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Saint Johns Wort Cheryl Templeton NFSC 345: Dietary Supplement and Functional Foods May 7, 2013

Saint Johns Wort Abstract According to the National Institute of Mental Health, approximately 21 million American adults will be affected by depression this year (St. John's wort and Depression, 2012). This paper looks at several studies and a very large meta-analysis to determine if Saint Johns wort is effective in treating symptoms of mild to moderate depression. The results of the meta-analysis and other studies agree that Saint Johns Wort is as effective as antidepressants and it costs significantly less than conventional medications like Zoloft, Paxil, and Prozac. Saint Johns wort has minimal side effects compared with conventional medications. An abundance of evidenced based research has been completed and these scientific studies suggest a certain amount of efficacy in its use. For this reason, the professional opinion of this study would recommend its use to future patients who have symptoms of mild to moderate depression. These symptoms of mild to moderate depression can include overall sad, anxious, and/or hopelessness, restlessness or irritability, fatigue, overeating, loss of appetite and weight loss. Patients would be advised to consult their physician before taking Saint Johns wort. Introduction Saint Johns wort or Hypericum perforatum is a yellow, flowering perennial herb that is found in regions from Asia, to Europe and parts of the Western United States. Saint Johns wort was found to be more effective than the placebo and as effective as old and new generation antidepressants in treating mild to moderate depression (Nahas, 2011). There are very few side effects and they are much less common when compared with antidepressant medications. Saint

Johns wort is recommended for adults suffering from depression. Saint Johns wort is not recommended for children, elderly or women who are pregnant. Saint Johns wort can be taken in multiple forms when used to treat depression. Both the flowers and leaves can be dried for use in teas, capsules, and powders. Otherwise, the flower is crushed and the reddish-brown extract is obtained for use in capsules. The types of Saint Johns wort used most frequently in the U.S. contain only certain chemicals, generally the hypericin and the hyperforin that have been removed from the flower extract. Doses of Saint Johns wort widely vary, out of the 29 double-blind randomized controlled trials, most trials used 500 to 1200 mg of 0.3% hypericin daily. The authors of the large meta-analysis reviewing the 29 double-blind trials recommend a starting dose of 600 mg/day and advancing dosage up to 1200 mg/day depending on tolerance build up (Nahas, 2011). However according to the mayo clinic the most common form are capsules and the dose is between 150 and 1800 mg of the 0.3% hypericin content daily (St. John's wort (Hypericum perforatum L.), 2012). One can also take 2-4 grams of powdered St. Johns wort 3 times per day, or use the dried herb in a tea and drink it 2 times per day. If someone is new to taking St. Johns wort, it is recommended that they introduce it to their body slowly, starting with a low dose (St. John's wort). Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression. SSRIs can cause an increase in thoughts of suicide, increased hostility, agitation, and anxiety. Side effects listed are: nausea, insomnia, dizziness, decreased sex drive, fatigue, headaches, weight gain or loss and more (Help Guide.org, 2012). These are pretty serious side effects and Saint Johns wort is a natural supplement with minimal side effects and has been proven to help treat depression. Discussion

The main goal of treatment with St. Johns wort is to reduce or eliminate the symptoms related to depression. These symptoms can include continual feelings of sadness, hopelessness, guilt, anxiety, restlessness, irritability, fatigue, difficulty concentrating, and insomnia (St. John's wort and Depression, 2012). Other benefits of Saint Johns wort include; anti-inflammatory, pain-reliever, wound healing, shingles, cold sores, spinal problems, joint pain and menstrual cramps. Safety and efficacy of Saint Johns wort has been well established for adults. Pub Med was searched from January 1966 to February 2010 for a large meta-analysis. 29 double-blind randomized controlled studies were identified when comparing Saint Johns wort with placebo and antidepressant drugs for a period of 4 to 12 weeks. It was found the Saint Johns wort was more effective than the placebo and as effective as old and new generation antidepressants. The side effects were much less common with Saint Johns wort compared to the antidepressants. Side effects reported with Saint Johns wort were dizziness, drowsiness, dry mouth, headache, irritability, and upset stomach. Side effects with antidepressants were increased thoughts of suicide, increased hostility, agitation, anxiety, nausea, insomnia, dizziness, weight gain or loss, decreased sex drive, drowsiness, fatigue, headaches and more. It was determined Saint Johns wort was as effective as antidepressants for short term use (Nahas, 2011). The Mayo Clinics website states, Overall, the scientific evidence supports the effectiveness of St. Johns wort in mild-to-moderate major depression (St. John's wort (Hypericum perforatum L.), 2012). Mechanism of action is unclear, the top theory is that Saint Johns wort inhibits reabsorption of the neurotransmitter serotonin, which is what the class of drugs known as selective serotonin reuptake inhibitors (SSRIs) are also engineered to do. It also alters levels of dopamine, norepinephrine, y-aminebutyric acid, and other neurotransmitters. It is also believed

that Saint Johns wort alters certain proteins used by the bodys immune system, however how this affects depression remains unclear. Another theory is that it works by decreasing adrenal activity, which is increased during depression (Nahas, 2011). A contradictory perspective is from a study conducted by Cedars-Sinai, David-Greffen School of Medicine, Massachusetts General Hospital and University of Pittsburgh involving 73 subjects who were taking a placebo, antidepressant medication or Saint Johns wort. The study showed no benefit over the placebo from Saint Johns wort or antidepressant medication. The authors point out, the reason there wasnt a difference in benefit was not because the study was too small, but because participants taking the placebo experienced substantial improvements in measure of depression and well-being (For Minor Depression, Study Shows No Benefit Over Placebo from St. John's Wort, Citalopram, 2011). There are some safety issues if taking Saint Johns wort. Saint Johns wort should not be taken together with foods containing tyramine (i.e. cheese, red wine, preserved meats, and yeast extracts). Saint Johns wort should never be combined with selective serotonin inhibitors, tricyclic antidepressants or monoamine oxidase inhibitors as these might lead to serotonin syndrome. Serotonin syndrome is a dangerous over supply of serotonin in the body, which may result in coma, seizures or death. Saint Johns wort should also be avoided in patients taking immune-suppressants, antiretrovirals and chemotherapeutic agents (Nahas, 2011). Conclusion It appears that Saint Johns wort has the potential to be an effective treatment for mild to moderate depression. The information found through the different studies and very large metaanalysis has been well researched, and scientific evidence suggests a strong amount of efficacy. The side effects of Saint Johns wort are very minimal compared to the side effects of prescribed

SSRIs; however, the side effect of Serotonin Syndrome can be very dangerous. Before taking Saint Johns wort it is recommended that all patients consult with their physician, especially if they are taking any medications. Further research needs to be completed for benefits of long term use and hopefully this will allow a specific mechanism of action to be revealed.

References
For Minor Depression, Study Shows No Benefit Over Placebo from St. John's Wort, Citalopram. (2011, July 22). Retrieved April 26, 2013, from National Institute of Mental Health: http://www.nimh.nih.gov/news/science-news/2011/for-minor-depression-study-shows-nobenefit-over-placebo-from-st-johns-wort-citalopram.shtml Help Guide.org. (2012, November). Retrieved May 2013, from Types of Antidepressants and Their Side Effects: http://www.helpguide.org/mental/types_of_antidepressants.htm St. John's wort (Hypericum perforatum L.). (2012, August 10). Retrieved 04 26, 2013, from Mayo Clinic: http://www.mayoclinic.com/health/st-johns-wort/NS_patient-stjohnswort St. John's wort and Depression. (2012, September). Retrieved April 26, 2013, from National Institutes of Health: http://nccam.nih.gov/health/stjohnswort/sjw-and-depression.htm Nahas, R. (2011). Complementary and alternative medicine for the treatment of major depressive disorder. Can Fam Physician, 57(6), 659-663. St. John's wort. (n.d.). Retrieved April 26, 2013, from University of Maryland Medical Center: http://www.umm.edu/altmed/articles/st-johns-000276.htm