How St. John's Wort Works

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    How St. John's Wort Works

    St. John's wort, and the effectiveness of the drug, has been in the news a lot lately. Many people have heard of the drug, but aren't sure what it is, what it's used for or what it's side effects are.

    In this edition of HowStuffWorks, you'll learn about St. John's wort, and who uses it and why.

    St. John's wort (hypericum perforatum) is a perennial shrubby plant with golden flowers. It is an herbal remedy that some people believe can be used to treat depression and even pain. People with depression are turning to St. John's wort because many of the psychotropic drugs used to treat depression have some severe side effects. The hope is that a medicine derived from a plant will cause fewer problems.

    Nearly 20-million Americans suffer from depression. Depression can be treated in a number of ways, most commonly by the use of anti-depressant drugs, such as Prozac, Paxil, Elavil and Nardil. The possible side effects of these drugs include sleeplessness, headaches, gastrointestinal disturbances and changes in sexual desire or activity. A 1994 study, reported in the British Medical Journal, indicated that St. John's wort was about as effective as standard anti-depressants -- better than sugar pill placebos in treating mild to moderate depression.

    The active therapeutic ingredients in St. John's wort are hypericin, pseudohypericin and xanthones, although other components may support the action of these compounds. St. John's wort extract preparations are standardized to 0.3 percent hypericin. The typical adult dosage is 300 milligrams taken three times a day, and that means that a person taking St. John's wort gets 2.7 milligrams of hypericin a day.

    It is not clear how St. John's wort works to treat depression. Most likely, hypericin helps to elevate the biochemicals in the brain that affect mood, namely dopamine and serotonin, and to reduce adrenal activity, which is increased in depression. St. John's wort has side effects, too. The most common are light-sensitivity, dry mouth, stomach irritations, dizziness and tiredness.

    St. John's wort may help with the treatment of some retroviruses, such as herpes, HIV and friend leukemia virus, and could help in treating some cancers. However, the evidence is not nearly as conclusive for the treatment of these conditions as it is for depression.

    Clinical trial studies are under way in the United States to determine just how effective St. John's wort is for treating depression. Because St. John's wort is marketed as a dietary supplement, it is not regulated by the U.S. Food and Drug Administration. Any use of this substance should be done under a doctor's supervision.

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    Older and Newer Antidepressants Both Effective: St. John's Wort May Help, But Buyer Beware
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    About nightingale

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  3. by   nightingale
    Another article of interest regarding St. John's Wart:

    Older and Newer Antidepressants Both Effective--St. John's Wort May Help, But Buyer Beware

    PHILADELPHIA -- (May 2, 2000) New guidelines for drug treatment of depression, released today by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), say that both older and newer antidepressant drugs are effective, and that St. John's wort may be effective in treating mild depression in the short term, but with caveats. "Depression strikes all ages, races, and income brackets. It's a very painful but very treatable illness, and there are many options available. It's important to talk to your doctor to determine the treatment that's best for you," says Herbert H. Waxman, MD, ACP-ASIM senior vice president for education.
    To expedite doctor-patient discussions about depression, ACP-ASIM has developed a patient education brochure that is available by calling 1-877-828-2525. The information is also available on an ACP-ASIM Web site:

    The guidelines, "Pharmacologic Treatment of Acute Major Depression and Dysthymia," and a background paper, "A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary," are published in the May 2 issue of Annals of Internal Medicine.

    The older drugs for treating major depression, such as tricyclics, and the newer drugs, such as selective serotonin reuptake inhibitors (SSRIs), have different side effects, interactions and costs. Patients taking tricyclics need dosage monitoring, and tricyclics can be fatal in overdoses. Tricyclics, most of which are available generically, are cheaper per pill. SSRIs and other newer drugs are not currently available in generic form and are generally more expensive. SSRIs are easier to take and do not require blood testing. Physicians should discuss with patients the uses and side effects of appropriate drugs, the guidelines say, and together, doctor and patient should come up with an antidepressant that fits the patient's needs.

    St. John's Wort
    ACP-ASIM recommendations about St. John's wort come with warnings. "Studies show that St. John's wort is better than placebo (a fake pill), but there are no good studies comparing St. John's wort directly with antidepressant drugs," says Waxman. Other concerns about St. John's wort cited in the ACP-ASIM background paper:
    St. John's wort studies were mostly done in Europe.
    In the U.S., St. John's wort is sold as a dietary supplement, not as a drug, and therefore is not regulated by the FDA.
    The bottle labels can be misleading.
    The amounts of active St. John's wort ingredients vary in these supplements, and the pills often contain additional substances.
    St. John's wort has side effects, may interfere seriously with blood thinners and other important medications and should never be taken with other antidepressant drugs.
    "We'll have to see more evidence-based studies on St. John's wort," says Waxman. "Meanwhile, if you are taking St. John's wort or any herbal supplement, let your doctor know."

    While ACP-ASIM's new guidelines address drug treatment, depression can be treated in other ways, Waxman says. "Our guidelines are aimed at helping internists, together with their adult patients, make informed choices about treating depression with antidepressant drugs and herbal therapies."

    . The guidelines are appropriate for adult patients with no other medical conditions. ACP-ASIM did not find sufficient evidence to make recommendations for treatment of depression in adolescents or to treat other depressive disorders.

    ACP-ASIM is a professional organization representing 115,000 internists, doctors for adults, and is the second largest medical organization in the U.S. It has been issuing evidence-based clinical practice guidelines for 20 years.

    NOTE to Editors: The article, "Pharmacologic Treatment of Acute Major Depression and Dysthymia" and background paper, "A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary," are available on the Web at, on May 2, 2000. Embargoed copies can be obtained by fax by calling Penelope Fuller at 215-351-2656 or 1-800-523-1546, ext. 2656.

    The ACP-ASIM patient education brochure on treatment of depression is available by calling 1-877-828-2525. The information is also available on an ACP-ASIM Web site:

    Interviews with Herbert Waxman, MD, ACP-ASIM senior vice president for education, and Vincenza Snow, MD, senior medical associate at ACP-ASIM, an author of the guidelines, can be arranged by calling Susan Anderson at 215-351-2653 or 800-523-1546, ext. 2653.

    The Agency for Health Quality Research report, "Treatment of Depression: Newer Pharmacotherapies" Evidence Report/Technical Assessment No. 7, Agency for Health Care Policy and Research; Feb. 1999. AHCPR Publication No. 99-E014 , can be obtained from the Agency for Health Quality Research or is available on the AHQR Web site:

    CONTACT: Susan C. Anderson, 215-351-2653 or 800-523-1546, ext. 2653
  4. by   frankie
    nightengale - I do not have the source, but I remember reading that hypertensive side effects may occur in some people taking St. Johns Wart. I have had my share of depression, and was searching for an alternative therapy. I do not have BP issues, and tried the tid St. Johns wart. It did not really work well. I took it for 4 months. I also remember reading a bit about research being done by NIH on St Johns Wart. frankie
  5. by   nightingale
    It has worked well for me witha 200 mg QD; sometimes, I take 300 mg QD.

    No problems with HTN but my stomach sometimes acts up. I tend to have that anyway. I have always had to watch my diet etc...
  6. by   sunnygirl272
    St John's Wort may counteract birth control pills.....
  7. by   live4today
    I have a friend who swears by it for her mood swings...

    I have a sister who tried it, but elevated her already high blood pressure too much, so her doctor told her not to take it.

    I've never tried it since I'm on a really good antidepressant drug already (Celexa).

    Thanks nightngale for sharing that info on it though. I always wondered how it worked.....or didn't! :kiss
  8. by   nightingale
    Oh my goodness....

    sunnygirl272 St John's Wort may counteract birth control pills.....
    now we can't let that one happen!

    As for me, well. let's jsut say I have a natural form of B.C.

    Renee.. yeah me too.. when I stumbled upon this article, in "How Stuff Works" of all places; I thought you my colleagues would be interested in it.

    Amazing how many of us are on something or other! Is it women or is it nursing? Hmmm but I am sure there is a thread on it elsewhere....