St. John's Wort Relieves Symptoms Of Major Depression

[Richard D]

ScienceDaily (Oct. 13, 2008) — New research provides support for the use of St. John's wort extracts in treating major depression. A Cochrane Systematic Review backs up previous research that showed the plant extract is effective in treating mild to moderate depressive disorders.

"Overall, we found that the St. John's wort extracts tested in the trials were superior to placebos and as effective as standard antidepressants, with fewer side effects," says lead researcher, Klaus Linde of the Centre for Complementary Medicine in Munich, Germany.

Extracts of the plant Hypericum perforatum, commonly known as St. John's wort, have long been used in folk medicine to treat depression and sleep disorders. The plant produces a number of different substances that may have anti-depressive properties, but the whole extract is considered to be more effective.

Cochrane Researchers reviewed 29 trials which together included 5,489 patients with symptoms of major depression. All trials employed the commonly used Hamilton Rating Scale for Depression to assess the severity of depression. In trials comparing St. John's wort to other remedies, not only were the plant extracts considered to be equally effective, but fewer patients dropped out of trials due to adverse effects. The overall picture is complicated, however, by the fact that the results were more favourable in trials conducted in German speaking countries, where St. John's extracts have a long tradition and are often prescribed by doctors.

http://www.sciencedaily.com/releases/2008/10/081007192435.htm

[TheDebbieDee]

1. I read articles on the internet about this same subject in 2000.

This must be a more extensive study that found the same results.

[Richard D]

3. The 2000 (ish) study

was for moderate depression. This one shows efficacy for major depression.

[GreenPartyVoter]

2. I used it for a time but I think it just destabilized me and made me manic.

[Jackpine Radical]

6. That would suggest a bipolar disorder; the same kind of destabilization

can also happen with the SSRIs or tricyclics.

[GreenPartyVoter]

9. At the time I was undiagnosed. The thing that finally made it clear was

Cymbalta.

Dear God, it is amazing I didn't kill myself when I was on that stuff!

[Dogmudgeon]

7. Mental illnesses are complex; people are complexer

(Is "complexer" even a word? :) )

SAMe, another OTC anti-depressant, for instance, often exacerbates the manic phase of bipolar illness. But fish oil has been found to be effective in depression and bipolar disorders with no mania being reported. And "old-fashioned" niacin is being re-evaluated for a number of disorders.

Magnesium has been used to complement lithium. Obviously, a person taking lithium has to work with a physician and keep tabs on their blood levels.

And one size does NOT fit all. What that it were true!

Ideally, a person with depression should work with a physician who is not opposed to complementary medicine, but who also takes a scientific clinical approach to it. "STJW", as I called it, worked very well for me for nearly a decade; but I also suffer from chronic and intractable pain, and now require Wellbutrin. That's life.

I don't oppose the medicines of "big pharma" so much as their behavior. Full Disclosure: I used to work for Merck and Co. And, yes, the execs are indeed the devil's spawn.

--p!

[GreenPartyVoter]

10. Yeah, I would love to find complementary things to take. I tried the

fish oil but it didn't make a dent. And I was taking about an entire fish's worth a day! LOL

I'm bp 2 so the depression is the main thing I have to deal with. I am baseline apathetic with dips into complete and utter despair. I do get manic and more frequently hypomanic, but not anything like bp 1 people have to go through.

I, am on Wellbutrin but I haven't noticed any help from it for physical pain. Ironically Cymbalta felt great (although that might have been the mania. I hurt less then.) When I went off of it though, I hurt so much in my feet, legs, hands, and arms that I cried myself to sleep every night for several days.

[BrklynLiberal]

4. No doubt Big Pharma will do thier best to undermine this. They make ALOT of $$ with their

antidepressant drugs.

To me, it is good news.
Aside from the lack of side effects it is incredibly cheaper than any prescription drug.

[Jackpine Radical]

5. ...albeit not covered by insurance.

I would far rather see people using hypericum than prescription antidepressants of any kind. But before going to any drugs or herbals, it might be worth exploring cranial electrostimulation. A month of daily sessions of very weak, pulsed electric current delivered by little clips on the earlobes may free you from antidepressants (and anxiolytics) forever. There is one very large meta-analysis showing a muh larger treatment effect for CES than for any of the antidepressants.

[BrklynLiberal]

11. I had read about this recently. They are looking for people for studies using it.

cranial electrostimulation

[Jackpine Radical]

16. I'm using it with patients, with pretty good results.

There is actually a very extensive literature on its use for anxiety, depression, and sleep disorders.

Blow $10 and get this book from Amazon:
http://www.amazon.com/Cranial-Electrotherapy-Stimulation-First-Monograph/dp/160247589X/ref=sr_1_2?ie=UTF8&s=books&qid=1223942794&sr=8-2

[Fire_Medic_Dave]

19. You are treating patients with Major Depressive Disorder with St. John Wort by itself?

[Jackpine Radical]

20. No, I was talking about CES.

And not by itself. Combined with appropriate psychotherapy. I use the CES as an alternative to medication. It seems faster, the effect is somewhat stronger, and it has an automatic anxiolytic effect.

[Fire_Medic_Dave]

21. Thanks for the explanation.

Sorry for the miss.

David

[trotsky]

13. But apparently "thier best" isn't good enough to stifle this little study, huh?

It should also be noted that the test is on St. John's Wort *extracts* - i.e., separated, isolated, and purified. Much like many medicines that "big pharma" has developed and sold. Dosage and potency are controlled and guaranteed.

[elfin]

8. I used it for a couple of months -

Don't know if it was it or the passage of time that made things even out for me during a period of extreme grief and stress.

One thing I do know - it increased photosensitivity on my skin extremely and I had to stay out of the sun altogether and it took a long time for that side effect to abate.

I will not use it again.

[glinda]

12. B12 Complex is safer

and good quality scented candles.

[felinetta]

14. A real culprit - wheat and gluten

It causes all kinds of problems, depression, bloating, no energy etc. If you remove it from your diet completely, it could very possibly remove these problems. It is difficult but not impossible to do. But beware, wheat is in many products including SOY SAUSE. Reading food labels is essential!

[Quantess]

27. Yes, for some people. Food allergens in general.

Whenever I have an allergic reaction to something I ate, I feel horribly depressed, confused, and mentally tired. I'm not allergic to wheat or gluten, but many people are, and don't know.

Donuts also make me feel tragically sad, although I doubt it's possible to be allergic to donuts. In any case, I have sworn off donuts for good. No pancakes & syrup anymore, either. No elephant ears, no pastries, no sugary cake.

Eating a lot of fruits, vegetables, whole grains, and protein is non-negotiable for me. Exercise improves mood, a lot.

[badgerpup]

15. Um, people?

:hi:
You might want to talk with your doctor before starting St. John's Wort if you're already on an anti-depressant.

More is NOT better. Found this out the hard way...they do not interact well.
Was very close to taking the razor-blade express when I just happened to mention to my doc
"I'm taking both this and St. John's Wort and I still feel lower than sharkshit..."

:think: BINGO.

[Hermes Daughter]

17. You are right but...

Mass General Hospital did a massive study that concluded StJW was MORE effective than Prozac in managing depression. Good-bye SSRI's. But here's the catch. It also has side effects. Just because it's herbal, doesn't mean it's harmless. If you have a heart condition, it can make it worse -- and you can't take it. And yes, it can make you manic... So, it's as good if not better than big Pharma's spawn but... it's also as bad. Talk to your doctor about it and, since the negative side-effects are LESS documented, start with a low dose and watch yourself! If you're lucky enough to tolerate it, it will work for you. It can be very good. But be careful...

[Fire_Medic_Dave]

18. Wow what a dishonest headline, that's simply inexcusable, someone should lose a job.

A Cochrane Systematic Review backs up previous research that showed the plant extract is effective in treating mild to moderate depressive disorders.

What happened to Major Depression as claimed in the headline?

David

[Jackpine Radical]

24. Major Depressive Disorder can be classified as

mild, moderate or severe.

Here is the DSM on severity specifiers for mood disorders:

> Mild: A few symptoms, if any, are present beyond what is needed to make a diagnosis, and a person can function normally although with extra effort.

> Moderate: The severity of symptoms is between mild and severe. For a manic episode, a person's activity is increased or judgment is impaired.

> Severe Without Psychotic Features: Most symptoms are present and a person clearly has little or no ability to function. For a manic or mixed episode, a person needs to be supervised to protect him/her from harm to self or others.

> Severe With Psychotic Features: A person experiences hallucinations or delusions. Psychoses may develop in about 15% of those with major depressive disorder. The presence of delusions and hallucinations often interfere with a person's ability to make sound judgments about consequences of their actions and this may put them at risk for harming themselves. Psychotic symptoms are serious and a person in this condition needs immediate medical attention and possibly hospitalization.

Note that the severe level is extremely debilitating, and not terribly common.

[Fire_Medic_Dave]

25. So you would say a patient had Mild Major Depressive Disorder?

[Jackpine Radical]

26. Yes. That Dx is a common one.

For example, a is coded on an insurance form on Axis I as 296.3x, where x is the severity specifier: 1 for mild, 2 for moderate, 3 for severe without psychotic features, 4 for severe with psychotic features, etc.

296.31 would be Major Depressive Disorder, Recurrent, Mild.

[Fire_Medic_Dave]

28. So the severity is just referring to the symptoms at the time of the exam?

It would seem that a patient meeting 5 of the following criteria for at least 2 weeks

1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective report or observation made by others)
3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), a decrease or increase in appetite nearly every day. Note: In children, consider failure to make weight gains.
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feeling of restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

would be hard to classify as having a mild mood disorder.

These criteria are too specific to say that they are mild in nature, for example, I have a depressed mood, psychomotor agitation, feelings of worthlessness, inability to concentrate, insomnia most of the day, nearly every day, take no pleasure in anything I used to enjoy and have recurrent thoughts of suicide, but it's not that bad, I think of killing myself in pleasant ways.

Am I missing something here?

David

[Jackpine Radical]

29. I guess "mild" in this case means "mild as major depressions go,"

not "mild as in not very significant." Mostly, "mildly" depressed people manage to go on with their lives and struggle through, but without much joy and with an impaired ability to concentrate, etc., while people with severe depressions are almost totally immobilized, and are likely to be hospitalized--or at least they used to be, when we still has a halfway functional health care system in this country.

Anyway, back to the original thread on St. Johns wort--the litereature I have seen, much of it European, seems to indicate that St. Johns wort is about as effective as antidepressants. Actually, that's not saying a whole lot. For many people, antidepressants are not hugely effective. For a somewhat dated review of the antidepressant literature, see Peter Breggin's books {i]Talking Back to Prozac and the Antidepressant Fact Book.

There s also a recent meta-analysis of antidepressant studies submitted to the FDA that shows the treatment effect of these medications to be relatively small. The authors had to use the FOIA to force some of the negative studies out of the FDA files. I can't recall the authors' names, but the study was published in a good, peer-reviewed journal within the past year or 2.

[Fire_Medic_Dave]

30. People react differently to different medications and combinations of meds.

This seems to be especially true of psychiatric medications. So the person you say is "mildly" depressed are they diagnosed with major depressive disorder? or something like mild clinical depression? I'm not trying to be difficult I realize at lot of this is caused by medicare codes not really fitting exactly what's going in with a particular patient, I'm just curious. Thanks.

David

[2Design]

22. the time release version from natures sunshine was good n/t

[2Design]

23. 5-HTP from natures sunshine and complex B vitamins work better for the long haul n/t