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- 1. St. Johns Wortand Depression What You Should Know
- 2. Who Experiences Depression?About 7.5% of Americans Can occur at any age Mostly occurs in women Incidence increases with age National Institute of Health, 2003
- 3. Signs of MinorDepression Depressed mood all day, nearly every day Less interest or pleasure in activities Changes in appetite Sleep disturbances Agitation or slowness Fatigue or loss of energy National Institute of Mental Health, 2003
- 4. Signs of MinorDepression Feelings of worthlessness or guilt Diminished ability to concentrate; indecisiveness Recurrent thoughts of death or suicide Symptoms last at least 6 months Yet less than 2 continuous years National Institute of Mental Health, 2003
- 5. Antidepressants Mostcommonly prescribed medication in the U.S. Use has tripled between 1999-2000 Side effects : dizziness, headache, weight gain to- Increased depression, suicide, heart and liver problems Withdrawals and cost CDC, 2004;Glenmullen, 2005
- 6. St. John’s Wort-The Alternative- Hypericum Perforatum Most popular natural remedy for depression First used in ancient Greece Used for centuries for many health conditions Muller, 2005; NCCAM, 2011
- 7. Clinical Evidence onSJW Extensively studied in Europe over the last two decades Found as effective as antidepressants More effective than placebo Fewer side effects May work even better for somatic symptoms Woelk, 2000,Hornig, 1998; Linde et. al 1996, Gaby, 2005; Mayo Clinic, 2011
- 8. Clinical Evidence Welltolerated May work similar to some antidepressants Use SJW because of intolerable side effects of meds. Mayo Clinic, 2011
- 9. Common Side EffectsInfrequent and mild Dry mouth, dizziness Gastrointestinal complaints (constipation) Confusion Some allergic reactions Sensitivity to the sun Hornig, 1998, Gaby 2005
- 10. Precautions Can interactwith medications, herbs and supplements Can limit effectiveness of prescription meds No regulations on herbal products Avoid preparations made with more than one herb. Beware of commercial claims of what herbal products can do . Harvard Women’s Health Watch, 2000; WebMd 2010
- 11. Recommendations Discuss use with your physician Not recommended for major depression Look for scientific-based sources of information. Sold as capsules, teas, and liquid extracts
- 12. How do Ichoose a supplement? Select brands carefully That have the common or scientific name Name and address of manufacturer Batch and lot number Expiration date Dosage guidelines Potential side effects WebMD, 2010
- 13. Information and ResourcesThe Alternative Medicine Foundation, Inc. www.amfoundation.org The American Botanical Foundation, Inc. www.herbalgram.org The National Center for Complementary and Alternative Medicine (NCCAM) www.nccam.nih.gov Bratman, S. (1997). Beat Depression with St. John’s Wort. Prima Publishers
- 14. Works Cited Almosthalf of Americans use at least one prescription drug annual report on Nation’s Health Shows. (2004). Centers for Disease Control and Prevention. Retrieved on February 1, 2011 from http://www.cdc.gov/nchs/pressroom/04news/hus04.htm Gaby, A.R. (2005, April). More evidence backs St. John's Wort for mild to moderate depression. Natural Foods Merchandiser , 26(4), 50. Retrieved January 26, 2011, from h ttp:// proquest.umi.com/pqdweb?did =909243831&sid=1&Fmt=3&clientId=2606&RQT=309&VName=PQD Glenmullen, J. (2005). The antidepressant solution: A step by step guide to safely overcoming antidepressant withdrawal, dependence and addiction. New York, NY: Free Press Publishers. Horning, M. (1998, January 1). Hypericum (St. John’s Wort) for treatment of depression. Alternative Medicine Alert, 1, 4-7. Academic Onefile. Retrieved on January 26, 2011 from http://find.galegroup.com/gtx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T004&prodId=AONE&docId=A206919667&source=gale&srcprod=AONE&userGroupName=apollo&version=1.0 Linde, K., Berner, M., Egger. M., & Mulrow, C. (2005). St John’s wort for depression. The British Journal of Psychiatry, 186, 99-107. Retrieved on January 26, 2011 from http://bjp.rcpsych.org/cgi/content/full/186/2/99 Muller, W.E. (2005). (Ed). St. John’s Wort and its active principles in depression and anxiety . Basil, Switzerland: Birkhauser Publishers
- 15. Works Cited NationalInstitute of Mental Health. (2003, March 21). Treatment for minor depression . Received on January 30, 2011 from http://www.nimh.nih.gov/science-news/2003/treatment-for-minor-depression.shtml Neurotoxicity from whole St. John's Wort. (1999, Jan 1). (Clinical report). Alternative Medicine Alert. Academic OneFile. Retrieved on January 26, 2011 from http://find.galegroup.com/gtx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T004&prodId=AONE&docId=A206906053&source=gale&srcprod=AONE&userGroupName=apollo&version=1.0 St. John’s Wort. (n.d). National Center for Complementary and Alternative Medicine. Retrieved on January 14, 2011 from http://nccam.nih.gov/health/stjohnswort/ataglance.htm St .John’s Wort for treating depression. (2010). WebMD. Retrieved on February 2, 2011 from http://www.webmd.com/depression/guide/st-johns-wort?page=2 Woelk, H. (2000, April 25) Comparison of St John's wort and imipramine for treating depression: Randomized controlled trial. British Medical Journal, 321:536. Retrieved on January 28, 2011 from http://www.bmj.com/content/321/7260/536.full
Editor's Notes
- #3 Depression is one of the most prevalent mental disorders in the general population. It often occurs with other psychiatric illnesses and most people do not have access to treatments to help with depression (NIH, 2003)
- #4 There is a lot of information about major depression, but minor depression affects people everyday in small ways that accumulate. It is the same as major depression but the symptoms are fewer in number and causes less impairment. It is important to go over the symptoms of depression to see if one may have minor depression or knows someone who may have it. Many people who experience depression also experience physical illnesses as well.
- #5 It is important to talk with a qualified professional if these symptoms are present or know someone who exhibits these symptoms. While St. John’s Wort is a viable alternative for antidepressants, for those suffering from major depression or other accompanying mental illnesses it may not be what is needed.
- #6 Too many people are taking drugs when they should be making changes in their lives. Many conventional doctors will find that their patients are suffering from depression and prescribe them an antidepressant without the patient knowing about the possible side effects (long and short term), the possibility of addiction to these medications, and withdrawals after use. Many people are given prescriptions simply because they complain of life situations or ask for one without proper diagnosis. Side effects can range from mild to severe, short term to long term. What seems like minor side effects such as headaches, dizziness, and weight gain can lead to further depression. Heart attacks, strokes, high cholesterol, akathisia,neurological problems, and paranoia can be long term (Glenmullen, 2005) Many people cannot afford the cost of prescription medications. St. Johns Wort is affordable.
- #7 Hypericum perforatum is a member of the Hypericaceae family which consists of about 400 species." It is found in temperate and tropical areas worldwide. The extract of the St. Johns wort flower is called Hypericum perforatum” (Muller, 2005). Today, it is prepared by extracting the upper aerial parts of H. perforatum, collected just before or during blossom, with mixtures of ethanol/water or methanol: water (Muller, 2005). It is the most popular remedy for minor depression in Germany and the most popular alternative remedy worldwide (Hornig, 1998; Gaby, 2005). It has been used for centuries for mental conditions, nerve pain, and a wide variety of other health conditions (NCCAM, 2011). (Muller, 2005). Many people choose alternative remedies such as St. John’s wort because they are dissatisfied with the side effects of antidepressants or they do not work effectively for them.
- #8 1.Studied for more than two decades (Mayo Clinic, 2011) 2.(Woelk, 2000) Study in British Medical Journal compared SJW to imprianime (commonly used antidepressant) and a placebo in 324 subjects with mild to moderate depression. SJW was found to be at least as effective as the antidepressant, and more effective than the placebo. 3.It was tolerated better and had fewer adverse side effects than those treated with imipramine (Horning, 1998) 4.Patients with somatic symptoms associated with their depression may do well with SJW. Improved symptoms such as fatigue, decreased activity, and sleep problems and seasonal affective disorder in only 4 weeks (Hornig, 1998). 37 clinical trials reviewed the effectiveness of St. John’s Wort to be effective (Linde et al. 1996). 251 people suffering with acute depression were given SJW (300mg). Results indicate SJW is a safe and effective alternative to antidepressants. Fifty percent of participants resolved their depression (Gaby, 2005) .
- #9 Subjects in studies seem to tolerate SJW well. How the compounds in SJW actually work is not yet fully understood, “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” (Mayo Clinic, 2011) Patients with mild depression many times do not like the side effects of antidepressants or do not work well with them and St. John’s Wort is an alternative to try (Mayo Clinic, 2011).
- #10 Out of 23 studies done on SJW, only 19.8% experienced side effects with SJW compared to 52.8% using standard antidepressant (Hornig, 1998). Infrequently, there are rare cases of photosensitivity reported (Alternative Medicine Alert, 1999)
- #11 Discuss taking St. John’s Wort with your physician, especially if you are taking other medications or considering surgery. 2. SJW can limit the effectiveness of antidepressant medicines, birth control pills, cyclosporine (a medicine that helps prevent the body from rejecting transplanted organs), Digoxin,(a medicine used to strengthen heart muscle contractions), Indinavir and other medicines used to control HIV infection Irinotecan and other anticancer medicines, Warfarin and related medicines used to thin the blood (known as anticoagulants) (Mayo Clinic, 2011). 2.FDA considers it a dietary supplement so it is not tested or approved as a prescription drug. There is no guarantee of strength, purity or safety of products
- #12 Discuss current medications, conditions, supplements, etc taken that may interact with St. John’s Wort. Report adverse effects to a health care provider. 2. NCCAM study using St. John’s Wort for major depression found it is of minimal benefit (National Center for Complementary and Alternative Medicine) Linde et al, 1998 also supports this finding. 3. It is important to read more about SJW for one’s self by doing research. Resources will be given at the end of the presentation. 4. Most European doctors prescribe 300mg. This amount seems to yield a greater therapeutic response without an appreciable increase in side effects (Hornig, 1998). Yet, starting at small doses it advisable.
- #13 1.“Additionally, the quality of different commercially available preparations is unknown, and the overall toxicity and its safety in overdose are unclear” (Hornig, 1998).