St. John’s wort, in depression

Rey JM, Walter G. Hypericum perforatum (St. John s wort) in depression pest or blessing Med J Aust 1998 169 583-586. 

Butterweck V. Mechanism of action of St. John s wort in depression what is known CNS Drugs 2003 17 539-562. 

The mechanism of action of St. John s wort in depression is not understood, but serotonin re-uptake inhibition is one possibility, for which evidence is increasing. In one case this may have led to the serotonin syndrome in a 33-year-old woman who developed extreme acute anxiety after taking only three doses of extracts of St. John s wort and recovered after withdrawal (6). 

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... 

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. 

Contrary to the situation with most alternative treatments, there is a growing body of research about the efficacy of St. John s wort in treating depression. At the time of writing, however, there were no controlled trials of children and adolescents. 

Clinicians should be aware that many of their patients may be taking alternative treatments either via self-care or prescribed by CAM practitioners. Inquiring about this should be routine because of potential side effects and drug interactions. A working knowledge of CAM treatments will allow child psychiatrists to give parents and patients advice about safety and effectiveness. Use of St. John s wort in children with unipolar depression may at times be appropriate, particularly in cases where more standard treatments are contraindicated or have failed. However, it should be used cautiously and with an appropriate explanation of its risks and benefits, as a competent clinician would do for any treatment. Use of St. John s wort for other conditions is not currently recommended given the lack of evidence for efficacy. Kava extracts may be used for anxiety, with similar provisos. There are much fewer data about the efficacy and safety of other dietary supplements and their use cannot be supported at this point. 

Hypericum Depression Trial Study Group Effect of Hypericum perforatum (St John s wort) in major depresssive disorder. J. Am. Med. Assoc. 287, 1807-1814. 2002. 

It should be noted that these clinical trials are typically conducted within a short time period and thus may not reflect long-term outcomes. The utility of St. John s wort in the treatment of moderate to severe depression has been investigated (14-17) in large randomized placebo-controlled multi-institutional studies. Some such studies demonstrated efficacy (16), but others failed to detect a clinically significant effect on the symptoms of the moderate to severely depressed individuals (15,17). Gelenberg et al. demonstrated a relapse rate of approximately 30% in moderate to severely depressed individuals who initially responded to St. John s wort therapy as would be expected from experience with prescription antidepressants (14). 

Gelenberg AJ, Shelton RC, Crits-Christoph P, et al. The effectiveness of St. John s wort in major depressive disorder a naturalistic phase 2 followup in which nonresponders were provided alternate medication. J Clin Psychiatr 2004 65(8) 1114 1119. 

Shelton RC, Keller MB, Gelenberg A, et al. Effectiveness of St John s wort in major depression a randomized controlled trial. JAMA 2001 285(15) 1978-1986. 

A few weeks earher he had diagnosed himself with mild depression, and he d known exactly what to do about it. He d seen stories about the potential benefits of the herbal remedy St. John s wort in all kinds of tabloids and magazines, and here was his chance to give it a try. It never crossed his mind to check with his doctors first, since St. John s wort was a natural remedy, and therefore (supposedly) completely safe. But the effects of drugs on our bodies can be very complex and sometimes mysterious. While the mechanism by which St. John s wort carries out its antidepressant effect is not clear, researchers have been able to identify an unwelcome side effect. Some component in St. John s wort stimulates the production of an enzyme with the cryptic name of cyp3a, one of a number of... 

Shelton R C et al 2001 Effectiveness of St. John s Wort in major depression. A randomised control trial. Journal of the American Medical Association 285 1978-1986... 

Shelton, R. C., Keller, M. B., Gelenberg, A., Dunner, D., Hirschfeld, R., Thasc, M. E., et al. (2001). Effectiveness of St. John s wort in major depression A randomized controlled trial. Journal of the American Medical Association, 285,1978-1986. 

There are numerous accounts of anecdotal evidence supporting the use of St. John s wort for premenstrual syndrome (PMS) (36). One open, uncontrolled study was conducted to determine the efficacy of St. John s wort in treating PMS. The primary outcome was measured by a daily symptom checklist of 17 symptoms rated on a scale of 0 to 4 based on the Hospital Anxiety and Depression (HAD) scale and modified Social Adjustment Scale (SAS-M) broken down into four subscales mood, behavior, pain, and physical. A total of 25 women were selected to participate in the study in which they received 300 mg hypericum standardized to 900 p.g hypericin daily. The results from the daily symptoms survey after the first cycle show a statistically significant reduction from the baseline value of 128.42 to 70.11. After the second cycle, there was a further reduction to 42.74. Of the four subscales, St. John s wort had the greatest improvement on the mood subscale (57%) and the least improvement on the physical subscale (35%). Of the individual symptoms, crying (92%) and depression (85%) were improved the most with treatment, and food cravings and headaches were improved the least (36). 

Davidson JRT, Gadde KM, Fairbank JA, Krishnan KRR, Califf RM, Binanay C. Effect of Hypericum perforatum (St. John s Wort) in major depressive disorder. JAMA 2002 287(14) 1807-1814. 

ABSTRACT Hypericum perforatum L., St. John s Wort, has become one of the most important medicinal plants of nowadays. This is a result of extensive research on the chemical constituents of this plant, and of increasing efforts for pharmacological and clinical profiling of St. John s Wort extracts and of their individual components. To date, these studies provide a solid basis for the the therapeutic use of St. John s Wort in the treatment of mild to moderate depressions. 

B. Gaster and J. Holroyd, St. John s Wort for Depression A Systematic Review. Archives of Internal Medicine 160 (January 24, 2000) 152-156 E. Shrader, Equivalence of St. John s Wort Extract and Fluoxe tine A Randomized, Controlled Study in Mild Moderate Depression. Inter-national Clinical Psychopharmacology 15, no. 2 (2000) 61-68 L. Taylor and K. A. Kobak, An Open-Label Trial of St. John s Wort in Obsessive Compulsive Disorder. Journal of Clinical Psychiatry 61 (August 2000) 575-578 J. R. T. Davidson and K. M. Connor, St. John s Wort in Generalized Anxiety Disorder Three Case Reports. Journal of Clinical Psychopharmacology 21... 

The National Institutes of Health conducted a double-blind, 3-year study in patients with major depression of moderate severity using St. John s wort and sertraline. This study did not support the use of St. John s wort in the treatment of major depression, but a possible role for St. John s wort in the treatment of miider forms of depression was suggested. Health care providers should alert their patients about potential drug interactions with St. John s Wort. Some other frequently used herbal supplements that have not been evaluated in large-scale clinical trials are ephedra, gingko biloba, echinacea, and ginseng. Any herbal supplement should be taken only after consultation with the physician or other health care provider. 

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