Can St. John's Wort replace Prozac for Depression Treatment?

The extract from St. John's wort (Hypericum perforatum), a bushy, wild-growing plant with yellow flowers, has been used for centuries in many folk and herbal remedies. Today in Europe, it is used extensively to treat mild to moderate depression. In the United States, it is one of the top–selling botanical products.

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Historical St. John's Wort Applications
The historical use of medical St. John's wort is well documented. Commencing 2400 years ago St. John's wort was used as a nerve tonic, a painkiller for arthritis, menstrual cramping, gastrointestinal problems (such as diarrhea and nausea) as well as ulcers.

The ancient Greeks and Romans used to treat many ailments, including sciatica and poisonous reptile bites as well as to ward against evil spirits, placing sprigs of the plant on statues of their Gods. In fact, the genus name Hypericum is from Greek and means "over an apparition" as the herb was once considered odiferous enough to cause evil spirits to depart.

In the first century St. John’s wort was referred to in Pliny the Elders famous book on natural history for its bracing quality in treating diarrhea and promoting urine flow and bladder troubles.

Dioscorides, a Roman army surgeon, recommended drinking St Johns wort in his medical text, “For it expels choleric excrements…” He also recommended rubbing it on burns. Paracelsus, a medical authority of the Renaissance also wrote of using St. John’s wort to treat wounds. He was also the first to mention using it for psychotic symptoms which he called “phatasmata”.

During medieval times, the Europeans used the plant to treat all forms of madness (They thought St. Johns wort had magical properties) as it blooms near the Summer Solstice. The Saltenitan drug list of the thirteenth century also referred to St. John’s wort as herba demonis fuga--an herb to chase away the devil.

Sixteenth century medical books refer to the plant as Fuga demonum, or devil’s scourge, a term that was repeated frequently in the literature of the next several hundred years.

The oil made from the flowers was listed in the first Pharmacopoeia Londinensis (1618). 1630 Angelo Sala stated that St. John’s wort treated illnesses of the imagination, melancholia, anxiety and disturbances of understanding. He wrote, “St. John’s wort cures these disorders as quick as lightening.” Gerard wrote that its use as a balm for wounds, burns, ulcers and bites was without equal (Gerard 1633).

There is even evidence that the American Indians used St. John's wort used it in the treatment of Tuberculosis and other breathing ailments.

Civil War soldiers collected St. John's wort to use on battle wounds. A prolific and hardy plant that threatened grazing land, a beetle was introduced into the Pacific Northwest in the early 1900's to keep St. John's wort under control.

19th century literature incorporated the use of hypericum to treat melancholia. 19th century British and American literature stressed the superficial use of the herb for the treatment of burns and wounds. A powerful antibacterial, St. John’s wort has been used through the centuries as an analgesic (pain reliever) to treat saddle sores and in poultices for certain lameness's in horses.

More contemporary St. Johns Wort applications
  • Over time, and the advent of modern pharmaceutical science, St. John's Wort was nearly forgotten as a medicinal herb. Only recently has St. John's Wort gained a renewed reputation as an effective treatment for all manner of infirmities most notably depression. Its complex and diverse chemical makeup has also shown to support depression related infirmities such as chronic fatigue syndrome, and pms.
  • St. John's Wort's antibacterial / antiviral properties render it very useful adjunctive treatment for bacterial and viral infections.
  • St. Johns Wort has also been shown to be useful in treating pulmonary complaints, bladder trouble, suppression of urine, dysentery, worms and nervous depression.
  • St. Johns Wort can act to dissolve and remove bacterially based tumors and boils. It calms the nerves and increase the flow of urine.
  • St. John's Wort is an excellent blood cleanser and blood purifier.
  • For Tourette's syndrome - used with Wormseed
  • Bells' Palsy (apply directly on face)
  • St. Johns Wort antibacterial/viral properties have been shown useful in relieve phlegm obstructions in the chest and lungs. It can be beneficial in addressing bronchitis as well.
  • Like Horsechestnut, St. Johns Wort may be valuable for treating internal bleeding.
  • St. Johns Wort is used to treat chronic uterine problems and will correct irregular and painful menstruation.
  • St. Johns Wort contains an alkaloid that is a heart and artery stimulant
  • Is useful for low back pain
  • Mattioli wrote of its use as an emmenagogue and antimalarial (Bombardelli and Morazzoni 1995).
  • Most recent research at two of the world's leading medical institutions, New York University and the Weizman Institute of Science in Israel ,found that 2 of the main constituents of St. John's Wort namely hypercin and pseudohypericin were found to inhibit the growth of retroviruses( including HIV, the AIDS virus) in animals. Although the results of these studies are promising, more work needs to be done. The mechanism is thought to involve the production of oxygen free radicals which can damage the viral envelope. 
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Why people use St. John's Wort as an alternative therapy for depression
Some patients who take antidepressant drugs do not experience relief from their depression. Other patients have reported unpleasant side effects from their prescription medication, such as a dry mouth, nausea, headache, or effects on sexual function or sleep.

Sometimes people turn to herbal preparations like St. John's wort because they believe "natural" products are better for them than prescription medications, or that natural products are always safe. Neither of these statements is true (this is discussed further below).

Finally, cost can be a reason. St. John's wort costs less than many antidepressant medications, and it is sold without a prescription (over the counter).

How is St. John's wort sold?
St. John's wort products are sold in the following forms:
  • Capsules
  • Teas--the dried herb is added to boiling water and steeped for a period of time.
  • Extracts--specific types of chemicals are removed from the herb, leaving the desired chemicals in a concentrated form.
Does St. John's wort work as a treatment for depression?
There has been scientific research to try to answer this question.

In Europe, results from a number of scientific studies have supported the effectiveness of certain St. John's wort extracts for depression. An overview of 23 clinical studies, published in the British Medical Journal in 1996, found that the herb might be useful in cases of mild to moderate depression. The studies, which included 1,757 outpatients, reported that St. John's wort was more effective than a placebo (a "dummy" pill designed to have no effect) and appeared to produce fewer side effects than some standard antidepressants.

Other studies conducted recently have found no benefit from the use of St. John's wort for certain types of depression. For example, the results of a study funded by Pfizer Inc., a pharmaceutical company, found that St. John's wort, when compared with placebo, was not effective for treating major depression.

In addition, several components of the National Institutes of Health--NCCAM, the Office of Dietary Supplements, and the National Institute of Mental Health--funded a large, carefully designed research study to find out whether St. John's wort extract benefits people with major depression of moderate severity. This trial found that St. John's wort was no more effective for treating major depression of moderate severity than placebo.

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Are there any risks to taking St. John's wort for depression?
Yes, there are risks in taking St. John's wort for depression.

Many so-called "natural" substances can have harmful effects--especially if they are taken in too large a quantity or if they interact with something else the person is taking.

Research from the NIH has shown that St. John’s wort interacts with some drugs--including certain drugs used to control HIV infection (such as indinavir). Other research shows that St. John’s wort can interact with anticancer, or chemotherapeutic, drugs (such as irinotecan). The herb may also interact with drugs that help prevent the body from rejecting transplanted organs (such as cyclosporine). Using St. John’s wort limits these drugs’ effectiveness.

Also, St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe and, in some cases, may be associated with suicide. Consult a health care practitioner if you or someone you care about may be experiencing depression.

People can experience side effects from taking St. John's wort. The most common side effects include dry mouth, dizziness, gastrointestinal symptoms, increased sensitivity to sunlight, and fatigue.

To address increasing American interests in St. John's wort, the National Institutes of Health conducted a clinical trial to determine the effectiveness of the herb in treating adults who have major depression. Involving 340 patients diagnosed with major depression, the eight–week trial randomly assigned one-third of them to a uniform dose of St. John's wort, one–third to a commonly prescribed SSRI, and one–third to a placebo. The trial found that St. John's wort was no more effective than the placebo in treating major depression. Another study is looking at the effectiveness of St. John's wort for treating mild or minor depression.

Other research has shown that St. John's wort can interact unfavorably with other medications, including those used to control HIV infection. On February 10, 2000, the FDA issued a Public Health Advisory letter stating that the herb appears to interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Because of these potential interactions, patients should always consult with their doctors before taking any herbal supplement.

In general, you should be alert for any of the following effects if you are taking St. John's Wort:
  • allergic reactions
  • fatigue and restlessness with long-term use
  • increased blood pressure
  • increased sensitivity to the sun -- especially if you are fair-skinned and taking large doses
  • stomach upsets

Sources and Additional Information:

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