Cheryl Templeton NFSC 345 April 24, 2013

Introduction Benefits and Efficacy Mechanism of Action Conflicting Results Safety Professional Position

Saint Johns Wort (Hypericum perforatum) is a five pedal yellow flowering herb Earliest recorded medicinal use was in ancient Greece SJW has been widely used to treat depression since the 1980s There are 400 different species Grows in different regions from Asia to Europe

#1 Benefit is to treat mild depression

Other Benefits: Anti-inflammatory Pain Reliever Wound Healing Shingles Cold Soars Spinal Problems Joint Pain Menstrual Cramps

Pub Med was searched from January 1966 to February 2010 In a large meta-analysis St Johns wort was found to be equivalent to anti depressant drugs with few side effects. 29 double-blind randomized controlled trials compared SJW with placebo and antidepressant drugs for 4 to 12 weeks. Doses varied widely, most trials used 500 to 1200mg a day. SJW was more effective than the placebo and as effective as old and new generation antidepressants. Side effects much less common with SJW compared to antidepressants. Short term use as effective as antidepressants. Controlled studies are needed for long term use.

Unclear, top theory is that SJW inhibits reabsorption of serotonin. Alters levels of dopamine, norepinephrine, yaminobutyric acid and other neurotransmitters. It is believed that SJW also alters curtain proteins used by the bodys immune system, how this affects depression is unclear. Some also believe that it work by decreasing adrenal activity, which is increased during depression

Cedars-Sinai, David Greffen School of Medicine, Massachusetts General Hospital & University of Pittsburgh conducted a study involving 73 subjects who were taking a placebo, antidepressant medication or SJW Study showed no benefit over placebo from SJW or antidepressant medication The authors point out the reason there was no difference in benefit was not because the study was too small, but because participants taking placebo experienced substantial improvements in measure of depression and well-being.

Most common dose is 300mg 3 times per day Study suggest starting dose 600mg 3x/day increasing up to 1200mg 3x/day when needed Pill Liquid Powder Topical Dried

Side Effects: Dizziness Drowsiness Dry Mouth Headache Irritability Upset Stomach Increased HTN

Active ingredient 0.3% hypericin however, preparation in U.S. has varied amount of active ingredient.

Not recommended for children, elderly or pregnant women.

If taking medications consult your doctor before taking SJW. Should not be taken together with foods containing tyramine i.e. cheese, red wine, preserved meats, and yeast extracts. Saint Johns Wort should not be combined with selective serotonin inhibitors, trycylic antidepressants or monoamine oxidase inhibitors these might lead to serotonin syndrome. Dangerous over supply of serotonin in the body. May result in coma, seizure and death. SJW should be avoided in patients taking immuno-suppressants, antiretrovirals and chemotherapeutic agents.

Saint Johns wort seems to be an effective treatment for moderate depression. The information has been well researched, and scientific studies suggest a certain amount of efficacy in its use. Should discuss with physician before taking Remember some side effects can be serious!

http://www.healthguidance.org/entry/3451/1/St-Johns-WortBenefits-and-Side-Effects.html http://www.ncbi.nlm.nih.gov/pubmed/21673208 http://www.nimh.nih.gov/science-news/2011/for-minordepression-study-shows-no-benefit-over-placebo-from-st-johnswort-citalopram.shtml http://www.herbwisdom.com/herb-st-johns-wort.html http://healthpsych.psy.vanderbilt.edu/2009/StopSadness.htm