BLAH BEGONE
St. John’s wort, the all-natural antidepressant.
As herbal medicine tiptoed into the mainstream in the 1990s, St. John’s wort joined the ranks of gingko biloba, ginseng and echinacea as stars of the supplement shelves. The demand for alternatives to conventional medicine grew, patients began searching for help with frequent ailments and a healthy consumer boom was born.
St. John’s wort is most commonly thought of as a supporting treatment for depression. Its success does vary with the degree, proving most successful for mild to moderate cases [1, 2]. Unfortunately, moderate to severe depression has not shown substantial improvement with St. John’s wort [3, 4]. This is complicated by an unclear definition between the extremes, mild and severe. Patients who wish to explore St. John’s wort need to discuss with their physician any concerns as well as the degree of their depression. There is additional evidence to support the use of this herb with black cohosh for women suffering from depression with symptoms linked to menopause [5].
Many conventional physicians shy away from St. John’s wort due to its interactions with other medications [6]. It’s known to induce specific reactions in the liver, meaning it actually speeds up how fast the body gets rid of certain. This can include birth control pills, warfarin (a common blood thinner) and digoxin, a heart medicine. St. John’s wort may also interact with antiviral drugs used in the treatment of HIV/AIDS, a condition that often prompts depression.
Patients who are already on antidepressant medications should always talk to their physician before starting this supplement. Combinations of prescriptions, like Prozac or Zoloft, with St. John’s wort could cause serious elevations in a neurotransmitter in the body called serotonin. This can lead to serotonin syndrome, a condition that includes high heart rate, muscle stiffness, anxiousness and even seizures.
St. John’s wort is otherwise tolerated well. Side effects may include stomach upset or fatigue [7]. Patients should also be aware that this herb may actually make the skin more sensitive to the sun. This is seen more in animals that actually graze in pastures with St. John’s wort, but it’s still a possibility [8].
Though the information is not all positive, St. John’s wort should be considered as a treatment option. Patients who wish to know other nutritional and alternative options for depression should visit our nutrition section.
The dosage of St. John’s wort is 300 mg, taken two to three times a day. Bottles are typically standardized to 0.3 percent hypericin [8, 9]. Like standard antidepressant medications, St. John’s wort may take one to two months to take full effect.
Is hypericin the active ingredient? Should I avoid supplements with less than 0.3 percent?
The standardization St. John’s wort contains either 0.14-0.3 percent hypercirin or 2-5 percent hyperforin. To date, there is no clear-cut winner between the two in the literature. The key is to look for a product that contains at least one of these, and ideally both. If it's not listed, assume you are dealing with a substandard product and move on.
Can St. John’s wort help with seasonal depression (winter blues)?
I am not aware of any specific data regarding St. John’s wort and seasonal affective disorder (SAD). However, prescription anti-depressants are often successful to some degree, so there is no reason why St. John’s wort would not be. Make it a consideration after checking vitamin D levels and working with a light therapy box.
References:
1. Linde, K., Mulrow, C.D. (2003). St John's wort for depression. Cochrane Depression, Anxiety and Neurosis Group. Cochrane Database Syst Rev, 3.
2. Friede, M., Henneicke, von Z., H-H, Freudenstein. (2001). Differential therapy of mild to moderate depressive episodes with St John's wort. Pharmacopsychiatry, 34S1:38-41.
3. Hypericum Depression Trial Study Group. (2002). Effect of Hypericum perforatum (St John's wort) in major depressive disorder: A randomized controlled trial. JAMA, 287(14):1807-14.
4. Shelton, R.C. (2002). St John's wort for the treatment of depression. Lancet Neurol, 1(5):275.
5. Uebelhack, R. (2006). Black cohosh and St. John's wort for climacteric complaints: A randomized trial. Obstet Gynecol, 107:247-255.
6. Shannon, M. (1997). Drug-drug interactions and the cytochrome P450 system: An update. Pediatr Emerg Care,13:pp 350-353.
7. Woelk, H. (1994). Benefits and risks of the hypericum extract LI 160: Drug monitoring study with 3250 patients. J Geriat Psychiatry Neurol, 7 Supp 1:S34-8.
8. Robbers, J.E., Tyler, V.E. Tyler’s Herbs of Choice; The Therapeutic Use of Phytomedicinals. P169.
9. Tariq, S.H. (2004). Herbal therapies. Clin Geriatr Med, 20(2):237-57.
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