St. John’s wort effectiveness

Uses Obesity Action Blocks uptake of norepinephrine, serotonin, dopamine Dose 10 mg/d PO, may to 5 mg after 4 wk Caution [C, -] w/ SSRIs, Li, dextromethorphan, opioids Contra MAOI w/in 14 d, uncontrolled HTN, arrhythmias Disp Caps SE HA, insomnia, xerostomia, constipation, rhinitis, tach, HTN Interactions T Risk of serotonin synd W/ dextromethorphan, ergots, fentanyl, Li, meperidine, MAOIs, naratriptan, pentazocine, rizatriptan, sumatriptan, SSRIs, tryptophan, zolmitriptan, St. John s wort effects W/ cimetidine, erythromycin, ketoconazole T CNS depression W/ EtOH EMS Use fentanyl w/ caution, may T risk of serotonin synd concurrent EtOH use can T CNS depression OD May cause tach, HTN, diaphoresis, HA, fever, agitation, muscle tremors, and Szs symptomatic and supportive... 

St. John s wort is very popular as a physician-prescribed antidepressant in Europe and is widely used for this purpose—usually without medical guidance—in the United States. A meta-analysis of 23 studies concluded that St. John s wort was more effective than placebo in treating mild to moderate depression and was as effective as imipramine and standard antidepressants. It was also better tolerated than the antidepressants to which it was compared. A recent meta-analysis, however, failed to find St. John s wort effective for severe depression. 

Roby CA, Anderson GD, Kantor E, Dryer DA, Burstein AH. St. John s wort effect on CYP3A4 activity. Clin Pharmacol Ther 2000 67 451-457. 

Numerousherbai diureticsare available as over-the-counter (OTQ products. Most plants and herbal extracts available as OTCdiureticsare nontoxic. However, most are either ineffective or no more effective than caffeine. The following are selected herbals reported to possess diuretic activity cetery, chicory, sassafras juniper berries St. John s wort, foxglove, horsetail, licorice, dandelion, digital is purpurea, ephedra, hibiscus parsley, and elderberry. 

Conversely buprenorphine metabolism could by increased by carbamazepine, phenytoin, St. John s wort, efavirenz, and nevirapine, or any other CYP3A4 inducer the effects may be less than expected may need to increase buprenorphine dose. 

Synergy of therapeutic pharmacological effects St. John s Wort will induce serotonin syndrome when co-administered with SSRIs. 

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). 

Some products available on the market contain a combination of Ma Huang and St. John s wort and are referred to as herbal phen-fen. Phen-fen received its name when the combination of phentermine and fenfluramine were used for weight loss. Herbal phen-fen is touted as a natural and effective weight loss agent that does not contain phentermine or fenfluramine. However, herbal phen-fen carries the same warnings that apply to Ma Huang and St. John s wort when each is used alone. Furthermore, there are no clinical studies to support the use of herbal phen-fen. ... 

Some precautions are based on the dietary supplement s side effect profile. St. John s wort may induce photosensitivity therefore, fair-skinned persons should be cautioned about exposure to bright sunlight while taking the herb. 

Although many patients believe that dietary supplements will not interact with medications, recent literature suggests otherwise. Recently, many St. John s wort-drug interactions have been reported in the literature. Cases of patients developing symptoms of serotonin syndrome have been reported with St. John s wort alone and in concomitant therapy with other antidepressants such as monoamine oxidase inhibitors, serotonin reuptake inhibitors, and venlafaxine. St. John s wort may exacerbate the sedative effects of benzodiazepines, alcohol, narcotics, and other sedatives. St. John s wort may decrease the levels of protease inhibitors, cyclosporine, digoxin, and theophylline. 

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... 

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. 

Dimpfel W, Hofmann R. (1995). Pharmacodynamic effects of St. John s Wort on rat intracerebral field potentials. EurJ Med Res. 1(3) 157-67. 

Dimpfel W, Schober F, Mannel M. (1998). Effects of a methanolic extract and a hyperforin-enriched C02 extract of St. John s Wort (Hypericum perforatum) on intracerebral field potentials in the freely moving rat (Tele-Stereo-EEG). Pharmacopsychiatry. 31(suppl 1) 30-5. 

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. 

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

Prescribers are advised to consult the package insert of any medication administered concomitantly with hormonal contraceptives, because some medications may decrease the effectiveness of these birth control products. Patients should be prospectively cautioned not to self-medicate with the herbal supplement St. John s wort because a possible interaction has been suggested with hormonal contraceptives based on reports of breakthrough bleeding while on oral contraceptives shortly after starting St. John s wort. Pregnancies have been reported by users of combined hormonal contraceptives who also used some form of St. John s wort. 

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