St. John’s Wort -An Effective Antidepressant Treatment? Dr. Manuela Padurariu

Dr. Manuela is back on AnxietyBoss.com with yet another interesting article. Please click here for her previous article. Dr. Manuela Padurariu, MD, PhD, is a psychiatrist practicing in Romania.

Many plant-based medicines are used OTC (over the counter) by patients suffering from depressive disorders hoping to find relief in alternative medicine. In depression, patients deal with various symptoms that can range from mild to severe forms, including depressed mood, loss of joy, fatigue, lack of energy, difficulty in concentration, sleep problems, sexual and appetite loss, social withdrawal, thoughts of death, and so on. When dealing with a severe depression, the best recommendation for treatment is a specific antidepressant medication with or without psychotherapy. But in some particular cases, including milder forms of depression, in people who do not tolerate classical psychotropic drugs or suffering from other health medical issues and cannot receive the typical antidepressant, some plant-based drugs may prove to be a viable treatment option.

Among plant-based medicines, one alternative treatment in depression may be St. John’s wort (Hypericum perforatum) (HP) that is currently being investigated as one of the plants with the best evidence for treating depression. Although studies are inconclusive and there is uncertainty regarding HP’s true effectiveness as an antidepressant, there are enough positive studies that are definitely worth our attention.

For someone who is considering HP for depression, many questions may arise. What aspects of depression might improve with Hypericum perforatum? What kind of patients might be responsive to this treatment? In what form and in what doses may HP have an antidepressant effect? What are the biological changes HP induces that may explain the antidepressant effect? Are there precautions to take into consideration (side effects, interactions)? What other positive effect might it have? And last but not least, are the studies on the antidepressant effect of this plant robust enough to be clinically recommended for depression?

Let’s attempt to answer these questions:

What aspects of depression might improve with HP?

Administration of St. John’s wort decreases the intensity of the depressive symptoms when measured with specific depression scales. Animal studies found that St John’s wort administered to rats induced changes in their behavior that suggested an antidepressant effect. In humans, the symptoms that seem to respond the most are depressive mood, psychological anxiety, and difficulty initiating sleep.

What doses and in what form may HP have an antidepressant effect?

HP is usually administered as a liquid or solid St. John’s wort extracts, taken orally in doses of 300-900 mg daily as a standardized extract for over 4 weeks.

What are the biological changes HP induces that may explain the antidepressant effect?

It seems that HP is a modulator of the neurotransmission of important molecules that are known to be imbalanced in depression including serotonin, dopamine, noradrenaline, GABA and glutamate in brain areas that are implicated in depression. Also, administration of this plant seems to regulate genes important in stress regulation (hypothalamic-pituitary-adrenal axis, or HPA axis). The components from this plant that may be responsible for the antidepressant effect include hyperforin, hypericin, pseudohypericin, flavonoids and procyanidines.

Are there precautions to take into consideration (side effects, interactions)?

Pharmacological treatment of depression is associated with unwanted side effects. Compared to classical antidepressant treatment, HP was found to be similar in efficacy but easier to tolerate and does not have as many adverse reactions. However, there are some reported adverse reactions including photosensitivity, gastrointestinal upset, allergic reactions, fatigue, dizziness, and restlessness. HP may also aggravate psychosis in people with schizophrenia and manic reactions in people with bipolar disorder. So despite being a natural compound and is generally easy to tolerate, for some patients HP may not be a good choice. Also, HP interacts with some drugs including antidepressants, warfarin, birth control pills and chemotherapy- the coadministration of these substances with HP have to be limited.

What other positive effect might it have?

HP seems to have antiviral and antimicrobial properties. HP has traditionally been used as an analgesic and diuretic, and has also been used for wound healing, burns, gastroenteritis, snakebites, menorrhagia, hysteria, bedwetting, and depression. It also seems to have a neuroprotective effect.

Are the studies on the antidepressant effect of this plant robust enough?

Despite a large amount of scientific evidence, Hypericum is not a standard therapy for depression and should be used with caution. The studies have been inconclusive, as they show HP is both efficacious and not efficacious. As such, HP should be reserved for select cases including milder forms of depression.

In my country and I suspect that all across the world there is a preference for alternative medicine and OTC natural treatment. Because of this, I chose this topic, and hope this helps you. Speak with your doctor to decide if St. John’s wort is right for you.

photo credit: jerryoldenettel CAC019949a via photopin (license)