St Johns wort and conventional medication – Let’s compare
Are you suffering with depression? Are you thinking of trying St Johns wort? You are not alone. The world health organisation predicts that depression will be among the leading illnesses in the 21st century. It is actually the second major contributor to disability around the world today. There are many diet, lifestyle, environmental, infectious and biological factors to consider.
One can argue that depression is a symptom of imbalance as the body tries to adapt, rather than a disease purely caused by a chemical imbalance. A holistic health assessment will consider you as a whole person. We address the environment you are in, and recommend diet, lifestyle, nutritional and or herbal medicines individually tailored to you. Today we will look specifically at St Johns wort.
Some antidepressant medications include selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), monoamine oxidase inhibitors and tricyclics. It’s important that you realise St Johns wort (SJW) is not a herbal medicine that can be used in combination with antidepressants.
There is a risk of serotonin syndrome (too much serotonin) and interactions with many drugs. Here we are looking specifically at St Johns wort for people who are not currently taking any medication or those seeking an alternative due to side effects. We aim to empower you with information so that you and your psychiatrist or doctor can consider all options. St Johns wort can be used as an alternative to antidepressant medications and here is a brief summary of the evidence to back it up.
Research summary – St Johns wort
In a study by Seifritz et al. 2016 the authors compared paroxetine (paxil) an SSRI to a standardised extract of St Johns wort. The study looked at treatment options for major depression over 6 weeks. The results of this study revealed a better effect and demonstrated increased remission response in the group receiving St Johns wort than paroxetine. The increased remission response is a key advantage.
Not only did SJW out-perform paroxetine in this study, but it has demonstrated to be safer than regular antidepressants with less risk of adverse reactions. Studies have shown efficacy for SJW reproducing results in mild to moderate depression as well as severe depression. The standardised extract used in this study (WS5570) is an evidence based safe and well tolerated treatment for depression.
Side effects may include gastrointestinal disturbance and photosensitivity although minimal and transient. Due to the undesirable side effects associated with antidepressants particularly weight gain and disturbed sexual function, SJW can be considered a superior option.
In a study by Sarris et al, the authors found that both SJW and sertraline (zoloft) demonstrated a positive effect after 26 weeks of treatment. This indicates that SJW stands up in long term treatment as well as in the short term for major depression. It is mportant to note (and interesting) is that the placebo effect was also significant at week 26 compared to the herb and the drug. This made clear a conclusion for the trial a challenge.
Singer et al, found SJW to be superior to citalopram (cipramil) and placebo in terms of remission and demonstrated a longer lasting response.
Fava et al, compared SJW, fluoxetine (prozac) and placebo and found SJW to be superior. This study noted a small sample size as a limitation.
A few notes on St Johns Wort
The main active ingredients in SJW are hypericin and hyperforin which regulate neurotransmitters. It is thought that the mechanism of action is not unlike standard antidepressant medications. The herb affects the reuptake of neurotransmitters. Therefore SJW increases the amount of serotonin, dopamine, gamma amino butyrate (GABA) and noradrenaline in the synapses.
Hyperforin exerts more of the antidepressant effect than hypericin which is one reason why not all products are the same! Low hyperforin extracts exist to try to limit the clearance of other medications but may have an inferior effect on mood. The amount of the actives can also vary between products and be affected by the manufacturing processes. This can also affect the results of various studies depending on whether a standardised extract was used and the hyperforin concentration.
Please keep in mind that St Johns wort interacts with medications
SJW interacts with many medications by inducing liver enzymes that promote clearance of various drugs. This is only one reason why it’s essential to refrain from self-prescribing herbal medicines. Also buying herbal medicines online should be out of the question. Please always consult a qualified naturopath or herbalist before taking herbal medicines. The quality and ingredients vary enormously between products and a practitioner is needed to assess your personal health case.
A naturopath will weigh risks and benefits with with your individual symptoms in mind. Similarly you must ensure if you are on an antidepressant medication that you manage any changes to dosage with your doctor or psychiatrist. These recommendations are general guidelines that are for your safety.
There are numerous other studies (clinical trials) to review on SJW for depression which we will go into further in part 2 of our comparison (coming soon…). In the mean while get in touch if you would like to know more about working together on your mental well-being.
Information found here is general in nature. This is not a substitute for personal health advice. If you are in a crisis emergency dial 000. If you are suffering with anxiety or depression seek advice from your doctor for a referral to a mental health professional. Naturopaths work alongside your doctor and mental health care team not instead of. St Johns wort should be prescribed by a naturopath or herbalist only after consultation and assessment of your personal health case. Do not take SJW if you have bipolar. Do not change your medications without first consulting the prescribing practitioner.
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If you enjoyed reading this blog have a read of our earlier article: Understanding the role of stress hormones in depression and epigenetics
Erich Seifritz, Martin Hatzinger & Edith Holsboer-Trachsler, 2016, Efficacy of Hypericum extract WSVR 5570 compared with paroxetine in patients with a moderate major depressive episode – a subgroup analysis, International Journal Of Psychiatry In Clinical Practice, Vol. 20, No. 3, pp.126–132
Fava, M, Alpert, J, Nierenberg, A, Mischoulon, D, Otto, M, Zajecka, J, Murck, H & Rosenbaum, J, 2005, A Double-blind, Randomized Trial of St John’s Wort, Fluoxetine, and Placebo in Major Depressive Disorder, Journal of Clinical Psychopharmacology, Vol. 25, No. 5
Sarris, J, Fava, M, Schweitzer, I &Mischoulon, D, 2012, St John’s Wort ( Hypericum perforatum ) versus Sertraline and Placebo in Major Depressive Disorder: Continuation Data from a 26-Week RCT, Pharmacopsychiatry, 45, pp.275–278
Singer, A, Schmidt, M, Hauke, W & Stade, K, 2011, Duration of response after treatment of mild to moderate depression with Hypericum extract STW 3-VI, citalopram and placebo: A reanalysis of data from a controlled clinical trial, Elsevier
Yi Rena, Chenjun Zhub, Jianjun Wuc, Ruwen Zhengd & Huijaun Caoe, 2015, Comparison between herbal medicine and fluoxetine for depression:A systematic review of randomized controlled trials, Elsevier, vol.23, pp.674–684