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[Treating
Depression with St. John's Wort]
[Drug Interaction Advisory | How St. John's Wort works]
[The FDA's role | Clinical trials of
St. John's Wort | References]
[St.
John's Wort Equivalent to World's Best-selling Antidepressant -
Prozac®]
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Clinical
Trials of St. John's Wort
Clinical trials (studies of a treatment's safety and effectiveness
in humans) have found a similar rate of response with St. John's wort
as with standard, conventional antidepressants in treating mild to moderate
depression.18,19 However,
it is hard to interpret these studies as definite proof of the efficacy
of St. John's wort because low doses of standard antidepressants were
used and there was no placebo (a pharmacologically inactive substance)
control. An analysis of 23 European clinical studies of St. John's wort
that was published in the British Medical Journal in 1996 concluded
that St John's wort has antidepressive effects in cases of mild to moderate
depression (the dosage varied considerably among the studies).2
However, no studies of long-term use of St. John's wort have been conducted.
More research is needed to explore the long-term effects and optimum safe
dosage of St. John's wort.
A new study funded
by the National Institutes of Health's National Center for Complementary
and Alternative Medicine (NCCAM), Office of Dietary Supplements, and the
National Institute of Mental Health will provide more information about
St. John's wort. This study, which is in progress, is the first large-scale
controlled clinical trial in the United States to assess whether St John's
wort has a significant therapeutic effect in patients with clinical depression.
The $4.3 million study
will involve 336 patients with major depression. Duke University Medical
Center in Durham, North Carolina, is coordinating the 3-year study, which
has 13 clinical sites around the country.
There are three different
treatment groups in the St. John's wort trial. One group will receive
an initial dose of 900 mg per day of St. John's wort; a second will receive
a placebo; and the third will receive Zoloft (a commonly used antidepressant).
Patients who respond positively to their randomly assigned treatment will
be continued on it for another 4 months.
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References
- American
Herbal Pharmacopoeia and Therapeutic Compendium. "St. John's Wort (Hypericum
perforatum) Monograph." Herbalgram. The Journal of the American
Botanical Council and the Herb Research Foundation. 1997. (40):1-16.
- Linde,
K., Ramirez, G., Mulrow, C.D., Weidenhammer, W., and Melchart, D. "St.
John's Wort for Depression-An Overview and Metaanalysis of Randomized
Clinical Trials." British Medical Journal. 1996. 313(7052):253-8.
- Murray,
M. "Common Questions About St. John's Wort Extract." American Journal
of Natural Medicine. 1997. 4(7):14-9.
- Nutrition
Business Journal. San Diego, CA: Nutrition Business International,
1998.
- National
Institute of Mental Health. Questions and Answers About St. John's
Wort. Bethesda, MD: National Institute of Mental Health, 1997.
- Monmaney,
T. "Remedy's U.S. Sales Zoom, but Quality Control Lags. St. John's Wort:
Regulatory Vacuum Leaves Doubt About Potency, Effects of Herb Used for
Depression." Los Angeles, CA: Los Angeles Times, August 31, 1998.
- Duke,
J. The Green Pharmacy. Emmaus, PA: Rodale Press, 1997.
- American
Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders. 4th ed. Washington, DC: American Psychiatric Association,
1995.
- National
Institute of Mental Health. General Facts About Depression. Bethesda,
MD: National Institute of Mental Health, 1997.
- Medical
Economics Company. Physician's Desk Reference 1998. 52nd ed.
Montvale, NJ: Medical Economics Company, 1997.
- Kincheloe,
L. "Herbal Medicines Can Reduce Costs in HMO." Herbalgram. The Journal
of the American Botanical Council and the Herb Research Foundation.
1997. (41):49-53.
- Woelk,
H., Burkard, G., and Grunwald, J. "Benefits and Risks of the Hypericum
Extract LI 160: Drug Monitoring Study With 3,250 Patients." Journal
of Geriatric Psychiatry and Neurology. 1994. 7(Supplement 1):S34-8.
- Laakmann,
G., Schule, C., Baghai, T., and Kieser, M. "St. John's Wort in Mild
to Moderate Depression: The Relevance of Hyperforin for the Clinical
Efficacy." Pharmacopsychiatry. June 1998. 31(Supplement):54-9
- Rezvani,
A.H. 1998 Annual Meeting of the Research Society on Alcoholism.
Hilton Head, SC: Research Society on Alcoholism, June 23, 1998.
- Andrews,
E. "In Germany, Humble Herb Is Rival to Prozac." New York, NY: New
York Times, September 9, 1997.
- Perovic,
S. and Muller, W.E.G. "Pharmacological Profile of Hypericum Extract.
Effect of Serotonin Uptake by Postsynaptic Receptors." Arzneimittel-Forschuns.
1995. 45:1145-8.
- Thiele,
B., Brink, I., and Ploch, M. "Modulation of Cytokine Expression by Hypericum
Extract." Journal of Geriatric Psychiatry and Neurology. 1994.
7(Supplement 1):S60-2.
- Harrer,
G., Hubner, W.D., and Podzuweit, H. "Effectiveness and Tolerance of
the Hypericum Extract LI 160 Compared to Maprotiline: A Multicenter
Double-Blind Study." Journal of Geriatric Psychiatry and Neurology.
1994. 7(Supplement 1):S24-8.
- Harrer,
G. and Sommer, H. "Treatment of Mild/Moderate Depressions With Hypericum."
Phytomedicine. 1994. 1:3-8.
This publication is
not copyrighted and is in the public domain. Duplication is encouraged.
National Institutes of Health
National Center for Complementary and Alternative Medicine (NCCAM)
NCCAM Clearinghouse.
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