Transcript Unit 5 Lesson - Darrell Zellars

St. Johns Wort and Depression
By: Darrell Zellars
What is Depression?
• Depression is a medical condition that affects
about 1 in 10 U.S. adults. Mood, thoughts,
physical health, and behavior all may be
affected. The symptoms and severity of
depression can vary from person to person.
Depression can be treated with conventional
medicine, including antidepressants and
certain types of psychotherapy.
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Different types of Depression
• Major depression,—severe symptoms that
interfere with your ability to work, sleep,
study, eat, and enjoy life. An episode can
occur only once in a person’s lifetime, but
more often, a person has several episodes
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Different types of Depression
• Persistent depressive disorder—depressed
mood that lasts for at least 2 years. A person
diagnosed with persistent depressive disorder
may have episodes of major depression along
with periods of less severe symptoms, but
symptoms must last for 2 years.
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Different types of Depression
• Psychotic depression, which occurs when a
person has severe depression plus some form
of psychosis, such as having disturbing false
beliefs or a break with reality (delusions), or
hearing or seeing upsetting things that others
cannot hear or see (hallucinations).
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Different types of Depression
• Postpartum depression, which is much more
serious than the "baby blues" that many
women experience after giving birth, when
hormonal and physical changes and the new
responsibility of caring for a newborn can be
overwhelming. It is estimated that 10 to 15
percent of women experience postpartum
depression after giving birth
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Different types of Depression
• Seasonal affective disorder (SAD), which is
characterized by the onset of depression during
the winter months, when there is less natural
sunlight. The depression generally lifts during
spring and summer. SAD may be effectively
treated with light therapy, but nearly half of
those with SAD do not get better with light
therapy alone. Antidepressant medication and
psychotherapy can reduce SAD symptoms, either
alone or in combination with light therapy.
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Different types of Depression
• Bipolar disorder, also called manic-depressive
illness, is not as common as major depression
or persistent depressive disorder. Bipolar
disorder is characterized by cycling mood
changes—from extreme highs (e.g., mania) to
extreme lows (e.g., depression).
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Signs and Symptoms of Depression
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Persistent sad, anxious, or "empty" feelings
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Irritability, restlessness
Loss of interest in activities or hobbies once pleasurable, including
sex
Fatigue and decreased energy
Difficulty concentrating, remembering details, and making decisions
Insomnia, early-morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Aches or pains, headaches, cramps, or digestive problems that do
not ease even with treatment.
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What is St. Johns Wort
• St. John’s wort, a plant that grows in the wild,
has been used for centuries for health
purposes. However, consumers need to be
aware of serious concerns about its safety and
effectiveness. This fact sheet summarizes
scientific research on St. John’s wort for
depression and suggests sources for
more information.
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What is St. Johns Wort
• St. John's wort is a shrubby plant with clusters of
yellow flowers that have oval, elongated petals.
Scientists believe it is native to Europe, parts of
Asia and Africa, and the western United States.
The plant gets its name because it is often in full
bloom around June 24, the day traditionally
celebrated as the birthday of John the Baptist.
Both the flowers and leaves are used as medicine.
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About St. Johns Wort
• Although St. John’s wort (Hypericum
perforatum) has been used for centuries for
mental health conditions and is widely prescribed
for depression in Europe, the herb can have
serious side effects. In addition, current evidence
that St. John’s wort is effective for depression is
not conclusive. It is also important to note that in
the United States, the Food and Drug
Administration has not approved its use as an
over-the-counter or prescription medicine
for depression.
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The types of forms of St. Johns Wort
• St. John's wort can be obtained in many
forms: capsules, tablets, tinctures, teas, and
oil-based skin lotions. Chopped or powdered
forms of the dried herb are also available.
Most products are standardized to contain
0.3% hypericin.
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How to take St. Johns Wort
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Pediatric
Most studies on St. John's wort have been conducted in adults. However, one
study (more than 100 children under age 12) indicated that St. John's wort may be
a safe and effective way of treating mild-to-moderate symptoms of depression in
children. Never give your child St. John’s wort without medical supervision.
Children being treated with St. John's wort should be carefully monitored for side
effects, such as allergic reactions or upset stomach. You should not try to treat
depression in a child without a doctor’s help, because depression can be a serious
illness.
Adult
Dry herb (in capsules or tablets): The usual dose for mild depression and mood
disorders is 300 mg (standardized to 0.3% hypericin extract), 3 times per day, with
meals. St. John's wort is available in time-release capsules.
St. John’s Wort is also available as a liquid extract or a tea. Ask your doctor to help
you find the right dose.
It may take 3 - 4 weeks to feel any effects from St. John's wort.
Don’t stop taking St. John’s wort all at once, because that may cause unpleasant
side effects. Gradually lower the dose before stopping.
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How does St. Johns Wort help with
Depression?
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St. John's wort has also shown promise in treating the following conditions, a few
of which are related to depression.
Premenstrual syndrome (PMS): An early study suggests that St. John's wort may
help relieve physical and emotional symptoms of PMS in some women, including
cramps, irritability, food cravings, and breast tenderness.
Menopause: Two studies suggest that St. John's wort, combined with black
cohosh, helps improve mood and anxiety during menopause.
Seasonal affective disorder (SAD): Used alone, St. John's wort has improved mood
in people with SAD, a type of depression that occurs during the winter months
because of lack of sunlight. SAD is usually treated with light therapy, and there is
some evidence that using St. John's wort together with phototherapy works even
better.
Eczema, wounds, minor burns, hemorrhoids: St. John's wort has antibacterial
properties and may also help fight inflammation. Applied topically (to the skin), it
may relieve symptoms associated with minor wounds and skin irritation.
Obsessive compulsive disorder, social phobia: One early open-label study found
that taking St. John's wort 450 mg two times a day for 12 weeks improved OCD
symptoms. But two other studies found that St. John’s wort didn’t help OCD.
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How does St. Johns Wort help with
Depression?
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Study results on the effectiveness of St. John’s wort for depression are mixed.
A 2009 systematic review of 29 international studies suggested that St. John’s wort may be better than a placebo
(an inactive substance that appears identical to the study substance) and as effective as standard prescription
antidepressants for major depression of mild to moderate severity. St. John’s wort also appeared to have fewer
side effects than standard antidepressants. The studies—conducted in German-speaking countries where
St. John’s wort has a long history of use by medical professionals—reported more positive results than those done
in other countries, including the United States.
Two studies, both sponsored by NCCAM and the National Institute of Mental Health, did not have positive results.
Neither St. John’s wort nor a standard antidepressant medication decreased symptoms of minor depression better
than a placebo in a 2011 study. The herb was no more effective than placebo in treating major depression of
moderate severity in a large 2002 study.
Preliminary studies suggest that St. John’s wort may prevent nerve cells in the brain from reabsorbing certain
chemical messengers, including dopamine and serotonin. Scientists have found that these naturally occurring
chemicals are involved in regulating mood, but they are unsure exactly how they work.
The Placebo Effect
The placebo effect describes improvements that are not related specifically to the treatment being studied. For
example, a recent reanalysis of the 2002 study on St. John’s wort for major depression showed that the study
participants’ beliefs about whether they were taking a placebo or St. John’s wort influenced their depression more
so than what they actually received. Even how a clinician talks with patients may lead to a positive response
unrelated to the treatment. To understand the usefulness of any intervention, rigorous studies are needed to
compare the product or practice being tested with comparable but inactive products or practices.
Side Effects of St. Johns Wort
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St. John’s wort is known to affect how the body uses and breaks down a number of drugs and can
cause serious side effects.
Serotonin is a brain chemical targeted by antidepressants. Combining St. John’s wort and certain
antidepressants can lead to a potentially life-threatening increase in serotonin levels—a condition
called serotonin syndrome. Symptoms range from tremor and diarrhea to very dangerous
confusion, muscle stiffness, drop in body temperature, and even death.
Psychosis is a rare but possible side effect of taking St. John’s wort, particularly in people who have
or are at risk for mental health disorders, including bipolar disorder.
Taking St. John’s wort can weaken many prescription medicines, such as:
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Antidepressants
Birth control pills
Cyclosporine, which prevents the body from rejecting transplanted organs
Digoxin, a heart medication
Some HIV drugs including indinavir
Some cancer medications including irinotecan
Warfarin and similar medications used to thin the blood.
Other side effects of St. John’s wort are usually minor and uncommon and may include upset
stomach and sensitivity to sunlight. Also, St. John’s wort is a stimulant and may worsen feelings of
anxiety in some people.
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References
• Source: St. John's wort | University of Maryland Medical
Center http://umm.edu/health/medical/altmed/herb/stjohns-wort#ixzz3CfQVlNjn
University of Maryland Medical Center
Follow us: @UMMC on Twitter | MedCenter on Facebook
• http://nccam.nih.gov/health/depression.htm
• http://www.nimh.nih.gov/health/topics/depression/index.s
html
• http://nccam.nih.gov/health/stjohnswort/sjw-anddepression.htm
• http://umm.edu/health/medical/altmed/herb/st-johnswort
Any Questions???