St. Johns Wort and Depression

1. What is St. John's wort?

St. John's wort (Hypericum perforatum in Latin) is a long-living, wild-growing plant with yellow flowers. Extracts of the plant have been used for centuries in efforts to treat mental disorders as well as nerve pain. In ancient times, doctors and herbalists (specialists in herbs) wrote about its use as a sedative and treatment for malaria as well as a balm for wounds, burns, and insect bites. Today, St. John's wort is used for treating mild to moderate depression, anxiety, or sleep disorders. St. John's wort remains among the top-selling herbal remedies, and many brands are now available and sold over the counter as dietary supplements.

2. Does St. John's wort have side effects or interact with prescription drugs?

The most common side effects of St. John's wort include dry mouth, dizziness, gastrointestinal symptoms, increased sensitivity to sunlight, and fatigue. St. John's wort may reduce the effectiveness of several drugs by speeding up activity in a key pathway responsible for their breakdown. The end result is that blood levels of these drugs decrease because the body breaks them down faster making the drugs less effective. St. John's wort especially affects indinavir, a drug used to treat HIV infection. It may also affect cyclosporin, a drug used to help prevent organ transplant rejection, and other drugs that work through this same pathway in the body, such as birth control pills and medications for heart disease and depression. Further information about these potential adverse interactions is available from www.fda.gov/cder/drug/advisory/stjwort.htm.

3. What is major depression?

Major depressive disorder, also known as major depression, is the most common type of depressive illness. Symptoms usually develop over days, weeks, or months. They can cause distress and interfere with the ability to work, study, sleep, eat, and enjoy once-pleasurable activities. People with depression may feel sad, irritable, hopeless, discouraged, tired, worthless, or guilty much of the time. The person also often cannot think clearly, concentrate, or make decisions. This depressed mood lasts most of the day nearly every day for a period of at least 2 weeks. Untreated, the depression can last for 6 months or longer. Other than depressed mood and loss of interest or pleasure, symptoms include at least four of the following:

• Significant weight gain or loss
• Disturbance of normal sleeping patterns
• Agitation or unusual slowness
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or guilt
• Diminished ability to think or concentrate
• Recurrent thoughts of death or suicide

Major depression can vary in degree from mild to moderate to severe. In mild cases, there may be some significant distress or interference with daily activities at work, at home, and in social life. In moderate depression, problems and impairments in these areas are more pronounced. If the depression is severe, the person may lose completely the ability to function.

4. Are there proven treatments for major depression?

Fortunately, major depression can be successfully treated. Treatments that have been scientifically proven include a variety of antidepressant medications and certain psychotherapies, such as cognitive-behavioural therapy and interpersonal therapy. A first step toward getting treatment for depression is an evaluation by a doctor. Your doctor can rule out medical conditions, such as a viral infection or thyroid disorder, which can cause the same symptoms as depression.

5. Why is St. John's wort used as an alternative therapy for depression?

Some patients who take antidepressant drugs do not experience relief from their depression. Other patients have reported unpleasant side effects from their prescription medication, such as a dry mouth, nausea, headache, or effects on sexual function or sleep.

Sometimes people turn to herbal preparations like St. John's wort because they believe "natural" products are better for them than prescription medications, or that natural products are always safe. Neither of these statements is true (this is discussed further below).

Finally, St. John's wort can be bought without a prescription (over the counter).

6. How widely is St. John's wort used for treating depression?

In Europe, St. John's wort is widely used for depression. In the United Kingdom, St. John's wort is not a prescription medication, but there is considerable public interest in it. St. John's wort remains among the top-selling herbal products in the United Kingdom.

7. How is St. John's wort sold?

St. John's wort products are sold in the following forms:

• Capsules
• Teas--the dried herb is added to boiling water and steeped for a period of time.
• Extracts--specific types of chemicals are removed from the herb, leaving the desired chemicals in a concentrated form

8. Does St. John's wort work as a treatment for depression?

There has been scientific research to try to answer this question.

In Europe, results from a number of scientific studies have supported the effectiveness of certain St. John's wort extracts for depression. An overview of 23 clinical studies, published in the British Medical Journal in 1996, found that the herb might be useful in cases of mild to moderate depression. The studies, which included 1,757 outpatients, reported that St. John's wort was more effective than a placebo (a "dummy" pill designed to have no effect) and appeared to produce fewer side effects than some standard antidepressants.

Other studies conducted recently have found no benefit from the use of St. John's wort for certain types of depression. For example, the results of a study funded by Pfizer, a pharmaceutical company, found that St. John's wort, when compared with placebo, was not effective for treating major depression.

In addition, a large, carefully designed American research study to find out whether St. John's wort extract benefits people with major depression of moderate severity found that St. John's wort was no more effective for treating major depression of moderate severity than placebo

9. Are there any risks to taking St. John's wort for depression?

Yes, there are risks in taking St. John's wort for depression.

Many so-called "natural" substances can have harmful effects--especially if they are taken in too large a quantity or if they interact with something else the person is taking.

St. John’s wort interacts with some drugs--including certain drugs used to control HIV infection (such as indinavir). Other research shows that St. John’s wort can interact with anticancer drugs. The herb may also interact with drugs that help prevent the body from rejecting transplanted organs (such as cyclosporin). Using St. John’s wort limits these drugs’ effectiveness.

Also, St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe and, in some cases, may be associated with suicide. Consult a health care practitioner if you or someone you care about may be experiencing depression.

People can experience side effects from taking St. John's wort. The most common side effects include dry mouth, dizziness, gastrointestinal symptoms, increased sensitivity to sunlight, and fatigue.

The strength and quality of herbal products are also often unpredictable. Products can differ in content not only from brand to brand, but also from batch to batch. Information on labels may be misleading or inaccurate.

10. Should St. John's wort be used for major depression?

At this time, it is not known what role St. John's wort should play in the management of depression. The results of research studies indicate that St. John's wort is not effective in treating major depression of moderate severity.

This article was adapted from:

http://nccam.nih.gov/health/stjohnswort/index.htm

http://nccam.nih.gov/news/2002/stjohnswort/q-and-a.htm