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Clinician’s Corner: St. John’s Wort

We treat a lot of depression at Thompson Pharmacy with the help of our local physicians.  Patients may ask if they can treat themselves with over the counter herbal supplements.

Common Names:  St. John’s wort, hypericum, Klamath weed, goatweed.

Antidepressant activity of SJW is attribute to its hyperforin content, which is highest in the plant during its flowering season. Hyperforin increases the brain levelsof  all four of the mood neurochemicals (serotonin, norepinephrine, dopamine and GABA)

USE: depression, anxiety and sleep disturbances.

DOSE: most common regimen is 300mg up to 3 times daily up to 6 weeks

EVIDENCE

  • The German Commission E has recognized St. John’s wort as a “modestly effective” antidepressant. Some sources say it is comparable to low dose Prozac or Elavil
  • Doubtful efficacy for the treatment of moderate to severe major depressive disorder
  • Remember: Almost ½ of patients will get a positive effect from taking a placebo.
  • Usual dose: The usual dose for mild depression and mood disorders is 300 mg (standardized to 0.3% hypericin extract), 3 times per day, with meals. As with all antidepressants expect about three weeks for benefit.

PRECAUTIONS

  • SUNBURN: make sure you are using sunscreen.  Risk increases when patients take 2-4 grams of St. John’s Wort extract (contains 5-10mg hypericin)
  • may precipitate manic attack if a patient is bipolar
  • Combining St. John’s wort with certain antidepressants can lead to a potentially life-threatening increase of serotonin, thus precipitating “serotonin syndrome”. Serotonin syndrome symptoms range from tremor and diarrhea, confusion, muscle stiffness, rapid heartbeat, seizures, high fever, and even death. Dextromethorphan (Delsym or Robitussin-DM may also precipitate serotonin syndrome when given with antidepressants.
  • Avoid if pregnant or nursing
  • MAKE SURE your THOMPSON PHARMACIST reviews your med list before taking St. John’s Wort!!

DRUG: DRUG INTERACTIONS: Speeds up the metabolism of certain drugs

  • Warfarin and blood thinners
  • Phenobarbital and phenytoin
  • Digoxin
  • Other antidepressants
  • Birth control pills
  • Some HIV drugs (NNRTI and Protease inhibitors)
  • Alprazolam (Xanax) will speed up its metabolism and decrease efficacy by half.

Given the facts of the drug interactions, the placebo effect of treating depression, the potential for serotonin syndrome and even suicide, managing depression by your self is not recommended.  Let’s leave the treatment of this condition to clinicians with some level of experience.  Our local mental health professionals are of great help!

As always if you have questions Go Ahead and AS…at Thompson Pharmacy it’s All for YOU!