St John Wort Demonstrates Positive Results For Mild Depression
St. John's wort has demonstrated clinical efficacy for mild to moderate depression and compares favorably to other more potent or toxic antidepressants. Low side effects and potential benefits warrant its use as a first-line agent for select patients with mild to moderate depression or anxiety-related conditions. Benefits related to other reported uses such as an antimicrobial, agent to treat neuropathic pain, antiinflammatory, treatment alternative for atopic dermatitis, and antioxidant are either not well documented or evidence is encouraging but not conclusive and further study is needed.
St. John's wort has been described in medical literature for thousands of years, including the writings of Hippocrates. Historically, St. John's wort has been used to treat neurological and psychiatric disturbances (anxiety, insomnia, bed-wetting, irritability, migraine, excitability, exhaustion, fibrositis, hysteria, neuralgia, and sciatica), gastritis, gout, hemorrhage, pulmonary disorders, and rheumatism, and has been used as a diuretic. Some forms of the herb have been used topically as an astringent and to treat blisters, burns, cuts, hemorrhoids, vitiligo, neuralgias, inflammation, insect bites, itching, redness, sunburn, and wounds. Oral doses of 300 mg of Hypericum extract three times daily for periods of 4 to 6 weeks is a typical dosing regimen.
There have been many clinical trials studying the effectiveness of St.John's wort in the treatment of depression. By the spring of 2002, there were 34 controlled trials including more than 3000 patients. When compared with the synthetic antidepressants, there was one trial with amitriptyline, four with imiprimine, two with fluoxetine, two with sertraline, one with bromazepam, and one with maprotiline. Of these trials, hypericum was equal to or superior to all of them except amitriptyline. The conclusion that hypericum was superior to placebo in mild to moderate depression.
Although the results from trials in patients with mild to moderate depression appear encouraging in their support of St. John's wort, there are limitations. First, the longest duration of these trials was 56 days and several of the trials were as short as 28 days. Also, most of the trials used relatively low doses of synthetic antidepressants. Finally, two of the trials did not state the exact number of responders, making the results somewhat questionable. The exact mechanism of action responsible for St. John's wort's neurological effects is not known. Additionally, it is not known if any one chemical constituent is responsible for its activity or if it is a combination of multiple components.
St. John's wort has been used topically for wound healing for hundreds of years. Antibacterial properties have been reported as early as 1959, with hyperforin found to be the active component. Along with antibacterial properties, it has also been reported that both the hypericin and pseudohypericin components of St. John's wort have antiviral properties.
A total of 47 patients completed the trial, which showed a trend toward lower total pain with the St. John's wort treatment; however, it was not statistically significant. There was also a trend toward people reporting moderate to complete pain relief during their treatment with St. John's wort. When the study population was further broken down into patients with and without diabetes, it was found that in the 18 participants with diabetes, there was still a trend toward lower total pain and a significant reduction in lancinating pain, whereas in the 29 participants without diabetes, there was no significant differences or trends in any pain scores. Interestingly, 25 participants preferred the St. John's wort treatment arm, 16 preferred placebo, and six did not have a preference.
A patient taking 1800 mg three times daily for 32 days discontinued her therapy because of a possible photosensitivity reaction. Within a day, she developed nausea, anorexia, retching, dizziness, dry mouth, chills, and extreme fatigue. Her symptoms peaked by the third day and gradually improved until they had completely resolved by the eighth day. Several patients taking St. John's wort have been reported to have elevated thyroid-stimulating hormone (TSH) levels.
A man who had been taking St. John's wort for 9 months reported having a severely diminished libido, which resolved after he discontinued St. John's wort and began citalopram. Hair loss has also been associated with the use of St. John's wort is hair loss. A 24 year-old female who took 300 mg of St. John's wort three times daily began experiencing hair loss of the scalp and eyebrows after 5 months of therapy, with the hair loss continuing for 12 months.
St John Wort does have it's side effects so use with caution or get advice from physician. However if used in moderation, it is can be consider as a good alternative to phamacuetical drugs.
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