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Is St. John's Wort an Effective Antidepressant? |
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Study Results May Be Confusing for Consumers and Health Care Professionals
With many thyroid patients suffering from resultant or simultaneous cases of mild depression, interest in natural and prescription anti-depressant remedies is particularly high. This week's announcement by the Jounal of the American Medical Association regarding St. John's Wort, a product that is taken by many thyroid patients, raises many questions for patients. I am happy to be able to bring you this analysis from the American Nutraceutical Association that may put some of the issues into perspective. -- Mary Shomon
Source: American Nutraceutical Association
Birmingham, AL (April 18, 2001) - A recent study published in the Journal
of the American Medical Association (April 18, 2001) reports that St.
John's wort (SJW) is not effective in the treatment of patients with major
depression. The randomized, double-blind, placebo-controlled clinical
trial was conducted in 11 academic centers in the United States involving
200 patients diagnosed as having major depression.
In this study, SJW's effect was compared to a placebo, and the authors
conclude that SJW was not effective in the treatment of major depression.
"However, this study can be thought of as apple and orange comparison,"
according to pharmacist Allen Montgomery, CEO and Executive Director of
the American Nutraceutical Association. "In Germany SJW is approved as a
non-prescription drug for the treatment of mild-to-moderate depression and
is considered to be a safe alternative to commonly used antidepressant
drugs. This study being reported on in the US lay press evaluated St.
John's wort for major depression, a condition for which SJW it is neither
recommended nor intended."
It is interesting to note that the current study at Vanderbilt that was
published in the Journal of the American Medical Association this week was
financed by Pfizer, the pharmaceutical manufacturer of sertaline
(Zoloft®), a leading antidepressant medication, and the product currently
being evaluated against SWJ in the NIH study.
"Unfortunately the results of the study might suggest that SJW is
ineffective for any forms of depression. Consumers and healthcare
professionals should judge the current study for what it is," observed
Bernd Wollschlaeger M.D., Associate Editor of the peer-reviewed Journal of
the American Nutraceutical Association and Clinical Assistant Professor of
Medicine and Family Medicine and Family Medicine at the University of
Miami School of Medicine. Dr. Wollschlaeger is a board-certified family
physician in private practice and was educated and trained in Germany,
Israel and the US.
According to Dr. Wollschlaeger, "This study reiterates that SJW is not indicated
in the treatment of major depression and has no adverse effects in its
clinical application. The study does not invalidate the clinical research
done with SJW," states Dr. Wollschlaeger.
"In a careful review of existing literature we have identified five
well-controlled clinical trials on 626 participants concluding that SJW
significantly benefits patients with mild to moderate depression without
significant side-effects," says Dr. Wollschlaeger. In Germany, SJW is listed in the German Drug Codex,
approved as a medicine in the Commission E monographs, and widely used and
endorsed by German physicians.
Dr. Wollschlaeger recommends standardized SJW extract for his depressed
patients who do not want to be treated with a prescription antidepressant
drug. "I have seen in my practice good responses to SJW for the clinical
use for which it is intended; mild or moderate depression and mood
enhancement. There is simply no indication for SJW in the treatment for
major depression."
"In checking frequently used reference texts such as The Physicians' Desk
Reference for Non-Prescription Drugs and Dietary Supplements, you will
find that the suggested use of SJW is to enhance mood, not treat severe
depression. The highly referenced Natural Medicines Comprehensive Database
states SWJ is likely effective when standardized hypercicin extract is
used orally for treating mild to moderate depression. In my personal
opinion, responsible physicians have not and never should turn to SJW for
treating their patients who suffer from severe depression. But to say
that there is not any evidence that it can be effective for mild to
moderate depression is just not accurate."
He added, "The authors of the study admit in their comments that patients
who are mild to moderately depressed might have a different response to
SJW. Furthermore, the statistical data of this study indicates that SJW
did produce a significantly greater proportion of remission compared to
placebo and was well-tolerated without significant adverse effects."
According to Dr. Wollschlaeger, "As a physician, I would encourage that future clinical research focus on
the clinical application of SJW in the treatment of mild-to-moderate
depression that represents the early stages of depression. Many patients
with minor depression often wish to avoid the use of prescription
antidepressants because of their side effects including sexual
dysfunction. These are the patients who may benefit from SJW to avoid a
further deterioration of their disease."
According to ANA Executive Director, Allen Montgomery, RPh, "Although
additional research is warranted the use of SJW for mild to moderate
depression is supported by its history of use in traditional medicine, in
vitro studies (Cott, 1997; Wonnemann et al., 1999), in vivo experiments
in animals (Butterweck et al., 1999; Okpanyi and Weischer, 1987)
pharmacodunamic studies in humans (Krueger et al., 1990; Schulz and
Jobert, 1993), pharmacokinetics studies in humans (Staffeldt et al., 1993;
Weiser, 1991), and human clinical studies (Hansgen et al., 1994; Cott,
1997; Fugh-Berman and Cottt, 1999).1
Montgomery notes that the medical community, consumers, and the lay press
should be aware that a major, three-year, multicenter clinical study on
the antidepressant effect of SJW is in it's final stages under the
auspices of the National Center for Complementary and Alternative Medicine
at the National Institutes of Health. This is the first clinical study to
test SJW against a pharmaceutical drug (serotonin reuptake inhibitor -
settraline, Zoloft®.) The trial consists of 330 patients (110 in each
arm - SHW, setraline, and placebo) for a duration of six months, the
longest human trial on SJW to date. Patients enrolled in the study
suffered with moderate-to-severe depression and not exclusively with
severe depression as in the current study."
It is interesting to note that the current study at Vanderbilt that was
published in the Journal of the American Medical Association this week was
financed by Pfizer, the pharmaceutical manufacturer of sertaline
(Zoloft®), a leading antidepressant medication, and the product currently
being evaluated against SWJ in the NIH study.
Dr. Wollschlaeger encourages the financial support of pharmaceutical
companies in the clinical research of herbal remedies, " But they should
sponsor well-controlled clinical trials evaluating SJW effectiveness in
mild and moderate depression for which it is intended."
The American Nutraceutical Association was established in 1997 by members
of the healthcare delivery system to develop and provide educational
materials and continuing education programs for healthcare professionals
and consumers on nutraceutical technology and science. In addition to
accredited continuing education programs healthcare professionals other
activities includes:
- A monthly E-Newsletter - The Grapevine" with the latest
developments.
- The Journal of the American Nutraceutical Association (JANA), a
quarterly peer-reviewed journal for healthcare professionals. The journal
is now available on-line at www.ana-jana.org
- An Annual Conference for Health Care professionals -
Nutraceutcials and Medicine that focuses on the integration of
nutraceuticals into the healthcare practices of physicians, pharmacist and
other licensed health care providers.
In January 2001, the ANA collaborated with Penguin Putnam to publish
Nutraceuticals: The Complete Encyclopedia of Supplements, Herbs, Vitamins
and Healing Foods. It is available in all major bookstores and directly
from ANA.
Reference:
1. Herbal Medicine - Expanded Commission E Monographs. Bluementhal et al.
Integrative Medicine Communications, Newton , MA. 2000:359-363.
Bernd Wollschlaeger, M.D. is a Florida-based board-certified family physician who specializes in the application of herbal remedies and nutritional supplements. Dr. Wollschlaeger is also the associate editor of the Journal of the American Nutraceutical Association (JANA). He works with thyroid patients and others in natural and holistic approaches for diseases and conditions. He can be contacted via his website, www.complemed.com or via email, at
Info@complemed.com.
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