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August 1, 1999
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ALTERNATIVE
HEALTH
Wort 101
Wondering about the wonder drug?
By Meredith Phillips
From his post across the room in his red leather chair, my therapist
uttered the words I dreaded hearing: "A prescription for an antidepressant
would probably make you feel much better." Suffering from a moderate
depression, I would have done anything to feel like myself again,
but I feared the side effects. What if antidepressants turned
me into a glassy-eyed, dry-mouthed zombie with no sex-drive and
a weight problem? I implored him to recommend something else --
yoga, maybe, or St. John's wort, an herbal supplement available
in most drugstores and natural groceries. Recently hyped as a
"wonder-drug," St. John's wort's pretty yellow star-shaped flowers
-- hypericum perforatum -- seem to be effective in the treatment
of some depressions.
Since I was under his regular care, my therapist agreed to let
me try St. John's wort as long as I took advantage of the herb's
full effects as a mood enhancer by taking the "research dose"
of a reputable brand. Like the prescription antidepressants Prozac
and Zoloft, St. John's wort may increase the body's level of serotonin,
a brain chemical that gives a person a sense of well-being. It
also seems to affect levels of neurotransmitters norepinephrine
and dopamine and has few known side effects, which makes St. John's
wort -- government regulated or not -- a popular alternative with
the public.
The National Institutes of Health (NIH) is launching a three-year
study on St. John's wort's effectiveness that they hope will satisfy
U.S. doctors in length and scope, but because the herb is not
yet regulated by the Food and Drug Administration (FDA), it remains
classified as an over-the-counter remedy. St. John's wort is also
being touted as an immune booster, so we've seen it cropping up
in teas, commercial herbal drinks, vitamin formulas, tinctures,
and pills. But if you're planning to use St. John's wort to help
alleviate the symptoms of depression, you should understand a
few things first. The effectiveness of the plant depends upon
the form in which it's taken, the duration
it's taken for, the dosage and ultimately,
the chemistry of the person taking it, meaning that it is not
effective in every case. Also, be sure to read up on the cautions:
St. John's wort should not be used in conjunction with other antidepressants,
and recent studies show that it may significantly reduce the effectiveness
of certain prescription drugs, including birth-control pills and
HIV medication.
Form: Currently St. John's wort is
available in tablet, capsule, and liquid form. Most conventional
research has focused on just two constituents of hypericum as
the primary antidepressant agents: hypericin and pseudohypericin.
Dosage: The effective research dose
for mild to moderate depression is 300 mg of 0.3 percent hypericin,
3 times a day for a total of 900 mg daily, if taken in tablet
or capsule form. For a liquid extract, it's 1/4 teaspoon of 0.3
percent hypericin for a total of 3/4 teaspoon daily.
- Because
the dosage is not strong or consistent enough, teas are not
recommended for the treatment of depression.
- Even
though vast quantities of St. John's wort have not shown short-term
side effects, don't exceed this standard dosage if it doesn't
seem to be working -- it may be that St. John's wort is not
effective in your case.
- Since
hypericum preparations are not standardized, their strength
can vary with each batch and each manufacturer.
Duration: St. John's wort, like
many prescription antidepressants, is a slow-acting drug that
takes time to build up in your system and become effective.
- Though
mild sedative effects may be recognizable sooner, the herb may
not be effective as an antidepressant for four to six weeks.
- n
Research suggests that St. John's wort should not be taken for
more than a year.
Cautions: Certain health conditions
become more dangerous in the presence of the herb. In addition,
St. John's wort can react negatively with certain other medications,
including prescription antidepressants, and may significantly
decrease the effectiveness of birth-control pills, a protease
inhibitor used to treat HIV, and other medications. Be sure to
discuss any possible interactions with your doctor before trying
St. John's wort.
- Do
not take St John's wort along with other antidepressants, such
as like Zoloft, Paxil, or Prozac. If you have recently been
on other medications, consult a doctor to avoid a dangerous
or unpleasant reaction. Other reactions can occur with decongestants,
diet pills, narcotics, and amino acid supplements.
- The
medical journal the Lancet cited a groundbreaking study
in which St. John's wort caused the early metabolization of
prescription medications, including a protease inhibitor used
to treat HIV, and the birth control pill. The early metabolization
of the birth control pill resulted in an effectiveness drop-off
of 50 percent, according to the study. The FDA issued an advisory
in February 2000 warning doctors and patients to use caution
with St. John's wort, noting that its use may influence the
effectiveness of other important prescription drugs as well,
including those used to treat heart disease, cancer, depression,
asthma, emphysema, and seizures.
- Some
literature advises people taking St. John's wort to avoid beer
and wine, coffee, chocolate, preserved meats, bouillon, yeast,
fava beans, soy products, yogurt, sour cream, avocados, eggplant,
tomatoes, raisins, and bananas because these foods include the
enzyme tyramine that in the past was believed to react with
St. John's wort. That belief is changing, but doctors advise
avoiding large quantities of these foods to be on the safe side.
- Reported
side effects can include increased photosensitivity, dry mouth,
dizziness, and minor stomach problems.
Though the right patient on the right dosage of St. John's wort
may feel less depressed, it isn't effective in every case. When
larger and more comprehensive medical studies are completed like
the one being conducted by NIH, perhaps we'll know why it works
for some people and not others, and how it really rates compared
to prescription antidepressants. St. John's wort is not recommended
for the treatment of serious depression, and the real risk of
taking St. John's wort lies in the practice of self-medication.
Depression has many causes -- including some physiological ones
like anemia, diabetes and migraine -- that need to be diagnosed
by a doctor before it can be treated effectively. Depression can
also be caused by certain medications. Other problems, such as
alcohol or drug abuse, exacerbate depression and should be treated
in conjunction with it. St. John's wort is a promising herbal
remedy that will be a reasonable treatment for some people suffering
from depression, but it should not be used as a replacement for
professional help; always consult a medical or health professional
before self-medicating.
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