Transcript St. John`s Wort

St. John’s Wort
An Alternative Treatment for Mild to
Moderate Depression
Presentation Outline
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Alternate Names
Description of Hypericum
Forms of Hypericum
History and Naming of St. John’s Wort
Treatment
Dosage
Side Effects
Drug Interactions
Cautions
Advantages/Disadvantages
Evaluation
Alternate Names
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Hardhay
Amber
Guttiferae
Goat weed
Tipton weed
Klamath weed
Hypericum Perforatum
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Most common
Latin
Hypericum Perforatum – The Plant
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Perennial plant
Flower: bright yellow oval
shaped leaves with black
dots
Native to Northern Africa,
Europe and Western Asia
Can be found in meadows,
dry pastures, near railroad
tracks and alongside
roadbeds worldwide
Forms of Hypericum
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Capsules
Teas
Tablets
Tinctures
Oil-based skin lotions
(not to be ingested)
Chopped/powered
Hypericum Perforatum – History
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St. John’s Wort was first documented in the first
century A.D. by Gaius Plinius Secundus (Pliny the
Elder), a Roman philosopher, who discussed the
herbs ability to treat diarrhea and bladder problems.
Following this, the ancient Greek physician Pedanius
Dioscorides recommended it to expel “choleric
excrements” (natural pharmacy, 2005) and to treat
burns.
Philippus Theophrastus Aureolus Bombastus von
Hohenheim (Paracelus) wrote about the use of St.
John’s wort to treat wounds and psychotic symptoms
(phatasmata)
Hypericum Perforatum – History
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In 1630AD Angelo Sala announced that St. John’s
Wort had the ability to treat illnesses of the
“imagination, melancholia, anxiety and disturbances
of understanding” (natural pharmacy, 2005).
The word continued to spread about St. John’s Wort
through “wise women” and midwives.
It was brought to the Northeastern United States by
European colonists and was used to treat breathing
problems (tuberculosis), fever, nosebleeds, bladder
and bowel problems, and for venereal diseases.
Naming St. John’s Wort
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St. John’s Wort is harvested and flowers by June 24th,
which is St. John’s (feast) day (John the Baptist)
When the petals are squeezed or rubbed, they leak red
sap which is believed to be representative of the
blood of the martyred saint (John the Baptist)
Hypericum Perforatum
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It is believed that the combination of
Hypericum’s constituents is what allows it to
have an antidepressant effect rather than just
one compound
These constituents include:
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Napthodianthrones hypericin
Pseudohypericin
Hyperforin
Treatment
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Researchers are unsure how St. John’s Wort
actually works to treat depression
St. John’s Wort was originally though to work
somewhat like MAOI’S do, however recent
clinical tests (Dr. Muller and Colleagues) show
that St. John’s wort is able to also inhibit
serotonin, norepinephrine and dopamine
without the added complications of MAOI’s
and side effects of SSRI’s and TCA’s
St. John’s Wort versus SSRI’s,
MAOI’s and TCA’S
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St. John’s Wort
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Affects Serotonin,
Norepinephrine and dopamine
Mild side effects
Rare side effects
Non-competitive inhibitor
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SSRI’S
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MAOI’s
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Serotonin
Side effects
Negative interaction with
other medications
Requires a strict diet
Affects tyramine (linked to
blood pressure)
TCA’s
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Side effects
Can be fatal
Dosage
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Dosage depends on the hypericin content
Usually advised that the St. John’s wort extract
be standardized to contain 0.3% hypericin at a
dosage of 300mg, three times a day
Takes about 6 weeks to notice a difference
Generally takes longer to reach full
effectiveness than prescription antidepressants
Side Effects
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Generally few side effects and quite mild
Not a single recorded hypericum-related death
in 2,400 years
All side effects are reversible (stops when the
herb is no longer being used)
Photosensitivity (sensitive to sunlight)
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Fair skinned people should avoid, if possible,
prolonged sunlight exposure
Side Effects
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Less Commonly:
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Constipation
Gastrointestinal problems (nausea, vomiting, diarrhea)
Fatigue
Dry mouth
Dizziness
Allergic reactions
Confusion
To help combat these side effects it is suggested that St.
John’s wort be taken with food.
Drug Interactions
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It is advised to be cautious when taking other
medications with St. John’s Wort as it has shown to
decrease their effectiveness
This includes:
 Antidepressants
 Immunosuppressive medications
 Especially in those with heart or kidney
transplants as it can cause the body to reject the
transplanted organs
 Indinavir and other protease inhibitors (treats HIV)
Drug Interactions cont’d
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Loperamide (diarrhea medication)
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Oral contraceptives
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Can lead to delirium
Can cause bleeding
Reserpine (treats high blood pressure)
Theophylline (treats asthma, emphysema, or
chronic bronchitis)
Warfarin (anticoagulant)
Digoxin
Cautions
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Should not be used during pregnancy or while breast
feeding as there is no information on it's safety under
these conditions
Should not be used for severe depression or bipolar
disorder as not enough research is yet available to
show effectiveness in these circumstances
Do not take St. John’s wort in combination with
MAOI’s
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Can produce a dangerous rise in blood pressure
Should not be taken in combination with prescription
SSRI’s as this can lead to serotonin syndrome – too
much serotonin.
Advantages
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Few side effects
Mild side effects
Reversible side effects
Do not need a prescription
Sexual dysfunction (as a side effect) has never been reported,
whereas this is a common problem with other antidepressants
and the reason many people choose to discontinue using them
Clinical studies have proven St. John’s Wort to be for mild to
moderate depression (a significant difference was found
between the placebo group and the group receiving St. John’s
Wort)
Disadvantages
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Is not recommended for Severe Depression or Bipolar disorder
Although St. John’s Wort is widely used and accepted in
Europe, specifically Germany, it is not FDA approved in the
United States for medical purposes
Since it is not regulated in the U.S., there is no regulatory
oversight of the manufacturing, distributing and labeling of St.
John’s Wort, therefore the contents and potency of the herb
cannot be guaranteed
There have been cases in the past where herbal products (not
necessarily St. John’s wort) were analyzed and sometimes
found to contain dangerous toxic compounds.
Evaluation
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St John’s Wort seems to be an effective alternative to
more popular antidepressants
The side effects are few and quite mild in comparison
with MAOI’s and TCA’s
While it is not as acceptable of a treatment for
depression as other antidepressants, it is widely used
in Europe, specifically Germany, where it has been,
and continues to be, widely researched. The research
shows significant effectiveness when compared to
placebos and other antidepressants
Evaluation
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There is some concern over Hypericum’s
interaction with other medication.
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For example, Women more commonly suffer from
depression than men do, yet this herb reduces the
effectiveness of oral contraceptives.
In the future, it would be beneficial to see
more sound research on how it works in the
brain and long term effects