defined clinical trials. J Nerv Ment Dis. 187(9) 532-38. 

Laakmann G, Schule C, Baghai T, Kieser M. (1998). St. John s wort in mild to moderate depression the relevance of hyperforin for the clinical efficacy. Pharmacopsychiatry. 31(suppl 1) 54-59. 

Lickey ME, Gordon B. (1991). Medicine and Mental Illness. New York W. H. Freeman and Company. Linde K, Ramirez G, Mulrow CD, Pauls A, Weidenhammer W, Melchart D. (1996). St. John s wort for depression—an overview and meta-analysis of randomised clinical trials. BMJ. 313(7052) 253-58. Lingjaerde 0, Foreland AR, Magnusson A. (1999). Can winter depression be prevented by Ginkgo biloba extract A placebo-controlled trial. Acta Psychlatr Scand. 100(1) 62-66. 

Schmidt U, Sommer H. (1993). [St. John s wort extract in the ambulatory therapy of depression. Attention and reaction ability are preserved]. Fortschr Med. 111(19) 339-42. 

Vorbach EU, Arnoldt KH, Hubner WD. (1997). Efficacy and tolerability of St. John s wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD-10. Pharmacopsychiatry. 30(suppl 2) 81-85. 

Kim HL, Streltzer 3, Goebert D. (1999). St. John s wort for depression a meta-analysis of well-defined clinical trials. J Nerv Merit Dis. 187(9) 532-38. 

Several natural products have been evaluated in rodent models of nicotine withdrawal. An extract of Hypericum perforatum (St. John s Wort, a putative antidepressant, and inhibitor of serotonin reuptake) reversed somatically expressed withdrawal behaviors and locomotor depression in spontaneous withdrawal (Catania et al. 2003). A benzoflavone compound isolated from Passiflora incarnata, interfered with the induction of physical dependence. Coadministration with chronic nicotine prevented various subsequent indicators of withdrawal syndrome in the mouse, including jumping, locomotor inactivity, immobility in the swim test and naloxone-precipitated escape jumping (Dhawan et al. 2002). 

St. John s wort (Hypericum perforatum) Relieves anxiety and depression prevents insomnia relieves some skin disorders... 

St. John s wort depression no evidence for its effectiveness against moderate to severe depression... 

Efavirenz (Sustiva) [Antiretroviral/NNRTI] Uses Hiv infxns Action Antiretroviral nonnucleoside RTI Dose Adults. 600 mg/d PO qhs Feds. See package insert avoid high-fat meals Caution [D, ] CDC recommends HIV-infected mothers not breast-feed Contra Component sensitivity Disp Caps SE Somnolence, vivid dreams, dizziness, rash, N/V/D Interactions T Effects W/ ritonavir T effects OF CNS depressants, ergot derivatives, midazolam, ritonavir, simvastatin, triazolam, warfarin X effects W/ carbamazepine, phenobarbital, rifabutin, rifampin, saquinavir, St. John s wort i effects OF amprenavir, carbamazepine, clarithromycin, indinavir, phenobarbital, saquinavir, warfarin may alter effectiveness OF OCPs EMS Concurrent EtOH usage can t CNS d ression OD May cause muscle contractions and adverse CNS effects activated charcoal may be effective... 

---