The Use of St. Johns Wort as an Antidepressant

The Clinic of Psychiatry and Psychotherapy in Giessen, Germany carried out the largest controlled trial of St. John's Wort for depression (Woelk, p.11). The screening process in eliminating unsuitable candidates was quite extensive. Possible candidates were eliminated if they had abnormal thyroid function, bipolar disorder (manic depression), previous psychiatric disease and alcohol or drug addiction. They were also eliminated if they had taken MOIs, antidepressant drugs, neuroleptic drugs, cimetidine, oral cort costeroids, anticonvulsants, theophylline or thyroid hormones within the previous 14 days. Finally, those included were men and women over the age of 18 with mild to moderate depression and without any suicidal tendencies (Woelk, p.5). 

The subjects were then divided into two groups: 157 were put on hypericum extract ZE 117 and 167 were put on imipramine. A placebo was also used (Woelk, p.7). The imipramine group received 75g twice daily and the hypericum extract group received 250mg twice daily for six weeks (Woelk, p.1). Although the therapeutic ability of both treatments was considered the same, the hypericum group faired better because they experienced fewer effects (Woelk, p.8). This is because the toxicology of tricyclic antidepressants in general includes dry mouth, decreased level of consciousness, seizures, water retention and hypertension (Maryland, p.1). 

The imipramine group experienced dry mouth, sweating, dizziness, nausea, and lack of strength, but only three participants in the hypericum group experienced any adverse effects. Bearing in mind that the tolerance of patients with symptoms of depression is higher than with the side effects of the antidepressants, hypericum would prove to be more beneficial (Woelk, p.10). As a result, the Clinic of Psychiatry and Psychotherapy recommend hypericum for mild and moderate depression in primary care (Woelk, p.11).

One reason St. John's Wort is only used in mild depression, however, is because one cannot combine hypericum with antidepressants and many other drugs. Combining St. John's Wort with prescription medication is, in fact, a major concern among doctors. Around 30-40 percent of Americans spend more than $3 billion annually on dietary and herbal supplements, many of which are taken alongside prescribed medications (Turton-Weeks et al, p.2). This survey of Drs. Crone and Wise in 1997 raised concerns reporting that 20% of their transplant patients who had taken herbal supplements could incur rejection of the donor organ if the herb compromised the drug (Turton-Weeks et al, p.2). 

In addition, further concerns have been raised about hypericum. The cornerstone of donor organ acceptance by the recipient is the antibiotic cyclosporine. In 1996, a woman received a kidney transplant that led to acute rejection. Transferred to the University of Arkansas' transplant center in 1999, she was stabilized with cyclosporine, mycophenolate mofetil and prednisone. Concerns were raised when the blood level concentration of cyclosporine didn't reach its target. Inquiries discovered that she had been taking up to three tablets of 300g of hypericum daily for six months along with her doses of cyclosporine. A suspected interaction between the herbal supplement and cyclosporine led to the request for her to stop taking hypericum. As a result, the concentration of cyclosporine rose in her blood without increased dosage over a two-week period (Turton-Weeks et al p.3). 

The patient did not develop any organ rejection whilst on hypericum, but in another kidney transplant patient who had taken hypericum, the cyclosporine was increased to 175mg twice daily, then reduced when the level was acceptable. Unfortunately, this woman developed acute organ rejection and died (Turton-Weeks et al, p.5, 6). Drs. Breidenbach and Burg reported 30 kidney transplant cases where hypericum was taken. The result was a 50% reduction in cyclosporine concentration, but no organ rejection occurred (Turton-Weeks, p.7).

In general, herbal remedies are safe. However, when combining herbal remedies with other medications, one should always consult a knowledgeable professional, keeping in mind that not all doctors know about herbs and not all herbalists are aware of the deadly interactions that herbs and drugs can have.

Sources:

• Cass, Hyla. “Using St. Johns' Wort With Other Antidepressants.” Health World Online.
• Green, James. “The Male Herbal,” US: The Crossing Press. 1991.
• Hoffman, David. “The Holistic Herbal.” Britain: Element Books. 1988.
• Maryland Poison Center. “TCAs.” Maryland School of Pharmacy. 08//20/01.

Hwaa Irfan is a staff writer for Health and Science section of Islamonline