Tag Archives: Health

St. John’s Wort (HypericumPerforatum): Can A Herbal Supplement Treat Major Depression Disorder?

St. John’s Wort is a yellow-flowered herb used to treat health conditions since the time of ancient Greece. The herb’s scientific name is Hypericumperforatum, and is sold in the United States as a dietary supplement. In Europe, St. John’s Wort is used to treat mild to moderate clinical depression.

St. John’s Wort Clinical Studies

While St. John’s Wort has a long history as a depression treatment, much of its reputation is based on historical use. Clinical trials suggest that while St. John’s Wort has some applications as a treatment for depression, it may not be well suited for all types of depression.

The National Center for Complementary and Alternative Medicine (NCCAM) funded one such study. The results of the NCCAM study were that placebos were as effective as St. John’s Wort for moderate to severe major depression disorder. The same study suggested that the antidepressant sertaline was also no more effective than placebo for depression treatment.

While such studies are discouraging, other research suggests that St. John’s Wort at least has potential as a treatment for mild depression. Further study is required to confirm or disprove this possibility.

How St. John’s Wort Treats Depression

It’s not entirely clear which compounds found in St. John’s Wort help people cope with depression. The two most likely active compounds are the chemicals hypericin and hyperforin, both of which are thought to affect neurotransmitters (compounds in the nervous system that act as chemical messengers). Low neurotransmitter levels appear to affect a person’s mood.

Types of St. John’s Wort

St. John’s Wort comes in three basic forms. Capsules or tablets of the herb are available, as are herbal teas made from St. John’s Wort. Liquid extracts are also available. St. John’s extracts are concentrated distillations of the plant chemical compounds.

Whether choosing teas, capsules or St. John’s extract, bear in mind that herbal and dietary supplements – in the U.S. at least – are not as well regulated as medications. The range of quality and purity from one herbal supplement to the next can vary widely, and it’s wise to bear this in mind when purchasing St. John’s Wort or any other natural remedies for depression.

St. John’s Wort, Side Effects and Serotonin Syndrome

St. John’s Wort is usually safe to use, but can cause unwanted side effects. The most common side effects associated with St. John’s Wort include:

  • anxiety
  • diarrhea
  • dizziness
  • dry mouth
  • fatigue
  • headaches
  • insomnia
  • irritability
  • photosensitivity (sensitivity to sunlight)
  • restlessness
  • skin rash
  • stomach problems
  • tingling sensations
  • vivid dreams.

St. John’s Wort can also interfere with the effectiveness of certain medications. People should avoid St. John’s Wort if they are prescribed any of the following:

  • anticancer medication
  • anticoagulants (blood thinners)
  • antidepressants
  • birth control pills
  • cyclosporine
  • digoxin
  • medications used to treat HIV.

Pregnancy and nursing women should avoid St. John’s Wort, as should anyone trying to conceive children. As the herb affects anticoagulants, people scheduled to have surgery should avoid taking St. John’s Wort for at least two weeks before surgery.

Using St. John’s Wort in combination with certain antidepressants can result in a potentially fatal condition known as serotonin syndrome. Before taking any dietary supplement with prescription medication, be sure to talk to a health care professional about possible interactions.

Other Depression Herbs

In addition to St. John’s Wort, a number of other natural remedies for depression exist, including kava kava and ginkgo biloba. Clinical studies into the efficiency of these natural treatments for depression are limited.

Read More: Report Encourages Widespread Use Of ASA: Benefits For Men, Women Of Certain Ages.

It cannot be overstated: before choosing natural remedies for depression check their safety with a mental health professional and be sure the dietary supplement does not interact with any prescribed or over the counter medications.

Report Encourages Widespread Use Of ASA: Benefits For Men, Women Of Certain Ages

The new recommendations are in a report from the US Preventive Services Task Force.

  • Women age 55 to 79 years old should take ASA to prevent strokes, providing the benefit outweighs the risk of ASA.
  • Men age 45 to 79 years old should take ASA to prevent heart attacks, providing the benefit outweighs the risk of ASA.

These new recommendation are stronger than the 2002 ones from the same group. Along with these new recommendations, the experts present ways to estimate personal benefit and risk. The report is available on the AHRQ website.

How to Calculate Stroke Benefit

The benefit is reduction in stroke risk. Tables are provided to estimate how women may benefit from taking ASA (Report Figure 4). For example, among 65 year old women with a 5% 10-year stroke risk, eight strokes per 1000 women will be prevented by taking ASA.

To Determine Stroke Risk

You can determine your personal stroke risk using the an interactive calculator at the Western Stroke Organization (for the web address, look under “Clinical Considerations, Women). For example, a 65 year old woman with systolic blood pressure of 160 has a 5.2% risk of stroke over 10 years (‘systolic’ is the first set of numbers in a blood pressure reading). If she also is a smoker, the risk jumps to 8.8%.

For a man of the same age, same systolic blood pressure, and a smoker, the ten year stroke risk is almost 14%.

To Determine Heart Attack Risk and Benefit

You can determine your personal heart attack risk using the provided link to an interactive calculator at the Medical College of Wisconsin.

Benefit–heart attacks prevented–is provided in Figure 2 of the report. For example, a 65 year old non-smoking man with no special risks, LDL cholesterol 99, HDL cholesterol 45, has a 10% risk of a heart attack in the next ten years. Taking ASA by 1000 men in this risk profile will prevent 32 heart attacks in ten years.

ASA Risks

Whether or not to take ASA depends on the downside–the risks of taking ASA–as well as the benefits. ASA use increases the risk of serious bleeding from the stomach and elsewhere in the gastrointestinal (GI) tract. The risk is increased in people who have bled once. Previous bleeding from the GI tract is associated with at least double the risk of bleeding from ASA.

The risk is increased four times over in people who concurrently take NSAIDS (Motrin, Aleve, Naprosyn, others). Uncontrolled hypertension increases bleeding risks. Taking warfarin (coumadin, others) is generally considered a contraindication to ASA (ASA should not be used with warfarin).

  • Men have twice the risk of bleeding than women.
  • Enteric coating on ASA has not been shown to reduce the risk of bleeding.
  • There are special safety considerations for older people.

Other Benefits of ASA

Not included in the Task Force’s considerations are other potential benefits from ASA. It may reduce the risk of dangerous colon polyps; however, a recent study indicated it does not reduce the risk of death from colon cancer. (Journal of the National Cancer Institute 2009 (Feb 18); 101:256)

What to Do

The panel encourages shared decision making. Individuals should discuss their potential personal benefits and risks from ASA with their physician.