Depression and St Johns wort

What is St. John's wort?

St. John's wort (Hypericum perforatum in Latin) is a long-living plant with yellow flowers. It contains many chemical compounds. Some are believed to be the active ingredients that produce the herb's effects, including the compounds hypericin and hyperforin.

How these compounds actually work in the body is not yet known, but several theories have been suggested. Preliminary studies suggest that St. John's wort might work by preventing nerve cells in the brain from reabsorbing the chemical messenger serotonin, or by reducing levels of a protein involved in the body's immune system functioning.

What is St. John's wort used for?

St. John's wort has been used for centuries to treat mental disorders as well as nerve pain. In ancient times, doctors and herbalists (specialists in herbs) wrote about its use as a sedative and treatment for malaria as well as a balm for wounds, burns, and insect bites. Today, St. John's wort is used by some people to treat mild to moderate depression, anxiety, or sleep disorders.

What is depression?

Depression is a medical condition that affects nearly 19 million Americans each year. It has been recognised for centuries and was previously known as melancholia. A person's mood, thoughts, physical health, and behavior all may be affected. Symptoms commonly include:

• Ongoing low mood - people mostly describe feeling "bad inside" rather unhappy or sad. This differentiates it from everyday unhappiness.
• Loss of interest or pleasure in activities that the person once enjoyed
• Significant change in appetite or weight
• Oversleeping or difficulty sleeping
• Agitation or unusual slowness
• Loss of energy
• Feelings of worthlessness or guilt
• Difficulty "thinking," such as concentrating or making decisions
• Recurrent thoughts of death or suicide and developing plans to complete.
• Depressive illness comes in different forms. The three major forms are described below. Each can vary from person to person in terms of symptoms experienced and the severity of depression.

In major depression, people experience low mood or loss of interest or pleasure in activities for at least 2 weeks. In addition, they have at least four other symptoms of depression. Major depression can be mild, moderate, or severe. If it is not treated, it can last for 6 months or more.

In minor depression, people experience the same symptoms as major depression, but they are fewer in number and are less disabling. Symptoms last at least 6 months but less than 2 years continuously.

In dysthymia, the symptoms are related more to personality traits rather than illness, people experience a depressed mood for at least 2 years (1 year for children) accompanied by at least two other symptoms of depression. The treatment is predominantly talking therapy.

Bipolar disorder, also called manic depression, is an entirely different disorder which requires treatment often unrelated to depression. Compared to depression (unipolar - the mood swings only to one pole) a person has periods of depressive symptoms that alternate with periods of mania (the mood swings to both poles). Symptoms of mania include an abnormally high level of excitement and energy, racing thoughts, and behavior that is impulsive and inappropriate. Antidepressants and St. John's Wort are not recommended as they commonly precipitate mania in a depressed person.

Some people still hold outdated beliefs about depression--for example, that the emotional symptoms caused by depression are "not real" and that a person can merely "will" himself out of it. However, emotional symptoms are often percieved by the sufferer as far worse than they really are. Depression is a real medical condition. It can be treated effectively with conventional medicine, including by antidepressant drugs and certain types of psychotherapy (talking therapy).

St. John's wort as an alternative therapy for depression

1. Some patients who take antidepressant drugs do not experience relief from their depression. Other patients have reported unpleasant side effects from their prescription medication, such as a dry mouth, nausea, headache, or effects on sexual function or sleep.

2. Sometimes people turn to herbal preparations like St. John's wort because they believe "natural" products are better for them than prescription medications, or that natural products are always safe. Neither of these statements is true (this is discussed further below).

3. Finally, cost can be a reason. St. John's wort costs less than many antidepressant medications, and it is sold without a prescription (over the counter).

How widely is St. John's wort used for treating depression?

In Europe, St. John's wort is widely prescribed for depression. In the United States, St. John's wort is not a prescription medication, but there is considerable public interest in it. St. John's wort remains among the top-selling herbal products in the United States.

How is St. John's wort sold

St. John's wort products are sold in the following forms:

• Capsules
• Teas--the dried herb is added to boiling water and steeped for a period of time.
• Extracts--specific types of chemicals are removed from the herb, leaving the desired chemicals in a concentrated form.

Does St. John's wort work as a treatment for depression?

There has been scientific research to try to answer this question.

In Europe, results from a number of scientific studies have supported the effectiveness of certain St. John's wort extracts for depression. An overview of 23 clinical studies found that the herb might be useful in cases of mild to moderate depression. The studies, which included 1,757 outpatients, reported that St. John's wort was more effective than a placebo (here, a "dummy" pill designed to have no effect) and appeared to produce fewer side effects than some standard antidepressants.

Other studies conducted recently have found no benefit from the use of St. John's wort for certain types of depression. For example, the results of a study funded by Pfizer Inc., a pharmaceutical company, found that St. John's wort, when compared with placebo, was not effective for treating major depression.

In addition, several components of the National Institutes of Health (NIH)--NCCAM, the Office of Dietary Supplements (ODS), and the National Institute of Mental Health (NIMH)--funded a large, carefully designed research study to find out whether St. John's wort extract benefits people with major depression of moderate severity. This clinical trial (a research study in people) found that St. John's wort was no more effective for treating major depression of moderate severity than placebo.

Potential risks to taking St. John's wort for depression

Many so-called "natural" substances can have harmful effects--especially if they are taken in too large a quantity or if they interact with something else the person is taking.

Research from NIH has shown that St. John's wort interacts with some drugs--including certain drugs used to control HIV infection (such as indinavir). Other research shows that St. John's wort can interact with chemotherapeutic, or anticancer, drugs (such as irinotecan). The herb may also interact with drugs that help prevent the body from rejecting transplanted organs (such as cyclosporine). Using St. John's wort limits these drugs' effectiveness.

Also, St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe and, in some cases, may be associated with suicide. Consult a health care practitioner if you or someone you care about may be experiencing depression.

People can experience side effects from taking St. John's wort. The most common side effects include dry mouth, dizziness, diarrhea, nausea, increased sensitivity to sunlight, and fatigue.

The strength and quality of herbal products are often unpredictable. Products can differ in content not only from brand to brand, but from batch to batch. Information on labels may be misleading or inaccurate. For more information on safety issues, see the NCCAM fact sheet "Herbal Supplements: Consider Safety, Too."

More Information

NCCAM Clearinghouse Toll-free in the U.S.: 1-888-644-6226 International: 301-519-3153 TTY (for deaf or hard-of-hearing callers): 1-866-464-3615

E-mail: info@nccam.nih.gov Web site: nccam.nih.gov Address: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg, MD 20898-7923

Fax: 1-866-464-3616 Fax-on-Demand service: 1-888-644-6226

CAM on PubMed Web site: www.nlm.nih.gov/nccam/camonpubmed.html

CAM on PubMed, a database on the Internet developed jointly by NCCAM and the National Library of Medicine, offers citations to (and in most cases, brief summaries of) articles on CAM in scientifically based, peer-reviewed journals. CAM on PubMed also links to many publisher Web sites, which may offer the full text of articles.

National Institute of Mental Health (NIMH) Web site: www.nimh.nih.gov Toll-free: 1-800-421-4211 E-mail: nimhinfo@nih.gov Address: 6001 Executive Blvd., Rm. 8184, MSC 9663, Bethesda, MD 20892-9663 Office of Dietary Supplements (ODS), NIH Web site: ods.od.nih.gov Address: 6100 Executive Blvd., Bethesda, MD 20892-7517