An antidepressant to the test

A German study attributed to St. John’s wort extract similar efficacy to the drug treatment of light depressions. Used in herbal medicine, this plant is available in pharmacies and in some stores in Dietetics. While this product is the object of a growing media coverage, fact Doctissimo point on its possible effectiveness and risks associated with its use.

Once the festivities ended, blues early in the year is in full swing and could encourage people to move to St. John’s wort. Until now his growing media coverage for the treatment of disorders of mood was accompanied by no evidence of its therapeutic effectiveness. A recent German study1 published in the prestigious journal The British Medical Journal compares Hypericum extract to imipramine, a drug commonly used in the treatment of depression.

antidepressant to the test

Demonstrated effectiveness

Most of the studies on St. John’s wort remained the subject of controversy. Among the most serious analysis2 dating to 1996 conduct on more than 1,700 patients had found a higher than placebo effectiveness of St. John’s wort. The next step naturally was to compare the effectiveness of St. John’s wort to a classic antidepressant. It is this that has just completed the team of Helmut Woelk of the University of Giessen and the results are surprising. After six weeks of treatment on 324 patients, researchers concluded that hypericum is also effective and better tolerated than imipramine in the treatment of mild and moderate depression.

Without calling into question the validity of this study, however, must emphasize three points. First, the doses of hypercube issued in this study (250 mg) are higher than those usually recommended. Second, imipramine is a fairly old medication that includes more side effects (dry mouth, sweating, flushing heat) than the past generations of antidepressants including fluoridation. Finally, the results are only slight depressions. Thus, it is imperative to consult a physician who diagnose the type of depression.

Today, this alternative treatment is already widely used in Germany and its sales in Europe were already in 1998 more than $ 6 billion. Currently available in Pharmacy and in some stores in Dietetics, is this product safe?

Dangerous interactions

Pending the effectiveness of St. John’s wort is compared to that of the latest antidepressants, certain risks associated with St. John’s wort should prompt caution. Indeed, certain drug interactions were observed with digoxin (used in the treatment of heart failure), theosophical (used in the treatment of asthma),indinavir3 (used in the treatment of HIV infection), oral anticoagulants, Cyclosporine4 (used against the rejection of grafts), some antidepressants, and even some contraceptives oral. 1Er March 2000, the French health products safety agency said some of the recommendations.

Must not take St. John’s Wort:

Patients treated by indinavir and, by extrapolation, patients treated with other antivirals on HIV drugs, given the risk of decline in effectiveness of antiviral therapy and development of viral resistance;

Patients treated with an inhibitor antidepressant of the serotonin reuptake, given the risk of a potentially serious serotonin syndrome, particularly in the elderly. Women on pill, because of the risk of decreased contraceptive efficacy;

By caution, any patient subject to other drug treatment, given the risk of drug interactions that can translate into a decline in effectiveness of the associated drugs.

Attention, patients receiving drug and taking St. John’s wort should not suddenly stop taking St. John’s wort without medical advice. Such disruption may result in increased plasma concentrations of these drugs. Such a phenomenon can be dangerous for products such as digoxin, Cyclosporine, theophylline, or oral anticoagulants

Before it has been comparing the effectiveness of St. John’s wort from the latest antidepressants, the therapeutic usefulness of this medicinal plant is not demonstrated. Only in cases of slight depressions appear to have the benefit of his virtues. According to the authors, a raw or poorly treated depression can lead to a vicious circle of relapse. Only a doctor can diagnose the degree of importance of the depression and propose the suitable treatment. No place in self-medication!