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The Detective Files: The Case of St. John and His Wort…

Treatments for depression and anxiety are a dime a dozen anymore. No doubt, we know how it feels to hurt so badly that trying most anything seems worth a go. But that can lead to some dicey decision making. And that’s why we always want to be your source for objective information for anything having to do with emotional and mental distress.

St. John’s Wort (SJW), technically extracts of the yellow flower hypericum perforatum, has been used for centuries to secure relief from a variety of physical, emotional, and mental situations. Hey, ever wonder where the name came from? Well, the plant blooms during the Roman Catholic Church’s Feast of St. John the Baptist in late June. And “wort” is synonymous with “plant” and “herb.”

As it applies to mild to moderate depression, what may be known as a dysthymia, many studies report the use of SJW exceeds placebo and performs equally as well as the tricyclic antidepressants (TCAs) in terms of short-term relief. Now, remember, the TCAs, which include imipramine (Tofranil), amitriptyline (Elavil), and nortriptyline (Pamelor), are first generation antidepressants.

From what we’ve read there are no reliable studies showing the selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), fluoxetine (Paxil), and escitalopram (Lexapro) have the same treatment efficacy with mild to moderate depression. And the same applies to the selective serotonin norepinephrine reuptake inhibitors (SSNRIs), such as duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq). Nonetheless, it’s at least been suggested that some degree of improvement, with fewer side effects, may be realized.

Now, when it comes to major depressive episodes, some highly touted studies indicated SJW had very little positive impact. However, the story goes it was later learned these studies had some design problems, and the results were trashed. So the jury is still out.

A few other items of note. What we’ve read shows no indication for the use of SJW by folks under the age of 18. And with regard to the anxiety disorders, we can’t find any data suggesting SJW can be relied upon for relief. Okay, it’s been suggested it may show some promise for obsessive-compulsive disorder (OCD), but I wouldn’t go to Vegas with it.

As with most any medicinal agent, the potential for side effects from using SJW is always there. Here are some possibilities, which very interestingly are identical to the traditional side effects of antidepressants. Actually, the presentation of side effects from the use of SJW is thought to be less of an issue than with antidepressants. Here we go…GI distress, fatigue/sedation, anxiety, sexual dysfunction, light sensitivity, weight loss, dizziness, headache, elevated thyroid stimulating hormone (TSH), dry mouth, and suicidal/homicidal ideation. And from what we read, SJW should not be taken during pregnancy or nursing.

Again, as with any medication, SJW can cause some major problems if taken with other meds, supplements, and herbs. It’s simply a matter of SJW altering how these substances are metabolized. So here’s a huge heads-up. If you have a physician, please talk things over with him/her if you’re considering the use of SJW. And this becomes all the more important if you’re taking medication, prescribed or over-the-counter. Here’s a list of potential trouble…

Antidepressants
SJW can increase the risk for adverse drug reactions and/or serotonin syndrome if used with any antidepressant. And it’s to be avoided altogether if one is taking the tricyclic antidepressants (TCAs), amitriptyline (Elavil) and nortriptyline (Pamelor).

Benzodiazepines
SJW holds the potential to negatively impact the elimination half-life of alprazolam (Xanax). And it would only make sense that its natural sedating potential could intensify the impact of the benzodiazepines, which also include lorazepam (Ativan) and clonazepam (Klonopin).

Other meds to be careful with are birth control pills, cyclosporine, digoxin, indinavir (and perhaps other HIV management meds), irinotecan (and perhpas other cancer management meds), and warfarin and related anticoagulants.

So there you have it readers and clients, an objective look at St. John’s Wort in the treatment of depression and anxiety. Certainly, it’s well worth your consideration, but make sure you do some thorough research and work with your physician before moving forward.

We’d like to know what’s on your mind. What’s been your experience with St. John’s Wort? How might St. John’s Wort fit into your depression and/or anxiety treatment strategy?