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This month's article comes from world renowned herbologist and botanical expert, Dan Kenner.
St. John's Wort (Hypericum perforatum)
St. John's wort has been used in Europe for centuries for mood disorders. In modern times, over-the-counter products for depression have been available for years in Germany and France. In the U.S. the herb first caught the attention of AIDS patients who began to import highly concentrated European St. John's wort products for strengthening the immune system. St. John's wort gradually became an herbal "superstar" after a survey of research on the herb's effectiveness for depression was published in the British Medical Journal in 1996. The study concluded that an extract of the herb is "more effective than placebo for the treatment of mild to moderately severe depressive disorder."
St. John's wort has attracted the interest of many people who suffer from depression and self-prescribe the herb. Anyone who has suicidal thoughts, even if they are using a prescription drug for depression should not rely on St. John's wort or anything else. It is essential to get emergency help at once by calling a doctor, a religious counselor, a suicide hotline or 911.
Key signs of depression include frequent feelings of sadness, frequent crying, feelings of worthlessness or unattractiveness, brooding, a loss of interest in sex or in other things that were previously interesting, excessive insomnia or feeling sleepy all the time, angry outbursts and binge eating. Depressed people may have difficulty sitting still or may be sluggish in movement and in speech. There is often difficulty in concentrating, foggy thinking and sometimes mild confusion. Most people experience these symptoms occasionally, but anyone who chronically experiences them should seek the help of a professional health care provider. St. John's wort can be helpful as a treatment for these symptoms even if they are not a clinical problem.
There are also several common prescription drugs that can cause depression: tranquilizers like valium, reserpine and some phenothiazines; levodopa and methyldopa; hormones like estrogen, oral contraceptives and cortisone-like steroids; digitalis, benzodiazepines, bromocriptine, clonidine, indomethacin and Halcion. Anyone taking any of these drugs who feels depressed should consult with the prescribing physician.
Symptoms of depression can also occur in people who have low thyroid function. Common symptoms of low thyroid function include fatigue, weight gain, poor memory, cold hands and feet, cold intolerance, hair loss, insomnia with morning sluggishness, and mood swings with anxiety. If you experience some of these symptoms, it may be useful to consult a health care provider about low thyroid function. In this case taking St. John's wort may be of some use, but will not address the cause of the problem.
This herb can be a useful treatment for mild depression and even for serious depressive disorders if used under the advice of a health care professional. For people with mild depression episodes, St. John's Wort can bring considerable relief. St. John's wort can have a slightly stimulating effect, so it is more appropriate for a lethargic individual than for one who suffers from agitation. It could create increased irritability in someone who is unable to sit still.
Health care professionals who use herbal medicine often look for a pattern of symptoms before selecting herbs for a patient. Because most herbs have complex effects, selection of herbs for treatment is a process of matching the properties of herbs with the patient's pattern of symptoms. In the case of St. John's wort, it has been used traditionally for treating infections, menstrual problems, skin conditions and digestive problems. It is also an immune stimulant. Another reason it attracted the attention of AIDS patients is because it can relieve diarrhea and has some antiviral properties.
The profile of the patient who will benefit from St. John's wort in the practitioner's eyes is not only the depression sufferer. A patient with poor immunity is also a likely candidate. This is a person who catches cold easily, in whom a simple cold quickly moves into the chest, who has chronically swollen lymph nodes in the neck, frequently has a sore throat and fatigue and who has slow wound healing. The patient who has digestive problems is another part of the St. John's wort profile. This includes people who have stomach irritation, even from ulcers, with nausea or diarrhea. The herb is indicated more for the person with a less robust build who may have a "dropped" stomach (gastroptosis) who often feels that food "sits" in the stomach for a long time. For women with menstrual problems, St. John's wort can help with menstrual cramps and leukorrhea (vaginal discharge). It can be used for pain relief and to speed up the healing of burns and wounds. Some of the diseases St. John's wort has been used to treat are bacterial and viral infections, AIDS, hepatitis C, cancer, headaches, insomnia and intestinal parasites.
St. John's wort is a very safe, nontoxic herb, but there are a few precautions to keep in mind. St. John's wort causes photosensitivity. This means that it could make your skin hypersensitive to the sun. For those taking prescription antidepressant medications, there are potential drug interactions with monoamine oxidase inhibitors (MAOIs) such as Nardil or Parnate. There have actually been no reported problems, but since St. John's wort is considered to act like a certain class of antidepressant known as selective serotonin reuptake inhibitors (SSRIs) like Prozac, Paxil or Zoloft, it could potentially cause the same type of drug interaction with MAOI's, typically sudden severe high blood pressure.
It is also not known if there are any potential additive effects with taking St. John's wort along with SSRI antidepressants. The prescribing physician should be informed of any use of St. John's wort by patients taking prescription antidepressants.
The recommended dose of St. John's wort is 300 mg (containing 0.3% hypericin) three times a day. Usually it is recommended to be taken early in the day so that any stimulating effects do not interfere with sleep. The single dose of the alcohol extract should be 1/4 teaspoon. For children ages three to eight, 300 mg per day is the recommended dose. Older children can take 600 mg a day. Teenagers can take the adult dose. The elderly or infirm should use a lower dose. A starting dose of 500-600 mg a day can be gradually increased if it is well tolerated. For the safest, best result, self-medication of St. John's wort should be discussed with your health care provider.
References:
Cott, J., "Natural product formulations available in Europe for psychotropic indications," Psychopharmacology Bulletin 31 (1995) pp. 745-751
De Smet, P.A., "St. John's wort as an antidepressant" (editorial), British Medical Journal 313 (1996) pp. 241-7 Hahn, G., "Hypericum perforatum-a medicinal herb used in antiquity and still of interest today," Journal of Naturopathic Medicine 3/1 (1992) pp. 94-96
James, J.S. "Hypericum: Common herb shows anti-retroviral activity," AIDS Treatment News, August 26, 1988
Meruelo, D., Lavie, G., and Lavie, D., "Therapeutic agents with dramatic antiretroviral activity and little toxicity at effective doses: Aromatic polycyclic diones hypericin and pseudohypericin," Proceedings of the National Academy of Sciences of the United States of America 85-14 (1988) pp. 5230-5234
Lavie, G., et al, "Hypericin as an inactivator of infectious viruses in blood components," Transfusion 35/5 (1995) pp. 392-400
Muller, W., and Rossol, R., "Effects of hypericum extract on the expression of serotonin receptors," Journal of Geriatric Psychiatric and Neurology 7/1 (1994) S63-64
Thiele, H.M., and Walper, A., "inhibition of MAO and COMT by hypericum extracts and hypericin," Journal of Geriatric Psychiatry and Neurology 7 suppl. 1 (1994) S54-56
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