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Sunday, December 20, 2009

Axing Anxiety/Ditching Depression with St. John’s Wort

"St. John's Wort" by M. Bates

"In Germany, more than fifty percent of depression, anxiety, and sleep disorders are treated with hypericum (St. John's wort)."(1)

There are many reasons to use St. John's Wort. Its active ingredient, Hypericin, has many helpful psychoactive properties and is recommended for the treatment of depression, anxiety, insomnia, and even inflammation.(2)

HOW DOES IT WORK? "Some references suggest that it may act like a SSRI (Selective Serotonin Re-uptake Inhibitor) while others suggest that it acts like a MAOI (monoamine oxidase inhibitor)."(1)

HOW MUCH SHOULD BE TAKEN? "200 to 1000 mg. of 0.3% standardized hypericin perforatum content per day. Start at the lower dosage and work up slowly. Discontinue if there are any apparent side effects. Do not use if you are taking any anti-depressant or anti-psychotic medications without first consulting your physician." (1)

IS IT 100% EFFECTIVE? St. John's Wort may not work for everyone suffering from acurate depression. Additionally, it may work for some people, but may not continue to work in the long term.(3)

WHAT MEDICINES SHOULD IT NOT BE TAKEN WITH? Are there any medications that "warfarin, phenprocoumon, cyclosporin, HIV protease inhibitors, theophylline, digoxin and oral contraceptives resulting in a decrease in concentration or effect of the medicines."(4)

MIGHT THERE BE ANY ADVERSE REACTIONS? "The most commonly reported adverse reactions ... are gastrointestinal symptoms, allergic reactions, dizziness/confusion, tiredness/sedation and dry mouth. The majority of these reactions were generally considered to be mild, moderate or transient."(4)

"Recent data suggest that photosensitivity reactions are dose related, with increased sensitivity associated with higher doses. However, the main body of evidence comes from anecdotal evidence in animals, particularly pale skinned cattle, which apparently gorge on Hypericum perforatum resulting in photosensitivity reactions presenting as severe sun burn."(4)

"Breakthrough bleeding among women taking both SJW and the oral contraceptive pill has been reported. As of December 2001, 7 cases of unplanned pregnancies possibly due to interactions with SJW have been reported through the Yellow Card Scheme in the UK and two cases have been reported in Sweden."(4)

ARE THERE ANY GOVERNMENT WARNINGS? According to the FDA, "St John’s wort may significantly decrease blood concentrations of all of the currently marketed HIV protease inhibitors (PIs) and possibly other drugs (to varying degrees) that are similarly metabolized, including the nonnucleoside reverse transcriptase inhibitors (NNRTIs)... "Based on this study and reports in the medical literature, St. John’s wort appears to be an inducer of an important metabolic pathway, cytochrome P450. As many prescription drugs used to treat conditions such as heart disease, depression, seizures, certain cancers or to prevent conditions such as transplant rejection or pregnancy (oral contraceptives) are metabolized via this pathway, health care providers should alert patients about these potential drug interactions to prevent loss of therapeutic effect of any drug metabolized via the cytochrome P450 pathway."(5)


(1) Advanced Health

(2) Journal of Geriatric Psychiatric Neurology. 1999 Spring;12(1):7-10. "St. John's wort and antidepressant drug interactions in the elderly" by Lantz MS, Buchalter E, Giambanco V.Department of Psychiatry, The Jewish Home and Hospital, New York, New York 10025-3757, USA, as published on

(3) Journal of Clinical Psychiatry. 2004 Aug;65(8):1114-9. "The effectiveness of St. John's Wort in major depressive disorder: a naturalistic phase 2 follow-up in which nonresponders were provided alternate medication." Gelenberg AJ, Shelton RC, Crits-Christoph P, Keller MB, Dunner DL, Hirschfeld RM, Thase ME, Russell JM, Lydiard RB, Gallop RJ, Todd L, Hellerstein DJ, Goodnick PJ, Keitner GI, Stahl SM, Halbreich U, Hopkins HS. - University of Arizona Health Sciences Center, Tucson, AZ 85724, USA.

(4) British Journal of Clinical Pharmacology. October 2002; 54(4): 349–356. doi: 10.1046/j.1365-2125.2002.01683.x

(5) FDA bulletin

Here's hoping that A Word to the Wise T.I. is sufficient.