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St. John's Wort and Depression

Introduction

St. John’s Wort, is one of the most well known herbs for treatment of depression. It was also a favorite herb among traditional healers medical to ‘drive out the devil’ from individuals who were possessed. Additionally, St. John’s Wort has been used for centuries for the treatment of open wounds and possess antibacterial properties.

In the US, St. John’s Wort is chiefly used to treat mild to moderate depression. Even though many people consume St. John's Wort for the treatment of numerous other medical disorders, the evidence is strongest for treatment of depression. The effectiveness of St. John’s Wort is much more than a placebo, and in some cases it has been shown to be as effective as some of the newest antidepressants.

How does it work?

How St. John’s Wort works is not well understood but laboratory research seems to suggest that hypercin is the active ingredient, which gives the herb its efficacy.

What is it used to treat?

The use of St. John's Wort to treat medical illness is not new. The herb has been used globally to treat a variety of diseases for centuries. Over the years, St. John's Wort has been extensively studied and overall most studies indicate that it is useful for the short-term relief of depression. Newer clinical studies have shown St. John's Wort to be as effective as the newer tricyclic antidepressant drugs like Paxil or Zoloft.

St. John’s Wort is also used to treat anxiety disorder, neuropathy, seasonal affective disorder, premenstrual syndrome, OCD, somatoform disorders and several types of pain disorders. On recent study showed that the hypericum ointment may also be effective for the treatment of eczema and atopic dermatitis.

Is it Safe?

For the consumer who is seeking an alternative way to treat depression, there is ample evidence indicating that for the short term, St. John's Wort is safe and effective. Unfortunately, the long-term benefits of the herb remain unknown. No one knows if the herb's’ efficacy diminishes with time.

What is the dose?

A standard starting dose quoted in the literature is 300 mg three times a day. Studies show that the herb is well tolerated for 3-6 months.

Who should not take St. John’s Wort?

Individuals who are on the following medications should not take St. John’s Wort because they effectiveness may be diminished: Digoxin, Cyclosporine, Anticonvulsants, Theophylline, Oral contraceptives and Warfarin  In addition, St. John’s Wort should not be used at the same time as a prescription antidepressant because this may lead to an exaggerated effect. Pregnant women and those who are breastfeeding should not take St. John’s Wort as the herb has not been adequately studied in this population.

Conclusion

St. John’s Wort is best recommended for mild to moderate depression. Like the anti-depressant medications, its peak antidepressant activity occurs several weeks after regular use. Finally tell your  healthcare provider of all supplements and herbs that you take to ensure that your care is safe and well coordinated.


References

Galeotti N. Hypericum perforatum (St John's wort) beyond depression: A therapeutic perspective for pain conditions. J Ethnopharmacol. 2017 Mar 22;200:136-146

Ng QX, Venkatanarayanan N, Ho CY. Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis. J Affect Disord. 2017 Mar 1;210:211-221. d

Apaydin EA, Maher AR, Shanman R, Booth MS, Miles JN, Sorbero ME, Hempel S. A systematic review of St. John's wort for major depressive disorder. Syst Rev. 2016 Sep 2;5(1):148. doi:

Thandar Y, Gray A, Botha J, Mosam A. Topical herbal medicines for atopic eczema: a systematic review of randomized controlled trials. Br J Dermatol. 2017 Feb;176(2):330-343.

Hazell P. Depression in children and adolescents: complementary therapies. BMJ Clin Evid. 2015 Dec 8;2015. pii: 1008.

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