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St John's Wort outperforms Paxil for moderate-severe depression

Posted by johnyb QLD Aust (My Page) on
Thu, Mar 10, 05 at 0:43

For those interested, a well conducted clinical trial has just been released showing St John's Wort to be effacious for the treatment of moderate to severe depression. Excellent tolerability and minor side effects from the herb will also no doubt be welcome by depression sufferers. It is also interesting to note more acute responses in dperession alleviation in patients when effacious dosages are used.

Previous trials have been conducted to lesser standards which resulted in mixed results. Exiting news!

The full extract is available at the base of the linked webpage for readers wishing to peruse the methodolgy and design protocols, results etc in full.

John

Here is a link that might be useful: BMJ - St John's Wort v Paxil


Follow-Up Postings:

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RE: St John's Wort outperforms Paxil for moderate-severe depressi

There have been many, many studies of SJW, and most agree that it is contraindicated for severe or chronic depression. It also interferes with most other herbs and conventional drugs. It's not short on other side-effects, either.

So my advice is to consult a doctor or professional herbalist before using SJW. It is not a herb to be taken lightly.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

"Conclusion: In the treatment of moderate to severe major depression, hypericum extract WS 5570 is at least as effective as paroxetine and is better tolerated."

"at least as effective as" is NOT the same as "outperforms".

It's good news ... and also shows that hitting serious depression hard with medication is a good idea.

I wonder at their claim they saw no photosensitivity reactions in the SJW group: when were the studies run, and what was the exposure to sunlight. A German fall and winter gives almost no opportunity for exposure to enough sun to create the effect.

SJW does interfere with other herbs and drugs because of the metabolic path it uses ... something to consider.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

This latest study (and one new one in another journal reporting equal effectiveness of SJW to a standard antidepressant in treating moderate depression) are interesting counters to the prevailing scientific view that SJW has not been proven effective in moderate to major depression.

Awhile back when the news was mostly gloomy about SJW, I posted here suggesting that we needed to wait for more conclusive trials before concluding that SJW was ineffective. The new studies are sure to provoke more attention in the psychiatric community and we can hopefully resolve this question once and for all (the authors of the paper John linked to are among those calling for more research).

I predict that when more final conclusions are made, SJW will be shown to be as effective as most standard antidepressants* for certain forms of depression (that is to say, helpful in many but certainly not all patients), and better tolerated than many of the other drugs (although posing some side effects and drug interaction problems). Not a wonder drug, but useful.

And hopefully, in the future we can be assured of getting over-the-counter SJW in an effective and standardized form (current preparations vary widely and there has been discussion that the most active agents are not present in some brands of SJW).

*in at least one major study, SJW wasn't found to be very effective in treating depression - but the same conclusion was made about Zoloft, to which it was being compared (!). Makes you wonder just how many of those millions of pills are really alleviating depression in real-world settings.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

Daisy,

St John's Wort is contraindicated in cases of severe depression with psychotic symptoms or suicidal risk, it is indicated for mild to moderate depression. The British Herbal Pharmacooeia of 1983 (albeit outdated now) in fact cites SJW as being containdicated for all depression, a statement hotly refuted by many herbalists both then and now.

SJW is not indicated for severe depresion by modern herbal texts in light of the need for continuing research such as that conducted by the clinical trial we have reviewed here on the forum. Anecdotally I can attest to SJW being used by chronic depression sufferers who have refused conventional drugs such as SSRI's on grounds of either philosophical basis, or severe adverse reactions and side effects,or a refusal to accept alternatives such as shock therapy. Some of these people do not respond to SJW, some have limited improvement, and others enjoy a good outcome with. A minority of patients refuse drug and shock treatment, and are sometimes referred to herbalists as a last resort by doctors. I realize the ethical dilemma of this situation, and the polarising viewpoints on this subject, and also that my personal anecdotal accounts would be given limited credence by many people. I just try to help people who have no other options.

SJW does not "interact with most other herbs and conventional drugs". It may interact with immune supressants such as cyclosporin, cardiac glycosides such as digoxin, HIV nonnucleoside reverse trancriptase inhibitors such as indinavar, chemotherapeutic drugs such as camptosar, and anticoagulants such as warfarin. Caution must be alsobe taken with patients taking SSRI medication such as paxil, and several recent reports have cited breakthrough bleeding in women taking SJW and the OCP. Some concerns have alsobeen raised about SJW being taken with theophylline (a bronchorelaxant), and phenytoin (an anticonvulsant). Providing thorough case taking history and current med use use are taken, these interactions can be avoided. To say that SJW interacts with MOST drugs and herbs is simply not true.

Lazygardens,

The title of the trial I beleive is conservative, which is understandable considering the need for continuing research in this feild. However, in the results of the trial we read " The Hamilton depression total score decreased by mean 14.4 (SD 8.8) points, corresponding to 56.6% (SD 34.3%) of the baseline value, in the hypericum group and by 11.4 (SD 8.6) points (44.8% (SD 33.5%) of baseline value) in the paroxetine group (intention to treat analysis; similar results were observed in the per protocol analysis). The intention to treat analysis (lower one sided 97.5% confidence limit 1.5 points for the difference hypericum minus paroxetine) and the per protocol analysis (lower confidence limit 0.7 points) showed non-inferiority of hypericum and statistical superiority over paroxetine."

Statistical superiority over paroxetine are the important words here. My interpretation is that hypericum has outperformed paxil in this trial, but I understand the authors conservatism in title wording, as this is a study now requiring replication by other researchers. I welcome that research and also call for many other herbs to be researched.

"I wonder at their claim they saw no photosensitivity reactions in the SJW group: when were the studies run, and what was the exposure to sunlight. A German fall and winter gives almost no opportunity for exposure to enough sun to create the effect."

Any patient taking higher doses of SJW is advised by herbalists to avoid excesive sunlight and exposure to UV radiation. I am sure the researchers would have also advised this to volunteers, thus no adverse reports were reported. Herbalist do the same with similair results, health food shop employees do not. It's simply a matter of being well educated in your medical field, I beleive.

SJW interacts with drugs via cytochrome p-450 induction in the liver, this is well understood by well trained herbalists, and forms a considerable study component for any course worth its salt.

John


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

"And hopefully, in the future we can be assured of getting over-the-counter SJW in an effective and standardized form (current preparations vary widely and there has been discussion that the most active agents are not present in some brands of SJW)."

Do you really think it would be a good idea to have effective SJW available over the counter Eric? I'm worried that it would be sold by non-medically educated staff, and inevitable abused by some ill informed consumers (the more is better attitude etc), could be a recipe for disaster that would discredit the herb. Simply an extension of the current supplement industry tactics, but with more effaciuos dosages may not be the answer.

I wonder what perspective Orrin Hatch may have on this concept?

"Makes you wonder just how many of those millions of pills are really alleviating depression in real-world settings." I have pondered this myself! I think that's a big statement for a physician to make, and shows a level of enlightenment and open mindedness, good stuff Eric.

I'm still exited by the SJW trial result, and hopefully later this month we should have more good news about another herb currently in the last stages of having trial results published, more on that to come...

John


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

I have no problem with over the counter sales of SJW, with a couple of cautionary statements.

The evidence to date suggests SJW has fewer side effects than some other antidepressants. Whether that will continue to hold true when more clinical experience comes to light remains to be seen. There's also the question of how much SJW on the market is of low potency, and thus less apt to cause side effects. We have had posters on this forum complaining that SJW didn't do much for their depression, and one wonders exactly what they were taking.
It would be a shame if people who could be helped by SJW were turned off it by sales of poorly regulated, ineffective supplement brands.
Lastly, many people with symptoms of depression could benefit from a general health checkup to ensure that another medical problem (like a hypofunctioning thyroid) is not responsible. And anyone with an acute major depressive episode really needs professional evaluation and help, regardless of what meds they wind up taking.

I should add that when I express skepticism about sweeping claims made for any antidepressant drug, whether it's SJW or a prescription med, I am not disparaging that type of drug in general. We've made big strides in the area of antidepressants and a lot of people are healthy and functioning as a result.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

My primary concern with over the counter sales of pharmacy strength SJW relates to concerns I have with self medication generally, that it can be dangerous.

Coltsfoot is one such example here in Australia. This is a very good respiratory herb when used correctly, as you well know in the US, and once here also.

Over the counter sales of this herb resulted in the overdose of 2 children, resulting in their deaths, and the subsequent removal of the herb from practice. In the correct dosages, Coltsfoot is safe, at extremely high dosages it can be deadly, as with anything. A useful herb has been removed from practice because of self medication, there are a few other examples.

As St John's Wort has possible serious adverse interactions with drugs, I would prefer to see it dispensed by trained professional well studied in herbalism. Whether that person is a doctor or a herbalist does not bother me, I emphasize well educated in herbalism.

As a footnote to the SJW discussion, I have just this hour in the mail recieved a copy of some US herbal texts including 'The ABC Clinical Guide to Herbs', written by Mark Blumenthal and dedicated to the to the memory of Varro E. Tyler. On page 321 of this late 2003 published text we find under the clinical overview of St John's Wort a review of clinical data with the inclusion of numbers of adverse effects from an estimated 8 million patients between 1991 and 1999.

Allergic skin reactions 27

Increased bleeding times 16

breakthrough bleeding with OCP 8

Plasma cyclosprin reductions 7

He lists phoytosensitization as not warranting a general adverse reaction warning as it is "so rare".

Low numbers of adverse reactions from 8 milion people, and testament to the excellent safety profile of the herb, but still warranting expert dispensing, in my opinion.

John


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

And dont forget side effects like hair lose for some men.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

Most drugs started out as copies of natural remedies. When it comes to scientists trying to synthetically reproduce nature, its not purely possible.

Why is it not purely possible to copy nature?
Imagine if you would a drug company trying to copy the natural extract from say, ephedrin. Imagine the ephedrin extract molecule looks like your left hand. When drug companies try to copy nature they get a left hand and a right hand at the same time(mirrored image). they have whats known as a chirality problems. They can not separate the 2 as they will have the same boiling points, size, shape and reactions. So when you get a synthetically made drug that is a copy of nature, half of what you are eating is something else. Of course, there are a few exceptions.

If it is possible, I take my chances with nature instead of manufactured drugs, politically guided.

I am in pain most of my day. I would rather use ice or heat or some other form of relief than the drugs I have been prescribed. Possibly a glass of wine :)) I was prescribed Vioxx and now glad I was a stubborn fool and didnt take them. Our bodies are more accustom to natural remedies. We just need to use them in moderation and with many other physical and dietary solutions.
I would definately learn all you can about the herb befor taking it. Too much of anything is harmful.

Marie


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

The generalization about chirality is not relevant to today's drugs. If this was crucial, aspirin would be less effective than willow bark and digoxin wouldn't work as well as a crude extract from the digitalis plant. But both aspirin and digoxin represent an improvement over nature in treating (respectively) pain and inflammation and heart failure, because the active principles are present in a consistent, standardized amount, designed to facilitate absorption by the body, eliminating non-useful and potentially harmful components and minimizing side effects.

While a number of useful drugs still on the market are (or were originally) derived from plants and many more are being tested, it is not correct that "most drugs started out as copies of natural remedies", or that our bodies are specially attuned to plant chemicals (rather than being designed for us, these complex compounds evolved to benefit plants, including toxins protecting them from consumption by plant-eaters).

Most of us welcome the introduction of the safest and most effective drugs possible ("natural" or "synthetic"), without regard to any political agendas.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

The last figure I heard the drugs derived from plants was 25%, and that was a couple of years ago, probably less now.

Let's not forget that drugs copied from nature, whilst being more potent, also have side effects not evident in natural form. There are many , many examples of this.

There is a scientific hypothesis that plant material shares an evolutionary cellular affinity with the human being. I too choose to select a natural product over a synthetic drug where possible.

John


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

"Let's not forget that drugs copied from nature, whilst being more potent, also have side effects not evident in natural form."

You've hit on a major reason why this would be true in some cases. A more potent form of the drug will tend to be more effective in treatment; at the same time its potential for side effects tends to be magnified.

Weak forms of a drug available in crude plant preparations are less likely to have a therapeutic effect at the same time that side effects are less likely.

If potency, effectiveness and reliability are important (as they should be), the pharmaceutical versions of plant-derived drugs are far preferable to raw herbal preparations. I doubt, for instance, that John would recommend medicating patients with home-brewed versions of digitalis or atropine.

"There is a scientific hypothesis that plant material shares an evolutionary cellular affinity with the human being."

I'm not sure what you're getting at here, but if you're suggesting that plants evolved various compounds for the purpose of helping mankind, you're getting into mysticism rather than science. The plant kingdom contains some of the most toxic poisons known - ricin, for one. It's difficult to see how the existence of such toxins proves plants' "cellulary affinity with the human being". :)


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

Herbalist use only a select grouping of herbs from the many thousands available, avoiding the dangerous ones which no doubt killed many people during medical trials and errors of the past.

St John's Wort was thought by many to be a weak antidepressant, a topic of review now in light of the above trial. The side effect profile of this herb is most
preferable to SSRi's (or any other drug treatment for depression). Which treatment is appropriate is another matter. Most herbs have many actives which combine to give a therapeutic effect(s) and keep side effects low, these qualities, in my view, give them a wonderful affinity for human beings.

Toxic plants are the exception rather then the main, and muddying the waters by comparing a few dangerous herbs with drug therapy is a hollow comparison.

John


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

Why do some choose not to recognize that our universe has all the sources for us to survive...i.e., the air we breathe, our water sources and then the plants we eat. Does it not follow the plan that NATIVE plants (that is native to each specific area)are available to us for our use. The more we interfere (synthetic drugs, etc.) with mother nature the more we destroy our ultimate survival. Animals have been sustained since day one eating plants that bring a balance to their lives.....act as natures "birth control" and provide them with all the nutrients they need. It is the same with us....if we would quit tampering with the environment. It is with these thoughts in mind that I visit this "herbal" forum - to learn more about "herbs" and their remedies - not prescription drugs.

Thanks for your input, John


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

"Herbalist use only a select grouping of herbs from the many thousands available, avoiding the dangerous ones which no doubt killed many people during medical trials and errors of the past."

While I'm sure most herbalists have learned from their mistakes of the past, the fact remains that many toxic and potentially dangerous herbs still are being promoted, on this forum and on various websites, including chaparral, bloodroot, aristolochia, comfrey and many more.

A major problem with plant-derived remedies is the assumption that since they are found in Nature, the presumption is that they are good for us. This is a viewpoint that I'd hope any responsible herbalist would strongly discourage.

The list of toxic plants is a long one. Some (like colchicum, digitalis, Jimson weed etc.) can be the source of beneficial drugs. For that matter, snake venom and curare have beneficial medical uses. If we are exposed to many of them under "natural" conditions, it could be fatal for us.

I think John has an inkling of this, as he has mentioned earlier in this discussion his conviction that only "trained professionals" should prescribe St. John's Wort because of drug interactions and other potential problems (a position with which I disagree). There are certainly hazards associated with many over the counter drugs, herbs and supplements about which we need to be educated, to be wary of any sweeping claims about a medication being harmless, and to require that any drug posing significant risks be proven effective before it is sold.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

If herbalists used dangerous and toxic herbs, there would be a strong correlation between herbalists dispensing herbs, and patients reporting adverse effects, side effects or death. No such correlation exists.

John


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

"Why do some choose not to recognize that our universe has all the sources for us to survive...i.e., the air we breathe, our water sources and then the plants we eat. Does it not follow the plan that NATIVE plants (that is native to each specific area)are available to us for our use." If we used all the native plants readily available to us, most of us would be dead! Not all NATIVE plants are healthy, much are extremely toxic!!!!
Let's hope that one would have enough common sense to not "assume" that just because it grows here, it must be meant for us to comsume.

"Herbalist use only a select grouping of herbs from the many thousands available, avoiding the dangerous ones which no doubt killed many people during medical trials and errors of the past." Ok, if this were true, the same would be said about prescribed medicines! However, how many have had strokes and fatel experiences Vioxx, aftewr being FDA approved! What makes you think that herbalist, or otherwise are perfect and have 100% complete knowledge? That is why we call it "trial and error"!

"Toxic plants are the exception rather then the main, and muddying the waters by comparing a few dangerous herbs with drug therapy is a hollow comparison." A hollow comparison? There are just as many, if not more than toxic herbs in this world!!! People need to educate themselves!!! There are plenty of resources out there. Muddying the waters, as you put it, says to me, and a few others on here, that a statement such at this leads one to believe that you have no idea what you are discussing.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

I don't think anyone here has espoused consuming native plants simply because they are native to an area. You are right, people indeed would be sick and dying in droves if they decided to begin eating native plants ad hoc.

I fail to understand the analogy between empirical based herbal medicine evolvement and Vioxx adverse reactions. Some might argue that drug therapy is still evolving. If I had "100% knowledge" I wouldn't be here typing this message.

There are many toxic plants, my advice is NOT to consume them. You can lessen the chance of this happening by 1)seeing a herbalist for your phytotherapies, and 2) not consuming plants of unknown species and/or constituency (including native plants in your environment.

John


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

I guess everyone is missing the point here......this is a herbalism forum.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

So we don't forget, the title of this thread is "St John's Wort outperforms Paxil for moderate-severe depression".

I for one am glad John started this discussion to compare the performance of a prescription antidepressant and St. John's wort. It is helpful in deciding on therapy to know if an herbal drug performs better or worse than a non-plant-derived drug.

Just discussing herbs out of context omits potentially valuable information.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

Ive tried both willow bark tea and aspirin.Aspirin can upset my stomach,Ive never had that problem with willow bark.The big factor is it takes alot of willow bark tea to equal a few aspirin for me, otherwise the results are about the same.

Ive also tried St.John's wort and consider it to be another option in my own personal health care which more and more seems to be taken out of my hands.I can grow St Johns wort myself for my own person use and it only costs a few pennies compared to manufactured drugs which have lots of questionable side affects and cost a few bucks a pop.If the health affects of St. Johns wort are such a big deal,why aren't the drug companies attacking the cigarette companies which are a proven health risk to the person smoking and anyone exposed to the second hand smoke?


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

It's an interesting comparison between drug companies and big tobacco that you raise franc, and one that perhaps deserves the contemplation of more people besides journalists worldwide.

John


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

hm.... I hate to sound like I'm defending drug (medical care) companies, but...well.... I kinda have to:

Without them, I'd be dead by now.

I'm insulin dependent. Was diagnosed with "juvenile" diabetes (type 1--the autoimmune kind that destroys the cells that create insulin) 6 years ago at the ripe old age of 37. And I'm glad I was diagnosed *after* they'd figured out how to make "synthetic" insulin from e.coli bacteria. It doesn't have as much potential for bad side-effects that beef and pork insulin had.

And also, there are the companies that make my test strips. I test 5-10 times a day depending on my food and activities.

And my insulin pump. I'm severely needlephobic and this is the only way to get insulin into me without me going all suicidal.

And then 2.5 yrs ago, I was diagnosed with auto-immune hypothyroid (Hashimoto's). Once again, they come to my rescue and give me pills to replace my lost thyroid hormones.

My uncle has rheumatoid arthritis and took vioxx for quite a long time. Last summer, he had to have a coronary artery bypass operation because they discovered that he'd had a couple of heart attacks that he confused with heart burn. It pisses me off that they didn't warn him, but... last I heard, he was STILL taking one of those coxib(sp)-type drugs because it helps him live without as much pain.

My grandmother (on the other side of the family, so I'm quadruply at risk considering that I already have two autoimmune diseases) died of complications from 15 years of absolutely the severest kind of rheumatoid arthritis that her docs had ever seen. She was in so much incredible pain for so many years. Vioxx wasn't around then.

So, while I don't condone whatever bad things they do, I also am deeply grateful to them for saving my life AND for helping that life have better quality... even while I continue to look for natural alternatives.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

"It's an interesting comparison between drug companies and big tobacco...." and way off base.

Anyone who claims "...tobacco...products kill people. But prescription drugs are no different." obviously has a few screws loose - or, as in this case, is interested in using scare tactics to promote a line of supplements (and $250 "health files"), not to mention a set of ho-hum pectoral muscles.

The suggestion that "Big Pharma" is somehow in league with tobacco companies ignores all the smoking cessation products produced by the pharmaceutical industry in recent years.

One could even more easily make comparisons between the tobacco industry and all the snake oil peddled by "alternative" healers and the multibillion dollar supplement industry over the years, but it too is a distraction from the subject at hand.

Consumers looking for reassurance about St. John's wort's safety and efficacy appreciate facts, not rants about the Evils of "Big Pharma".


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

If consumers are looking for reassurance about St John's Wort efficacy, this internet forum is not the place to find it.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

Thanks Johny for your information on the subject I have no problem with St. John's wort but thats just from personal experience.Ive always felt the affects were mild so I could see how someone with severe depression may not even notice any affect at all.Also its hard to trust any study or test conducted using herbs as products can vary sooo much.And the way the herb is cultured,cured,and then prepared can vary.Some of the products sold as some certain herb may only have a fraction of that herb in the bottle,and the studies hardly ever go into detail.I think growing the herb yourself or buying from a grower is the best way at present.


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

* Posted by: Tressa SECA (My Page) on Mon, Apr 11, 05 at 10:36

I guess everyone is missing the point here......this is a herbalism forum.
==============================================================
Just because this is a herbalism forum doesn't mean we should leave our commensence at the door, skipping happily and meanderingly through some dreamscape forests picking various herbs. Nature isn't some wonderful charming grandmotherly type person baking you healthy cookies. Its a lot more complex then that.

not to mention that its a lot easier to measure out dosages that the pharmaceutical companies put out, then figure out the dosages in live plants. it varies from plant to plant and where they were grown.

And their are some valid concerns on st johns wort here. Something more experienced people with herbs are pointing out that some are ignoring. I know from a friend of mines experience that st johns wort made his severe depression worse. It can work for mild but in his severe depression (bipolar i think) it made his downtime real real bad almost suicidal. enough digitalis can give someone a heart attack, and that comes from foxglove. ANd as learned with ephedra if you drink it with cofee adn other stimulants and take it then you can get heart attacks with it as well. Ok those are a few examples i can think of.

I'm sure you would want to know the side effects of asprin like don't give it to children with a fever or you could give them rye(sp?) syndrome. Or that paxil is addictive. Why should herbs discussed on the herbalism forum be any different?


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

OK isn't herbalism the use of herbs for medicinal purposes? If so, then it is completely valid to compare herbs to other forms of medication, herbal and pharmaceutical. That's just good science. (Maybe some out there consider it to be Magick, which to me means doing something you don't understand.)

Some comments: I believe that willow bark contains salicylic acid (aspirin is a derivative of that).

Chemists CAN separate chiral molecules. Ever since Thalidomide, they have been required to do so for any pharmaceutical product. And yes, there is a lot of pressure to copy nature and only produce the desired product. There has been a lot of progress in that area in the last 20 or so years.

Plants are the source of some very important pharmaceutical drugs: digitalis (from foxglove), taxol (from yew trees), and plenty more. There is a lot of crossover here.

And some questions:

Is there a process by which a person can become a certified herbalist in the US? What criteria are used? Is anyone on this forum a certified herbalist?

I am growing St. John's Wort (because it is a pretty ground cover and shade tolerant). Is there a process by which a person can easily test its strength and determine a dosage?

Lynne


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

In reply to the last post, to Lynne in Linden: Before you use your plant, make sure of which variety you have. If it is growing as a ground cover, it may not be the medicianal type. Hypericum perforatum is medicinal, the shrubby St. Johns Worts aren't. I make my own tincuters, don't know how to test strength with out a laboratory, but if I gather the same time of year, and the results look, smell and "feel" the same, it probably is.
Enjoy! Lynn


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

Wishing to say something that may help all to understand proper usage of St. John's Wort within the realm of our modern world with its medicines, I point you all to a helpful website that discusses the Cytochrome p450 pathways. These are metabolic enzyme pathways, mostly in the liver, that our bodies utilize to "tag" molecules for elimination by the kidneys and also sometimes cause slower clearance of other molecules.

So we talk about inducers and inhibitors as well as metabolism. Some of these substances, whether drugs, herbs, or even foods, affect other substances that come into our bodies by making them stronger or weaker in effect. For example, if a drug like paclitaxel, which is metabolized in CYP3A4 pathway is taken with St. John's Wort, a CYP3A4 inducer, the metabolism is speeded up and the drug clears from the body faster, making it less effective in killing cancer cells. The "side effects" may seem weaker because the effect of the drug is weaker.

On the other hand, a form of Ginseng with a high concentration of ginsenoside Rh2, may act as a CYP3A4 inhibitor, making the metabolism of the paclitaxel slower, increasing thereby the effect of the drug. This also could cause a more noticeable "side effect." This is shown in cell culture studies that combined paclitaxel with Rh2. There may be other reasons why the IC50 increased (a measure of effectiveness in killing cancer cells in culture), but this is one of them.

While we do have good data available from our pharmacies about cytochrome p450 pathways, the practitioners do not always have time to look things up. Recently, at an all-night pharmacy, I asked about a prescription I was picking up for a family member. That family member was considering taking either SJW or an SSRI, so I wanted to know about the reaction with cytochrome p450 and the new drug. The answer I got was curteous, but what was actually done was for the pharmacist to hand me the notes from the drug company that come in the package that the pharmacist uses to fill our bottles. I hesitate to think that most people might not ask about it and others who do may not know what the drug company's paper says.

Of course, I want to be fair with the pharmacy. It was late at night. Maybe they take more time during the day.

The website referenced below even mentions grapefruit juice and its effect. So be careful out there in your morning juice selection if you take drugs.

I hope that my post helps with out marshalling the opposing sides too much. We all need to try to educate ourselves about the herbs and drugs that we take. I look forward to the day when the drug companies list the potential negative effects that their drugs may have on the herbs that I take. But I won't lose sleep waiting.

Richard

Here is a link that might be useful: Cytochrome p450 site


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

Hi john, thanks for posting this. I didn't read through all the responses, but it looks like it stirred some contravercy!

Anyway, thought you or others might be interested in looking into omega-3's link to depression and mental illness. Found in cold water fish, and flaxseeds and a few other sources. You can google it, tons of sites on this topic. Also a couple books on amazon with good reviews-
The Omega 3 diet, and The Omega 3 Connection.

Here is a link that might be useful: Omega-3 for Depression and Bipolar


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RE: St John's Wort outperforms Paxil for moderate-severe depressi

I was using SJW for mild depression and I thought I was doing OK with it. I have had skin cancer (at 40 - I grew up on the beach) so I always try to stay out of the sun. I didn't know what "sensitivity to light" meant until I realized that walking just 25 feet to the mail box in full noon time sun hurt! SJW was getting me through the days, though, and I didn't want to give it up. A year later I was diagnosed with major depression. (Do you have any idea what it is like to get a doctor so say, "Oh, my god. You've got the worst case I have ever seen.") The doctor would not prescribe antidepressants unless I quit taking SJW. That was three years ago. And multiple doctors and different kinds of antidepressants ago. I am better now, but it has been h@11. I would say that it does work for mild depression, but at some point, if the depression gets worse, you have to get off SJW. My two bits.


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