St. John’s Wort - an effective herbal anti-depressant ?
A systematic review of 23 randomised clinical trials of Hypericum perforatum (St John’s Wort), has compared hypericum extract with placebo and conventional antidepressants, yielding interesting results. St John’s Wort extracts were significantly superior to placebos in 55% of respondents suffering from depression. The authors of the study have concluded that extracts of hypericum are more effective than placebo for the treatment of mild to moderately severe depressive disorders. In 1996 the British Medical Journal contained an overview of European clinical trails featuring hypericum. It was found that hypericum is more effective than a placebo and equal in effectiveness to tricyclic antidepressants in the treatment of mild to moderate depression.
Although native to Europe, Western Asia and North Africa, the plant now grows wild throughout Australia and North America. The main indications for hypericum are mild to moderate depression, especially when accompanied by restlessness, anxiety and irritability. The popularity of St John’s Wort has increased tremendously over the past decade, particularly in Europe. Hypericum is currently the most commonly prescribed formulation in Germany – almost 66 million daily doses of the extract were prescribed in the country during 1994. However, despite extensive use in Germany and growing use in other parts of the world, there has been no published research on drug interactions, serious adverse reactions or toxicity in overdose. The most commonly reported adverse reactions reported in an uncontrolled study involving 3250 patients in Germany were gastrointestinal symptoms, allergic reactions and fatigue.
According to Dr Hagen Rampes, Senior Registrar at the Chelsea and Westminster Drug Treatment Centre in the UK, the increasing popularity of hypericum correlates to increasing interest in alternative and complementary medicine. Recent figures suggest that one in four Americans consult an alternative health care practitioner. One of the major attractions of St John’s Wort to patients is their perception that it is a “natural and holistic” treatment. While this may be true, caution should still be exercised when taking the treatment, and under no circumstances should St. John’s Wort be taken in combination with any conventional anti-depressants.
“Although hypericum is available over the counter in health food shops, treatment for depression should at all times be under the supervision of a general practitioner or psychiatrist”, says Dr Rampes.
Following are guidelines for the use of St John’s Wort :
The recommended daily dosage of hypericum is two to three capsules (350mg each). A decreased dosage of one or two capsules is recommended for teenagers, while children should not take more than one capsule each day. Although the capsules may be taken at any time during the day, it is best taken an hour before retiring to bed – a full dose in the morning may result in lethargy. The use of St John’s Wort may be supplemented with vitamins, such as Vitamin B12 or Vitamin B-complex.
Like any other pharmacological or herbal agent, hypericum does present with side effects. There may be increased skin sensitivity to the sun, particularly when high doses of the herb are used. As a precaution, ensure that exposure to sun is kept to a minimum. Another side effect noted is fatigue, although this may be overcome by taking the herb at night, as previously suggested (Ginkgo Biloba, a herb with anti-depressive properties may increase energy levels and improve concentration, when taken at a dose of up to 120mg per day). Other side effects include stomach upset, dry mouth and dizziness. It is important to consult a doctor should any of the side-effects continue for an extended period of time, or become more severe.
General Cautions :
St John’s Wort should not be taken during pregnancy. While little is known about the use of hypericum during breastfeeding, the herb should be avoided while breastfeeding. Under no circumstances should St. John’s Wort be taken in combination with any conventional anti-depressants