Hypericum side effects

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. 

Pharmaceutical Comparison. At least 8 studies to date have examined the effectiveness of hypericum compared to the pharmaceutical antidepressants imipramine, amitriptyline, and maprotiline. Preliminary results indicate that hypericum is equivalent to standard antidepressants in effectiveness (Linde et al. 1996 Vorbach 1997). Similar to the pharmaceutical antidepressants, there is a 10-14 day lag for therapeutic effects of hypericum (Harrer et al. 1994). Indeed, the differences seen between hypericum and placebo groups becomes apparent between 2 and 4 weeks (Sommer and Harrer 1994). Hypericum has been reported to have a more favorable side-effect profile than several pharmaceutical antidepressants as well (Vorbach et al. 1994 Harrer et al. 1994). In double-blind studies, subjects have reported fewer and less-severe side effects. Although these initial results are promising, Linde and colleagues (1996) have concluded that the present evidence is inadequate to establish... 

A review of case reports, clinical trials, post-marketing surveillance, and drug monitoring studies concurrently showed that the most common side effects were gastrointestinal, dizziness/confusion, and sedation (Ernst et al. 1998). Importantly, the side effects of hypericum in this study were comparable to placebo levels. A pharmacokinetic study showed that plasma levels of up to 300 ng/ml were well tolerated. Headache occured in one subject who was taking 1200 mg extract (59 mg hyperforin, plasma cone. >400 ng/ml) (Biber et al. 1998). 

Future directions for research on hypericum may continue the work done in clinical efficacy. More specifically, studies may be of interest that examine its effects in treatment of more severe depression and different subtypes of depression. The comparative efficacy of different hypericum preparations could be further investigated, and optimum dosages need to be established (Linde et al. 1996). Further work is needed to compare hypericum s efficacy and side effects with those of the SSRIs or atypical antidepressants, because published studies to date have only compared it with tricyclics. 

There is no empirical evidence available for clinical use in children and adolescents. Yet, Hypericum seems to be used for the treatment of mild to moderate depression in the young (Walter et ah, 2000). St. John s wort should be avoided in young patients with severe depression and bipolar disorder (given the lack of adult data about effectiveness and risk of manic induction, respectively) and in those who have significant suicide risk. Treatments of proven efficacy (e.g., SSRIs, mood stabilisers) should be preferred in these cases. However, St. John s wort may be considered in cases of unipolar depression where conventional treatments have failed and prior to the use of combinations of drugs that have an increased risk of side effects and whose efficacy has not been demonstrated. 

As with prescription antidepressants, there is a 2- or 3-week lag in onset of action. If side effects are marked, or if at 6 to 8 weeks Hypericum is deemed to be ineffective, the patient can be weaned off and another treatment considered. Unfortunately, there are no data about washout periods following discontinuation of St. John s wort. A conservative approach is to wait 2 weeks after ceasing St. John s wort before commencing another agent. 

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. ... 

Schulz V. Incidence and clinical relevance of the interactions and side effects of Hypericum preparations. Phytomedicine 2001 8(2) 152-160. 

Increasingly, consumers are choosing alternative forms of therapy, such as herbal medications including St. John s wort." " Some evaluations have found that the active ingredient in St. John s wort, hypericum, is a safe and effective treatment for mild to moderate depression" " when compared with placebo, TCAs, and fluoxetine." " In most cases, side effects appear to be mild. St. John s wort is available as an over-the-counter medication. Although this... 

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). 

St John s wort (Hypericum perforatum) This herb is frequently used in Europe, particularly Germany, where it is prescribed twenty times more often than Prozac. Research suggests that St. John s wort is more effective than placebo and as effective as some medications, with fewer side effects. ... 

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