Posted by SLS on November 3, 2009, at 12:09:59
In reply to Re: You Must Use Caution With St. Johns Wort, posted by TenMan on November 3, 2009, at 9:13:30
> I personally have tried several prescription antidepressants and nothing has come close to the efficacy and ease of use that SJW has provided.
I have seen it work, too. A woman I know who had a mild to moderate depression reported feeling better on it. However, for a more severe episode, she needed Nardil to obtain a remission. I have not tried SJW. If I had, and it worked, I would be first in line to extol its virtues. As it is, I have not yet come across someone with severe major depressive disorder who has responded well to it. Of course, that doesn't mean very much. If I lived in Germany, perhaps things would be different.
> SJW has been in use for far, far longer than any pharmaceutical medication. It has been used in millions of doses by almost as many people worldwide and has a proven track record of being relatively safe and just as effective as its newer synthetic cousins.
I guess that depends upon whose data and interpretations you place your trust in.
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* I do place a great deal of trust in the National Institutes of Health (NIH):
"The extract from St. John's wort (Hypericum perforatum), a bushy, wild-growing plant with yellow flowers, has been used for centuries in many folk and herbal remedies. Today in Europe, it is used extensively to treat mild to moderate depression. In the United States, it is one of the top-selling botanical products.To address increasing American interests in St. John's wort, the National Institutes of Health conducted a clinical trial to determine the effectiveness of the herb in treating adults who have major depression. Involving 340 patients diagnosed with major depression, the eight-week trial randomly assigned one-third of them to a uniform dose of St. John's wort, one-third to a commonly prescribed SSRI, and one-third to a placebo. The trial found that St. John's wort was no more effective than the placebo in treating major depression.29 Another study is looking at the effectiveness of St. John's wort for treating mild or minor depression.
Other research has shown that St. John's wort can interact unfavorably with other medications, including those used to control HIV infection. On February 10, 2000, the FDA issued a Public Health Advisory letter stating that the herb appears to interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Because of these potential interactions, patients should always consult with their doctors before taking any herbal supplement."
http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml
______________________________________________________________________* I also have the the utmost respect for the following research team:
"J Clin Psychopharmacol. 2005 Oct;25(5):441-7.
A Double-blind, randomized trial of St John's wort, fluoxetine, and placebo in major depressive disorder.Fava M, Alpert J, Nierenberg AA, Mischoulon D, Otto MW, Zajecka J, Murck H, Rosenbaum JF.
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. mfava@partners.org
OBJECTIVE: This study looks to compare the antidepressant efficacy and safety of a standardized extract of St John's wort with both placebo and fluoxetine. METHOD: After a 1-week single-blind washout, patients with major depressive disorder diagnosed by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were randomized to 12 weeks of double-blind treatment with LI-160 St John's wort extract (900 mg/d), fluoxetine (20 mg/d), or placebo. The 17-item Hamilton Rating Scale for Depression (HAMD-17) was the primary efficacy measure, and analysis of covariance was used to compare differences in end point HAMD-17 scores across the 3 treatment groups, treating the baseline HAMD-17 as the covariate. RESULTS: One hundred thirty-five patients (57% women; mean age, 37.3 +/- 11.0; mean HAMD-17, 19.7 +/- 3.2) were randomized to double-blind treatment and were included in the intent-to-treat analyses. Analysis of covariance analyses showed lower mean HAMD-17 scores at end point in the St John's wort group (n = 45; mean +/- SD, 10.2 +/- 6.6) compared with the fluoxetine group (n = 47; 13.3 +/- 7.3; P < 0.03) and a trend toward a similar finding relative to the placebo group (n = 43; 12.6 +/- 6.4; P = 0.096). There was also a trend toward higher rates of remission (HAMD-17 <8) in the St John's wort group (38%) compared with the fluoxetine group (30%) and the placebo group (21%). Overall, St John's wort appeared to be safe and well tolerated. CONCLUSION: St John's wort was significantly more effective than fluoxetine and showed a trend toward superiority over placebo. A (25%) smaller than planned sample size is likely to account for the lack of statistical significance for the advantage (indicating a moderate effect size, d = 0.45) of St John's wort over placebo."
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This study chose subjects whose degrees of depression were rated as moderate-to-severe, although not very severe. I would like to see the full text, as I find the abstract to be confusing and contradictory. Anyway, on the surface, it would seem that the authors report that SJW produces a higher rate of remission than Prozac. However, they also try to account for why the advantage of SJW over placebo did not reach statistical significance. Also, Prozac was not to be as effective as has been demonstrated historically. It might be a failed study. I'm not sure.
- Scott
poster:SLS
thread:924178
URL: http://www.dr-bob.org/babble/20091029/msgs/924287.html