St. John’s Wort
Depression in Adults and the use of St. John’s Wort
Description of the pathophysiology of depression in adults
An estimated 9.5% of the American population, or about 20.9 million American adults, suffer from depression. Major depression is a severe mental illness that inhibits a patient’s daily functioning. Patients are unable to work, study, sleep, eat, or feel pleasure. Dysthymia is a less debilitating but still pervasive form of depression that does not interfere with daily functioning. (“Depression,” 2000, National Institute of Health)
Current research indicates that people suffering from depression have imbalances in their brain chemistry, specifically regarding their neurotransmitters serotonin and norepinephrine. A deficiency in serotonin may cause sleep problems, irritability, and anxiety. A decreased amount of norepinephrine, which regulates alertness and arousal, may contribute to the fatigue and depressed mood. Cortisol, a hormone that the body produces in response to stress, anger, or fear, is also often implicated in depression. The level of cortisol in the bloodstream usually peaks in the morning, and then decreases as the day progresses. In depressed people, cortisol peaks earlier in the morning and does not level off or decrease in the afternoon or evening. (“Depression,” 2006, Healthy Place) This elevated cortisol level is likely a response to the increased level of environmental stress that the body perceives in the environment, because of the patient’s depressed mood.
Signs and symptoms of depression
Signs of depression vary from person and with the severity of the illness. Not every depressed person experiences all symptoms, although most depressed persons experience a persistent sad, anxious, or empty feeling. Feelings of hopelessness, pessimism, guilt, general worthlessness, helplessness, a loss of interest or pleasure in hobbies and activities that were once enjoyed, decreased energy, fatigue, and sexual desire, and difficulty concentrating, remembering, making decisions are all common. Some persons, especially younger adults, may feel more restless and irritable than sad. Some depressives experience insomnia. Other depressives are always tired and compensate by oversleeping. Weight loss or gain may arise because of disordered appetite. (“Depression,” 2000, National Institute of Health)
Prognosis for individual: Disability/death
Depression may also be characterized by thoughts of, or actual attempts to commit suicide. Restlessness and irritability can lead to increased risk-taking, like careless driving. Also, the patient may experience persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain. (“Depression,” 2000, National Institute of Health)
What specific cellular and organ system changes occur?
The bodies of depressed people, because of the increased levels of cortisol, often show the same signs of people under considerable physical or emotional stress. Unhealthy eating or sleeping habits worsen these symptoms. Also, physical changes in the body can exacerbate depression or cause depression, such as stroke, a heart attack, cancer, Parkinson’s disease, and hormonal disorders. (“Depression,” 2000, National Institute of Health)
Most common theories about the health problem combination of genetic, psychological, and environmental factors are involved in depression. There seems to be a strong genetic component involved in depression, as depression often runs in families. “For example, if one identical twin suffers from depression…the other twin has a 70% chance of also having the illness.” (“Depression,” 2006, Healthy Place) There is also a hormonal component, as women are more likely to become depressed then men. Outside physical or psychological stresses may trigger depression (like pregnancy, growing older, having a heart attack, or puberty). (“Depression,” 2000, National Institute of Health)
Because a deficit of the neurotransmitter serotonin has been identified in patients with depression, the development of selective serotonin reuptake inhibitors (SSRIs) like Prozac is thought to be effective in depression. (“Depression,” 2000, National Institute of Health)
Complications of depression
Depression is a mood disorder, and can affect daily life, making it difficult to engage in effective self-care. Suicide is a risk of untreated depression.
Using St. John’s Wort for depression: Mechanism of action
According to the National institute of Health, there has been a widespread interest in St. John’s Wort as an alternative treatment for depression. St. John’s Wort has been used for many years as a folk remedy for depression, and it is speculated that it may increase serotonin levels. (“St. John’s Wort,” 2006, NCAM: National Council of Alternative Medicine)
Research, at present, is inconclusive. The National Institutes of Health (NIH) conducted a 3-year study of 336 patients with major depression of moderate severity. The study randomly assigned patients to an 8-week trial. One-third of patients received a uniform dose of St. John’s Wort, another third a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, and the final group received a placebo. The study participants who responded positively were followed for an additional 18 weeks. At the end of the first phase of the study, participants were measured on two scales, one for depression and one for overall functioning. There was no significant difference in rate of response for depression, but the scale for overall functioning was better for the antidepressant than for either St. John’s Wort or placebo. (“Depression,” 2000, National Institute of Health)
Another study, described in the Journal of American Medicine also involved adult outpatients with major depression who were randomly assigned to receive St. John’s Wort, an SSRI or a placebo. Of this study: “On the 2 primary outcome measures, neither sertraline [the antidepressant] nor H. perforatum [St. John’s Wort] was significantly different from placebo.” (JAMA, 2002, pp.1814) but another study in the British medical journal BMC found “significantly” more patients taking St. John’s Wort, compared with either a placebo group or a group taking SSRIs, “showed treatment response and remission.” (Kasper, et.al, 2006) There is a difficulty in quantifying ‘depressed mood’ in such studies, although all of the comparative studies use the same mood inventory to measure levels of depression in test subjects.
How the drugs mode of action resolves of affects the health problem at the cellular and organ system level?
The method of interaction of St. John’s Wort upon the brain and physical body chemistry of the depressed patient is uncertain, as even the herb’s efficacy is uncertain, although some speculate it may impact serotonin levels. The herb has been found to unpleasantly exacerbate the side effects of other SSRIs if taken in conjunction with other antidepressants. (“St. John’s Wort,” 2006, NCAM: National Council of Alternative Medicine)
Side effects that can occur
St. John’s Wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat physical conditions such as AIDS, heart disease, depression, seizures, certain cancers, birth control pills, and drugs to prevent the rejection of transplanted organs. (“St. John’s Wort,” 2006, NCAM: National Council of Alternative Medicine)
St. John’s Wort has not been tested on pregnant women. It has been found that taking the herb can interfere with the ability of birth control pills to prevent pregnancy. (“St. John’s Wort,” 2006, NCAM: National Council of Alternative Medicine)
St. John’s Wort may cause increased sensitivity to sunlight. Other side effects can include anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction. (“St. John’s Wort,” 2006, NCAM: National Council of Alternative Medicine)
Cost of a one months supply
St. John’s Wort varies in cost, although its cost is seldom above $20 dollars for a month’s supply, which is well below the cost of even generic SSRIs.
Most common dosage in generic and name brand if available
Most St. John’s Wort capsules contain about 300mg of the herb, and suggest taking the capsules three times a day, or a daily dose of 900mg.
Depression.” (2006) Healthy Place. Retrieved 23 Oct 2006 at http://www.healthyplace.com/Communities/depression/causes.asp
Depression.” (2000) National Institute of Health. Retrieved 23 Oct 2006 at http://www.nimh.nih.gov/publicat/depression.cfm
Hypericum Depression Trial Study Group.”(2002). Journal of the American Medical
Association. 287(14): 1807-1814. Retrieved 23 Oct 2006 at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11939866&query_hl=2
Kasper, S., I.G. Anghelescu, a. Szegedi, a. Dienel & M. Kieser. “Superior efficacy of St.
John’s Wort extract WS 5570 compared to placebo in patients with major depression: a randomized, double-blind, placebo-controlled, multi-center trial.” (2006) BMC Med 2006 Jun 23:4:14. Retrieved 23 Oct 2006 at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16796730
St. John’s Wort.” (2006). NCAM: National Council of Alternative Medicine. Retrieved 23 Oct 2006 at http://nccam.nih.gov/health/stjohnswort/
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