St John's Wort : An Alternative and Effective Treatment for Depression
Author: David Puchol Esparza

St JOHN’S WORT :
AN ALTERNATIVE AND EFFECTIVE TREATMENT FOR DEPRESSION
David Puchol Esparza
Psychologist & Naturopath
dpuchol@yahoo.es


Introduction

St. John's Wort, also known as Hypericum Perforatum, has a long history of medicinal usage.It was recommended by Hippocrates for ‘nervous unrest’.Hypericum has a 2400-year history of therapeutic use for sleep disturbances,anxiety and depression.Effects as a ‘tonic’ for the nerves has been recorded as far back as the Roman period in Europe.The name Wort is thought to be derived from the Old English word for plant.The origins of the designator ‘St. John’ might be attributable to its medicinal usage by the Knights of St. John in Jerusalem to heal the wounds of Crusaders.

Today,Hypericum is one of the best-documented herbal treatments,with a scientific research approaching that of many psychiatric drugs.It was not until 1980 when the true value and effectiveness of St. John's Wort was rediscovered by German scientists, approved as a safe anti-depressant medicine in 1984, and began to outsell any other antidepressant drug.German physicians,typically ‘resort’ to psychiatric drugs after St. John's Wort treatment fails. Since 1994, the sales volume of St. John's Wort in Germany soared from million to million in 1997. This surge in the use of Hypericum and other medicinal herbs is common in the entire Europe.Scientific evidences suggest that for mild to moderate depression, it is at least as effective as standard drugs, with fewer and less severe side effects (Bratman et al.,2000).

The mechanism by which St. John's Wort acts as an effective antidepressant is not fully understood.Early research indicated that this herb inhibits (mildly) the enzyme monoamine oxidase.This enzyme is responsible for the breakdown of two key brain chemicals : Serotonin and Norepinephrine.By inhibiting this enzyme and increasing Norepinephrine,Hypericum may exert a mild antidepressive action. St. John's Wort may also block the receptors that bind Serotonin.Its action is based on the ability of the active ingredient (hypericin) to inhibit the breakdown of specific neurotransmitters in the brain.Hypericum also works as a Serotonin reuptake inhibitor.Both are actions similar to the most commonly prescribed drugs for mood disorders.


Dosage Recommendations

Research studies have shown significant improvement in symptoms of apathy, depression,anxiety,hypersomnia,psychomotor retardation and feelings of worthlessness. Clinical double blind studies indicated that St. John's Wort extract (0.3% hypericin) at a dosage of 300 milligrams three times daily is as effective in relieving symptoms of depression as synthetic antidepressants but is much better tolerated,with fewer side effects. In addition to Hypericum's ‘mood-elevating’ properties, Germany's Commission E has approved this herb for the treatment of anxiety and sleep disorders.

Lengths of administration are usually based on the severity of the symptoms and the type of disorder.To date,of 25 controlled therapy studies, dosages were typically between 300 to 900 mg total extract (usually hypericum extract LI 160) daily with the therapy duration lasting 2 to 6 weeks (Hippius,1998).


Interactions & Side Effects

Recent medical case reports and clinical studies suggest that St. John’s Wort extracts may reduce blood levels of some drugs.These drugs include cyclosporine,indinavir,oral contraceptives,theophylline,tricyclic antidepressants (amitriptyline) and anticoagulants (warfarin).Many experts feel this is due to St. John’s Wort interacting with enzymes (cytochrome P450 enzymes) in the body responsible for normal metabolism of synthetic drugs (Ernst,1999).

There have been incidences of photosensitization as a side effect.Anyone who is hypersensitive to sunlight or is taking other photosensitizing drugs should be cautious. If you are pregnant or lactating,check with your physician before taking this medicinal herb.

According to information available on herb interactions, Hypericum extracts should not be used while taking other synthetic antidepressants or narcotics without physician supervision.Hypericum should not be combined with a MAO inhibitor antidepressant such as Nardil (phenelzine) or Parnate (tranylcypromine).This specific combination can produce a dangerous rise in blood pressure or hypertensive crisis, along with severe anxiety,fever,confusion and muscle tension.After stopping a MAO drug,one should wait (at least) four weeks before taking other types of natural or synthetic antidepressants.

Hypericum has an exceptional safety record over centuries of therapeutic use.In contrast to some psychiatric drugs,there have been no reports of Hypericum-related deaths. Preliminary evidence suggests there may be a risk of St. John’s Wort interacting with Selective Serotonin Reuptake Inhibitor (SSRI) drugs, such as Prozac (fluoxetine), and causing some side effects (mental confusion,muscle twitching or sweating) known collectively as Serotonin Syndrome.Anyone taking an SSRI should consult a physician before taking Hypericum.

Drug monitoring studies on over 7000 patients and twenty-seven double-blind research studies confirm its overall safety. The extensive use of Hypericum by millions of people has not resulted in significant reports of serious side effects.St John’s Wort is considered a safe herb and incidents of adverse reactions are rare,however it is not recommended for allergic individuals (Blumenthal,1997).


Clinical Applications of Hypericum Perforatum : Scientific Evidences

1.-Hypericum Perforatum has been favorably compared to numerous antidepressant drugs (Amitriptyline,Imipramine and Maprotiline).These clinical studies have revealed equivalent results yet with reduced incident and severity of side effects.To date, there have been 23 randomized trials conducted which included 1757 patients with mild or moderate mood disorders. The data collected and reviewed from these studies showed St. John’s Wort extracts to be "significantly superior to a placebo" and "similarly effective as standard antidepressants" (Linde et al.,1996).

2.-The results of numerous studies suggest Hypericum is effective for mild to moderate depression.For example,in a 4-week trial, 102 patients were given either St. John's Wort or placebo. Over 70% of the patients taking Hypericum improved significantly (defined as a greater than 50% drop in HAM-D scores), whereas only 24% of the placebo group responded. Five patients dropped out, mostly from the placebo group, due to worsening depression (Hansgen & Vesper,1996).

3.-In a randomized,double-blind study by Dr. Vorbach et al. (1997),published in Pharmacopsychiatry, 209 patients with severe,recurrent depression (but with no psychotic or delusional symptoms) were treated for six weeks with 600 mg of Hypericum extract (standardized to 0.3 % hypericin) three times a day. This high-dose treatment (1800 mg daily of Hypericum is double the usual dosage) proved equal to treatment with a full dose of Tofranil (Imipramine) -50 mg three times daily-, but even at this higher dosage either,St. John's Wort showed considerably less side effects.

4.-Studies of Hypericum Perforatum (and synthetic antidepressants) use a set of questions called the Hamilton Depression Index (HAM-D).This scale rates the extent of depression, with higher numbers indicating more serious symptoms. Double-blind placebo-controlled trials involving a total of more than a thousand participants with mild to moderate depression have generally found that use of St. John's Wort can significantly reduce HAM-D scores as compared to placebo (Laakmann et al.,1998).

5.-Numerous double-blind placebo-controlled studies enrolling a total of more than 1,000 individuals have compared Hypericum to placebo.Taken together, the results strongly suggest that St John’s Wort is an effective (and safer) treatment for mild to moderate depression. Good evidence from head-to-head trials tells us that it is at least as effective as Fluoxetine –Prozac- (Schrader,2000) and Sertraline –Zoloft- (Brenner et al.,2000) for this condition, and causes fewer and less severe side effects.


Conclusion

Depression is very common, affecting about 121 million people worldwide.About half of all cases of Depression is unrecognised and untreated.Fewer than 25 % of those affected have access to effective treatments.The World Health Organization predicts that by the year 2020 Depression will be the greatest burden of ill-health to people in the developing world, and that by then severe Depression will be the second largest cause of death and disability.

Herbal medicine is one of the oldest methods of healing on the planet with a history of over 100,000 years of continuous use.Numerous psychoactive herbal medications are available to treat cognitive and emotional conditions.One of the most popular (and effective) herbs for the treatment of mood disorders is St. John's Wort.Recent medical research has shown that Hypericum can be as effective as synthetic antidepressants for mild to moderate Depression.Several controlled studies have shown positive results in treating patients with mild to moderate Depression.Significant improvement was shown with symptoms of helplessness,sadness,anxiety,headache,exhaustion and hopelessness with fewer and less severe side effects.


References

Blumenthal,M.(1997).The Complete German Commision E Monographs.Therapeutic Guide to Herbal Medicines.American Botanical Council.

Bratman,S.;Kroll,D. & DePalma,A.(2000).The Natural Pharmacist: Natural Health Bible.Prima Health.

Brenner,R.;Azbel,V.;Madhusoodanan,S. et al. (2000).Comparison of an extract of hypericum and sertraline in the treatment of depression: a double-blind, randomized pilot study. Clin Ther. 22:411–419.

Cass,H.(1998).St.John’s Wort : Nature's Blues Buster. N.Y.Avery.

Ernst,E.(1999).Second thoughts about safety of St. John’s wort.Lancet 354:2014–6

Hansgen,K. & Vesper,J.(1996).Antidepressant efficacy of a high-dose hypericum extract .Munch Med Wochenschr. 138:29–33.

Hippius,H.(1998).St John's Wort : A Herbal Antidepressant. Curr Med Res Opin 14: 171-184

Laakmann,G.;Schüle,C.;Baghai,T. et al.(1998).St. John's wort in mild to moderate depression: the relevance of hyperforin for the clinical efficacy. Pharmacopsych 31: 54–59.

Linde,K.;Ramirez,G;Mulrow,C.;Pauls,A.;Weidenhammer,W. & Melchart D.(1996):St John's Wort for Depression.An Overview and Meta-Analysis of Randomised Clinical Trials.,BMJ, Aug 3, 313 (7052) : 253-258

Schrader,E.(2000) Equivalence of St John's wort extract (Ze 117) and fluoxetine: a randomized,controlled study in mild–moderate depression. Internat Clin Psychopharm 15:61–68.

Vorbach,E.;Arnoldt,K. & Hubner,W.(1997). Efficacy and tolerability of St. John's wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD-10. Pharmacopsychiatry. 30 Suppl 2:81-85.






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Licensed Psychologist.

Diploma in Naturopathy.

Master Practitioner of NLP.

Postgraduate Qualifications in Clinical Psychology,Hypnosis, and Nutrition.

Contact : dpuchol@yahoo.es

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