Well studied and mass produced. Many have tried this supplement and have had great results. Others have had mediocre to no results. As an MD, I have to see reproducible studies stating low risks and high benefits for its use. Several problems exist in that it is not controlled by the FDA so quality varies tremendously with over the counter brands. If there are no great US studies on its uses for mild to moderate depression I would feel comfortable with "other data outside the US". European studies show it has equal to or/better than results compared to anti-depressant drugs in the treatment of mild to moderate depression. Multiple studies found in the a Roswell Park Cancer Institute reveiwed information and the results were concluded that St Johns Wort was no help with major depression. (It's unusual that most US studies state it doesnt make a difference with major but they dont mention it is equal to antidepressants in treating mild to moderate depression.)
http://www.aafp.org/afp/20051201/2249.html
With the season in Chicago about to go dark and gloomy for 4-6 months, no doubt that a few of us with Seasonal Affective Disorder will feel the pressure of the "season" in a few months. (It was not until I moved to Florida for 18 months that I realized how productive and fun the winter could be. I believe we, in Illinois, make it a point to hold the picture of the first days of spring as a stimulus to get through the harsh winters). People with SAD or different types of depression already have symptoms that effect social interaction, job performance, sex and/or sleep. With the side effects of prescription drugs being well established, some would shy away from the use of the medicine for the holiday season. Certainly, if the diagnosis of mild to moderate depression is untreated or undertreated, the symptoms do have a possibility of worsening. One should always be diagnosed by a specialist first and then treatment plan started. Most important is for the patient to realize that treatment includes oral medications, psychotherapy, lifestyle modifications and dietary changes. The herb is not without it's drawbacks. There have been documented interactions with several medications:
Amitriptyline (Elavil)- Decreased blood levels
Carbamazepine (Tegretol)- No change
Cyclosporine (Sandimmune)- Decreased levels
Digoxin- Decreased levels
Midazolam (Versed)-Decreased levels
Oral contraceptives-Decreased levels
Sertraline (Zoloft)- Decreased levels
Simvastatin (Zocor)- Decreased levels
Theophylline- Decreased levels
Warfarin (Coumadin)- Decreased levels
If the above drugs are already in use, caution should be exercised when attempting to use St Johns Wort. Dose starts out at 300 mg usually taken three times a day. This would be in the Dry Herb form tablet or capsule. It also comes in extract, and tea leaf form. The doses are given three times a day like other herbal supplements because of the short half life. The effects would hopefully be felt in 2-3 weeks. If not either the brand is poorly absorbed or the dose is to low. One of the reasons to look into if the company states they sell pharmaceutical grade supplements. Side effects include photophobia, gastric irritation, dizzyness, confusion, fatigue. The mechanism of action is not well studied but surmised to be blocking the reabsorption of serotonin by the active ingredients of hyperforin and hypericin.
The symptoms of depression can fall into:
Ongoing sad mood
Loss of interest or pleasure in activities that the person once enjoyed
Significant change in appetite or weight
Oversleeping or difficulty sleeping
Agitation or unusual slowness
Loss of energy
Feelings of worthlessness or guilt
Difficulty "thinking," such as concentrating or making decisions
Recurrent thoughts of death or suicide
If there are no other medical problems occurring then a short attempt of the herb for three to four weeks may be started. I would always suggest being seen by a physician first and ruling out other disease. (Had a lady come into the ER the other day and chief complaint was fatigue, irritability, diffculty with sleep and headache worsening over 6 months. After doing several tests all come back normal except for a red blood cell level that was 1/5 that of a normal human. Hopefully iron deficiency but if her heart was stressed out in its normal duties over the few months prior, it will have hypertrophied and she's on her way to see the cardiologist...all because she thought it was going to get better).
The "Saguil Approach" is to first get the right diagnosis by listening to symptoms, rule out other causes with physical exam and testing appropriately. Then look into changing the home and work environment, both could be a large stressor and time away can help in the healing. Psychotherapy always suggested with close follow up and conversations between psychologist and primary care doctor. I try to enforce sleep hygiene or at least a structure to sleep. Diet will probably be poor but proper supplementation and elimination of certain foods would be important. (There is a doctor in clermont florida I met who had a great dietary approach to kids with ADHD. Consequently when I used the same diet with my mild to moderately depressed patients results were also just as good. Check ADHD diets in the FAQ section of my website) Some form of exercise would be important to maintain structure to the day anddevelop meditation skill, yoga or tai chi (watch for my tai chi blog in FAQs section with pod casting a local instructor). Medications that start with St Johns Wort, Omega 3 Fish Oil, then possibly the perscription meds if all else fails. Light therapy may also provide improvement in symptoms. If a patient is in severe depression or all the above aren't producing positive results, time to call the psychiatrist in for extra help. Now we should all have a good winter season but it's good to look out for others. (....a trip to the bahamas never hurt either).
