St. Johns Wort and St. Johns Wort and DepressionDepression

What You Should KnowWhat You Should Know

Who Experiences Who Experiences Depression?Depression?

About 7.5% of About 7.5% of AmericansAmericans

Can occur at any Can occur at any ageage

Mostly occurs in Mostly occurs in womenwomen

Incidence Incidence increases with increases with ageage

National Institute of Health, 2003

Signs of Minor Signs of Minor DepressionDepression Depressed mood all day, nearly every Depressed mood all day, nearly every

dayday Less interest or pleasure in activitiesLess interest or pleasure in activities Changes in appetiteChanges in appetite Sleep disturbancesSleep disturbances Agitation or slownessAgitation or slowness Fatigue or loss of energyFatigue or loss of energy

National Institute of Mental Health, 2003

Signs of Minor Signs of Minor DepressionDepression

Feelings of worthlessness or guiltFeelings of worthlessness or guilt Diminished ability to concentrate; Diminished ability to concentrate;

indecisivenessindecisiveness Recurrent thoughts of death or Recurrent thoughts of death or

suicidesuicide Symptoms last at least 6 monthsSymptoms last at least 6 months Yet less than 2 continuous yearsYet less than 2 continuous years

National Institute of Mental Health, 2003

Antidepressants Antidepressants Most commonly Most commonly

prescribed medication prescribed medication in the U.S.in the U.S.

Use has tripled Use has tripled between 1999-2000between 1999-2000

Side effects : Side effects : dizziness, headache, dizziness, headache, weight gain to-weight gain to-

Increased depression, Increased depression, suicide, heart and suicide, heart and liver problemsliver problems

Withdrawals and costWithdrawals and cost

CDC, 2004;Glenmullen, 2005

St. John’s WortSt. John’s Wort-The Alternative--The Alternative-

Hypericum Perforatum Hypericum Perforatum

Most popular natural Most popular natural remedy for depressionremedy for depression

First used in ancient First used in ancient GreeceGreece

Used for centuries for Used for centuries for many health conditionsmany health conditions

Muller, 2005; NCCAM, 2011

Clinical Evidence on SJWClinical Evidence on SJW Extensively studied in Europe over the last two Extensively studied in Europe over the last two

decades decades

Found asFound as effective effective as antidepressants as antidepressants

More effective than placeboMore effective than placebo

Fewer side effectsFewer side effects

May work even better for somatic symptoms May work even better for somatic symptoms

Woelk, 2000,Hornig, 1998; Linde et. al 1996, Gaby, 2005; Mayo Clinic, 2011

Clinical EvidenceClinical Evidence

Well toleratedWell tolerated

May work similar to May work similar to some some antidepressants antidepressants

Use SJW because of Use SJW because of intolerable side intolerable side effects of meds. effects of meds.

Mayo Clinic, 2011

Common Side EffectsCommon Side Effects Infrequent and mild Infrequent and mild Dry mouth, dizzinessDry mouth, dizziness Gastrointestinal complaints Gastrointestinal complaints

(constipation)(constipation) Confusion Confusion Some allergic reactionsSome allergic reactions Sensitivity to the sunSensitivity to the sun

Hornig, 1998, Gaby 2005

PrecautionsPrecautions Can interact with medications, herbs and Can interact with medications, herbs and

supplementssupplements Can limit effectiveness of prescription medsCan limit effectiveness of prescription meds No regulations on herbal products No regulations on herbal products Avoid preparations made with more than one

herb. Beware of commercial claims of what herbal

products can do.

Harvard Women’s Health Watch, 2000; WebMd 2010

RecommendationsRecommendations

Discuss use with your Discuss use with your physicianphysician

Not recommended for major Not recommended for major depressiondepression

Look for scientific-based Look for scientific-based sources of information.sources of information.

Sold as capsules, teas, and Sold as capsules, teas, and liquid extractsliquid extracts

How do I choose a supplement?How do I choose a supplement? Select brands carefullySelect brands carefully That have the common or scientific nameThat have the common or scientific name Name and address of manufacturerName and address of manufacturer Batch and lot numberBatch and lot number Expiration dateExpiration date Dosage guidelinesDosage guidelines Potential side effectsPotential side effects

WebMD, 2010

Information and ResourcesInformation and ResourcesThe Alternative Medicine Foundation, Inc.The Alternative Medicine Foundation, Inc.

www.amfoundation.orgwww.amfoundation.org

The American Botanical Foundation, Inc. The American Botanical Foundation, Inc.

www.herbalgram.orgwww.herbalgram.org

The National Center for Complementary and The National Center for Complementary and Alternative Medicine (NCCAM)Alternative Medicine (NCCAM)

www.nccam.nih.govwww.nccam.nih.gov

Bratman, S. (1997). Beat Depression with St. Bratman, S. (1997). Beat Depression with St. John’s Wort. Prima PublishersJohn’s Wort. Prima Publishers

Works CitedWorks CitedAlmost half of Americans use at least one prescription drug annual report on Nation’s Almost half of Americans use at least one prescription drug annual report on Nation’s

Health Shows. (2004). Centers for Disease Control and Prevention. Retrieved on Health Shows. (2004). Centers for Disease Control and Prevention. Retrieved on February 1, 2011 from February 1, 2011 from http://www.cdc.gov/nchs/pressroom/04news/hus04.htmhttp://www.cdc.gov/nchs/pressroom/04news/hus04.htm

Gaby, A.R.  (2005, April). More evidence backs St. John's Wort for mild to moderate Gaby, A.R.  (2005, April). More evidence backs St. John's Wort for mild to moderate depression. depression. Natural Foods MerchandiserNatural Foods Merchandiser, 26(4), 50.  Retrieved January 26, 2011, , 26(4), 50.  Retrieved January 26, 2011,

from hfrom http://ttp://proquest.umi.com/pqdweb?didproquest.umi.com/pqdweb?did=909243831&sid=1&Fmt=3&clientId=2606&RQT=309&VName=PQD=909243831&sid=1&Fmt=3&clientId=2606&RQT=309&VName=PQD

Glenmullen, J. (2005). The antidepressant solution: A step by step guide to safely Glenmullen, J. (2005). The antidepressant solution: A step by step guide to safely overcoming antidepressant withdrawal, dependence and addiction. New York, NY: overcoming antidepressant withdrawal, dependence and addiction. New York, NY: Free Press Publishers.Free Press Publishers.

Horning, M. (1998, January 1). Hypericum (St. John’s Wort) for treatment of Horning, M. (1998, January 1). Hypericum (St. John’s Wort) for treatment of depression. depression. Alternative Medicine Alert,Alternative Medicine Alert, 1, 4-7. Academic Onefile. Retrieved on 1, 4-7. Academic Onefile. Retrieved on January 26, 2011 from January 26, 2011 from http://find.galegroup.com/gtx/infomark.do?&contentSet=IAC-Documents&type=rehttp://find.galegroup.com/gtx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T004&prodId=AONE&docId=A206919667&source=gale&srcprod=Atrieve&tabID=T004&prodId=AONE&docId=A206919667&source=gale&srcprod=AONE&userGroupName=apollo&version=1.0ONE&userGroupName=apollo&version=1.0

Linde, K., Berner, M., Egger. M., & Mulrow, C. (2005). St John’s wort for depression. Linde, K., Berner, M., Egger. M., & Mulrow, C. (2005). St John’s wort for depression. The British Journal of Psychiatry,The British Journal of Psychiatry, 186, 99-107. Retrieved on January 26, 2011 from 186, 99-107. Retrieved on January 26, 2011 from http://bjp.rcpsych.org/cgi/content/full/186/2/99http://bjp.rcpsych.org/cgi/content/full/186/2/99

Muller, W.E. (2005). (Ed). Muller, W.E. (2005). (Ed). St. John’s Wort and its active principles in depression and St. John’s Wort and its active principles in depression and anxietyanxiety. Basil, Switzerland: Birkhauser Publishers . Basil, Switzerland: Birkhauser Publishers

Works CitedWorks CitedNational Institute of Mental Health. (2003, March 21). National Institute of Mental Health. (2003, March 21). Treatment for minor depressionTreatment for minor depression. .

Received on January 30, 2011 fromReceived on January 30, 2011 from http://www.nimh.nih.gov/science-news/2003/treatment-for-minor-depression.shtmlhttp://www.nimh.nih.gov/science-news/2003/treatment-for-minor-depression.shtml

Neurotoxicity from whole St. John's Wort. (1999, Jan 1). (Clinical report). Neurotoxicity from whole St. John's Wort. (1999, Jan 1). (Clinical report). Alternative Alternative Medicine Alert.Medicine Alert. Academic OneFile. Retrieved on January 26, 2011 from Academic OneFile. Retrieved on January 26, 2011 from

http://find.galegroup.com/gtx/infomark.do?&contentSet=IAC-http://find.galegroup.com/gtx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T004&prodId=AONE&docId=A206906053&sourDocuments&type=retrieve&tabID=T004&prodId=AONE&docId=A206906053&source=gale&srcprod=AONE&userGroupName=apollo&version=1.0 ce=gale&srcprod=AONE&userGroupName=apollo&version=1.0

St. John’s Wort. (n.d). National Center for Complementary and Alternative Medicine. St. John’s Wort. (n.d). National Center for Complementary and Alternative Medicine. Retrieved on January 14, 2011 from Retrieved on January 14, 2011 from http://nccam.nih.gov/health/stjohnswort/ataglance.htm http://nccam.nih.gov/health/stjohnswort/ataglance.htm

St .John’s Wort for treating depression. (2010). WebMD. Retrieved on February 2, St .John’s Wort for treating depression. (2010). WebMD. Retrieved on February 2, 2011 from http://www.webmd.com/depression/guide/st-johns-wort?page=22011 from http://www.webmd.com/depression/guide/st-johns-wort?page=2

Woelk, H. (2000, April 25) Comparison of St John's wort and imipramine for treating Woelk, H. (2000, April 25) Comparison of St John's wort and imipramine for treating depression: Randomized controlled trial. depression: Randomized controlled trial. British Medical Journal,British Medical Journal, 321:536. 321:536. Retrieved on January 28, 2011 from Retrieved on January 28, 2011 from http://www.bmj.com/content/321/7260/536.fullhttp://www.bmj.com/content/321/7260/536.full