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Rated St. John's Wort (Hypericum perforatum) for Obsessive Compulsive Disorder

28 of 57 people found the following helpful

Perceived effectiveness 8.0	Tolerability (higher=less side effects) 9.0
Ease of use 10.0	Would you recommend? 9.0

Comment

Good supplement! Although I am not taking it anymore, St. John's Wort worked well for me for years for Obsessive Compulsive problems, as well as for Social Anxiety. It wasnot as effective though for depression by itself. But in combination with Ginseng and Ginkgo, it worked to really elevate my mood too! For the price, and the very low risk of bothersome side effects, it is a good alternative to SSRI's, and it works more like an MAO-I or a Tricyclic in the fact that it induces motivation and energy as well as calm. I would highly recommend it for any anxiety disorder, and especially for lethargic depression as well. On the downside, the withdrawal effects are very bad once 2 weekshits!

http://www.organicconsumers.org/articles/article_12944.cfm

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St. John's wort and serotonin syndrome

From AAFP article:

Adverse Effects, Contraindications, and Drug Interactions

Because of the possibility of developing serotonin syndrome, use of St. John's wort in conjunction with selective serotonin reuptake inhibitors is not recommended. St. John's wort should be used cautiously in patients with bipolar disorder because there have been a few case reports of St. John's wort-related mania.28

Table 229-40 lists the possible drug interactions that may occur with St. John's wort. The results of one report41 suggest that induction of cytochrome (CYP) P450 3A4 activity by St. John's wort may have a substantial impact on the effectiveness of pharmaceutical agents because at least one half of all marketed medications are metabolized via this pathway.

Given the induction of CYP 3A4, concurrent use of St. John's wort may reduce the effectiveness of oral contraceptives. In a study35 of 12 healthy premenopausal women who received an oral contraceptive along with 900 mg of St. John's wort daily in three divided doses, researchers noted a shorter estrogen half-life and increased breakthrough bleeding. Women using oral contraceptives should be counseled regarding possible breakthrough bleeding and might consider a barrier method of contraception when taking St. John's wort.35

Additional study is needed to establish if and how St. John's wort interacts with specific pharmaceutical agents. Experience to date suggests few clinically significant interactions. Until the results of ongoing studies on this matter have been published, the medications listed inTable 229-40 should be considered to have potential interactions and should be monitored when used concurrently with St. John's wort. Family physicians should query all patients about the use of St. John's wort and other herbal agents.

Also

Dosage

Findings suggest that 900 mg of St. John's wort (450 mg two times daily or 300 mg three times daily) is needed to reduce symptoms of depression.8,10,17 Because plasma levels continue to show a gradual rise over several weeks, the full clinical effect of St. John's wort may take two to four weeks to manifest.

St. John's wort research

From the American Academy of Family Physicians, http://www.aafp.org/afp/20051201/2249.html:

"A Cochrane Systematic Review9 used specific criteria to examine the use of St. John's wort for depression. Study limitations included heterogeneous diagnoses of depression, short trial durations, and low dosages of standard antidepressants in comparison trials. In all but one of the 27 clinical studies (n = 2,291) of different hypericum preparations, investigators concluded that St. John's wort was either more effective than placebo or as effective as older pharmaceutical antidepressants in the treatment of mild to moderate depression.

More recently, 13 additional clinical trials have been published, some of which, along with a Cochrane review, are summarized in Table 1.9-19 In 10 of these studies, investigators found that St. John's wort was superior to placebo11,16,20-22 or as effective as standard antidepressants (e.g., amitriptyline [Elavil],10 fluoxetine [Prozac],12,13 imipramine [Tofranil],11,14 sertraline [Zoloft]15) in the treatment of mild to moderate depression. Two updated meta-analyses exploring the effectiveness of St. John's wort for the treatment of depression are based on studies published between 1979 and 2003.23 Although their results suggest the possibility that St. John's wort may be less effective than previously assumed, the meta-analyses indicated that St. John's wort was significantly more effective than placebo (risk ratio for first meta-analysis: 1.97, 95% confidence interval [CI], 1.54 to 2.53; risk ratio for second meta-analysis: 1.73, 95% CI, 1.40 to 2.14).

Studies17-19 on the use of St. John's wort in patients with major depression have had conflicting results.According to the results of one double-blind, placebo-controlled, multi-center clinical trial18 (n = 200), St. John's wort was effective in treating outpatients with major depression. Although the number of patients achieving remission in symptoms of depression was significantly higher with St. John's wort therapy than with placebo (P = .02), overall remission rates were low (14.3 and 4.9 percent, respectively).

[SOME NEUTRAL REPORTS] The Hypericum Depression Trial Study Group conducted a double-blind, randomized controlled trial19 (n = 340) in 12 academic and community psychiatric research clinics in the United States. Investigators found that St. John's wort and sertraline did not differ from placebo for major depression outcomes or adverse events. The authors of an earlier study17 (n = 209) concluded that St. John's wort was equivalent to imipramine in patients with severe depression.

Taken together, the data10-22 continue to support the overall conclusions of the Cochrane review,9 as well as other published reviews,24,25 that St. John's wort is more effective than placebo and as effective as standard antidepressants for the treatment of mild to moderate depression. "

St. John's wort most prescribed antidepressnt in Germany

From the journal of the American Academy of Family Physicians, http://www.aafp.org/afp/20051201/2249.html:

"In Germany, St. John's wort is the most commonly prescribed antidepressant. In 1984, the German Commission E designated St. John's wort as an approved herb,1 and its safety and effectiveness are reevaluated periodically."

The rest of the article can be found at the link.

St. John's wort: Used since ancient times

From http://cms.herbalgram.org/herbalmedicine/StJohn27swort.html:

Many of SJW's therapeutic applications (except antiviral use), including its uses as a vulnerary, diuretic, and treatment for neuralgic conditions, stem from traditional Greek medicine, originally documented by ancient Greek medical herbalists Hippocrates (ca. 460–377 B.C.E.), Theophrastus (ca. 372–287 B.C.E.), Dioscorides (first century C.E.),and Galen (ca. 130–200 C.E.) (Bombardelli and Morazzoni, 1995; Hobbs, 1990; Leung and Foster, 1996; Upton, 1997).Since the time of Swiss physician Paracelsus (ca. 1493–1541 C.E.) it has been used to treat psychiatric disorders. At that time it was described as "arnica for the nerves" (Reuter, 1998). The aerial flowering parts of SJW have been used in traditional European medicine for centuries to treat neuralgia, anxiety, neurosis, and depression (Rasmussen, 1998). The traditional way to take SJW was as herbal tea, an aqueous extract whose single dose corresponded to 2–3 g of dried crude drug (Schulz et al., 1997). In the nineteenth and twentieth centuries, American Eclectic physicians prescribed SJW to treat hysteria and nervous affections with depression. It was prescribed externally to treat wounds, bruises, sprains, and much more (Ellingwood, 1983; Felter and Lloyd, 1983; Felter, 1985; King, 1866; Snow, 1996; Upton, 1997). Today, St. John's wort is official in the national pharmacopeias ofCzechoslovakia, France, Poland, Romania, and Russia (Bruneton, 1995; Hobbs, 1989; Newall et al., 1996;Ph.Fr.X, 1990; Reynolds, 1993; Upton, 1997; USSR X, 1973).

St. John's wort: Few side effects

From http://cms.herbalgram.org/herbalmedicine/StJohn27swort.html:

"Studies that compare treatment with SJW to treatment with a synthetic antidepressant have not lasted longer than six weeks and have been compared using about one-half the usual dose of the antidepressant (75 mg imipramine instead of 150 mg). In addition, they have not been conducted with severely depressed patients. Yet SJW has been shown to be safe, with very few side effects, compared with synthetic antidepressants: out of 3,250 patients, only allergic reactions (0.5%), gastrointestinal upset (0.6%), and fatigue (0.4%) were observed (De Smet and Nolen, 1996). Evidence of the antidepressant activity of SJW extracts can be found in reviews by Bombardelli and Morazzoni (1995), Linde et al. (1996), and Upton (1997). No significant modern human studies investigating SJW's other therapeutic uses have been found (e.g., orally for dyspeptic complaints and topically for burns, lesions, wounds, and myalgia)."

St. John's Wort: Not sure what it should be standardized to, Hyperforin or Hypericin; possible flaw with some studies

From http://altmedicine.about.com/cs/anxietydepression/a/SJW.htm:

Regarding a study published in JAMA saying St. John's Wort is not effective for major depression:

"The 200 subjects in the study were randomly divided into two groups. One group received a 300 mg tablet extract of St. John's Wort and the other group received an identically matched placebo for an eight week treatment period. Both groups were instructed to take one tablet three times per day.

After four weeks, the dose of St. John's Wort or placebo was increased to four tablets per day for the remainder of the study if the subject had not shown improvement. The researchers concluded that St. John's wort was not effective for the treatment of major depression."

However, some important caveats:

The dose may have been too small - 900 mg/day is the standard dose for mild to moderate depression, so perhaps more than 900 to 1200 mg was needed for major depression.

Also:

"Another possible issue with this study is that St. John's wort extracts used in this study were standardized to an ingredient called hypericin. The process of standardization is for quality assurance. It's a guarantee that a specified amount of an ingredient (presumably the medicinally active ingredient) is present in the herbal extract. The PDR for Herbal Medicine, a respected herbal reference, states that hyperforin and not hypericin may be the primary active ingredient for treating depression.

In another study, patients received either placebo, a St. John's Wort extract standardized to 0.5% hyperforin, or a St. John's Wort extract standardized to 5% hyperforin. Only patients who received the extract of 5% hyperforin showed significant improvement of depressive symptoms."

However, most of the successful clinical trials used extract standardized to Hypericin. From http://cms.herbalgram.org/herbalmedicine/StJohn27swort.html:

"Since 1979, there have been about 30 controlled trials with Hypericum extracts, involving thousands of patients with mild to moderate depressive disorders. Most studies lasted 28 to 42 days with daily dosages of 900 mg of an extract standardized to 0.3% hypericin (Jarsin^®, LI 160, Lichtwer Pharma, Berlin). Up to 1997, there have been at least 15 controlled studies on a methanolic extract of SJW (LI 160) and 12 controlled studies on four additional preparations made from ethanolic extracts of SJW (Schulz et al., 1998). They have confirmed the antidepressant action of SJW extracts in humans (Bombardelli and Morazzoni, 1995; Linde et al., 1996; Reuter, 1998; Upton, 1997)."

But, perhaps there is one more twist that supports Hyperforin, after all:

"Other experimental studies have also shown the relevance of hyperforin (Chatterjee et al., 1998; Bhattacharya et al., 1998). However, additional animal and human research is being conducted to clarify the importance of hyperforin, since most of the studies on St. John's wort were conducted on preparations standardized to hypericin, not hyperforin, content [This is what we just pointed out]. Nevertheless, a representative of the leading manufacturer of the most clinically tested hypericin-based SJW extract (i.e., LI 160 from Lichtwer Pharma) has written that this product showed hyperforin levels of 1% to 6% upon analysis; new studies by Lichtwer on LI 160 will be carried out on an extract standardized to hyperforin values of approximately 4% (Schulz, 1998)."

So, maybe hyperforin was the active ingredient all along.

St. John's Wort for Mild Depression

Research into the use of St John's Wort to treat depression

 

St John's Wort and depression

 

St John's Wort was tested in a double-blind study of 105 patients suffering from mild-moderate depression. The patients were male and female , 20 to 64 years of age, and diagnosed as having neurotic depression or temporary depressive mood. They were then divided into two groups and monitored over a period of four weeks. One group were given 300mg of St John's Wort extract, three times daily, and the other group were given a placebo. All of the patients were given psychiatric evaluations before the start of the study , and after two and four weeks of treatment.

 

The results revealed that, after the four weeks, 67% of the Hypericum group had responded positively to the treatment without any adverse side effects whereas only 28% of the placebo group showed any signs of improvement.

 

The authors of the study state clearly that the study was deliberately confined to patients affected by mild forms of depression because, for those patients, the possible risks of traditional antidepressants often outweighed any expected benefits. Indeed many patients within that category were known to refuse medications because of the possible side effects. Therefore, whilst there was no evidence to suggest that Hypericum would be of any benefit to patients suffering from the more serious forms of depression, in relation to the lesser but more common forms of depression, the researchers recommend: 'Hypericum should be used as a remedy of choice'.

 

Harrer. G, and Sommer.H., Treatment of Mild/Moderate Depressions With Hypericum, Phytomedicine, Vol. 1, 1994, pp 3 - 8.

From http://www.clinical-depression.co.uk/faq/herbal.htm

Low Dose Naltrexone

http://www.lowdosenaltrexone.org/

Just a little snippet...

by Scott M. Shannon, MD, author of Please Don't Label My Child

From http://www.mommynature.com/Nutrition-Alternative-to-Meds-for-Children_Shannon.html:

Recently the number of nutritional compounds found to be effective or helpful in psychiatric disorders has dramatically risen. Folate, B-6 and SAMe have proven value in treating major depression. Chromium has good evidence for improving atypical depression. A number of studies document the value of magnesium in mood disorders and it shows great similarity to the mineral lithium in its effects upon neurons. A 2006 study found that 7/10 children with major depression got better with omega-3 oils versus 0/10 with a placebo. Suddenly, we have scientific proof that nutrition helps to heal psychiatric disorders.

...


As I mentioned, in recent years we have witnessed an explosion of children and teens labeled with bipolar disorder. These kids are aggressive, violent and out of control. Our current medications are not very effective. A growing number of psychiatrists around the country have been using a vitamin/mineral product to effectively treat this disorder. A well-known Harvard child psychiatrist, Charles Popper, MD in 2001, popularized this approach. He published a report in a psychiatric journal about his experience: he treated a 10 year old boy with severe bipolar with this natural product and the boy was completely symptom free within 5 days. Three other published studies on this product have followed and a large randomized controlled trial is underway right now.

From http://www.nutritionj.com/content/7/1/2 , "Nutritional Therapies for mental health disorders"

Obsessive-Compulsive Disorder

Obsessive compulsive disorder (OCD) is an anxiety disorder that causes recurring stressful thoughts or obsessions that are followed by compulsions, which are repeated in an uncontrollable manner as a means of repressing the stressful thought [66]. It is well documented that selective serotonin reuptake inhibitors (SSRIs) help patients with OCD [67]. Therefore, it is clear that nutrients which increase serotonin levels will reduce the symptoms of OCD. As discussed earlier, the amino acid tryptophan is a precursor to serotonin, and tryptophan supplements (which are better than 5-Hydroxytryptophan) will increase serotonin levels and treat OCD [68].

A commercially available supplement called Amoryn has recently proven to help patients suffering from depression, anxiety, and OCD [69,70]. The main ingredient in Amoryn, St. John's wort, has been shown to help OCD patients better deal with their recurring thoughts and compulsions. Two double-blind, placebo-controlled studies were recently performed that compared the affects of a 900 mg daily dose of St. John's wort extract to 20 mg daily doses of Paroxetine (Paxil) or Fluoxetine; which are both SSRIs used to treat OCD. In comparison to patients taking Paxil, those who took the St. John's wort supplement showed a 57% decrease in OCD symptoms and were 47% less likely to exhibit side effects [69]. In comparison to patients taking Fluoxetine, consumption of the St. John's wort extract reduced 48% of OCD patient's symptoms [70]. These results clearly depict how the use nutritional supplements can be effective treatments for mental disorders.

Susannah E Murphy, Calogero Longhitano, Rachael E Ayres, Philip J Cowen, and Catherine J Harmer (2006)

Tryptophan supplementation induces a positive bias in the processing of emotional material in healthy female volunteers.

Psychopharmacology (Berl), 187(1):121-30.

Abstract

RATIONALE: The serotonin precursor L-tryptophan (TRP) is available as a nutritional supplement and is licensed as an antidepressant in a number of countries. However, evidence of its efficacy as the primary treatment for depression is limited, and the direct action of TRP on the symptoms of depression and anxiety has not been well-characterised. OBJECTIVES: The present study assessed whether TRP induces cognitive changes opposite to the negative biases found in depression and characteristic of those induced by serotonergic antidepressants in healthy volunteers. MATERIALS AND METHODS: Thirty eight healthy volunteers were randomised to receive 14 days double-blind intervention with TRP (1 g 3x a day) or placebo. On the final day, emotional processing was assessed using four tasks: facial expression recognition, emotion-potentiated startle, attentional probe and emotional categorisation and memory. RESULTS: TRPincreased the recognition of happy facial expressions and decreased the recognition of disgusted facial expressions in female, but not male, volunteers.TRP also reduced attentional vigilance towards negative words and decreased baseline startle responsivity in the females. CONCLUSIONS: These findings provide evidence that TRP supplementation in women induces a positive bias in the processing of emotional material that is reminiscent of the actions of serotonergic antidepressants. This highlights a key role for serotonin in emotional processing and lends support to the use of TRP as a nutritional supplement in people with mild depression or for prevention in those at risk. Future studies are needed to clarify the effect of tryptophan on these measures in men.

Keywords

Adolescent, Adult, Attention, Cognition, Emotions, Female, Humans, Male, Memory, Reaction Time, Startle Reaction, Tryptophan

Note

automatic medline import

Link to PubMed entry

Increase Tryptophan, Increase Melatonin

Increased melatonin serum level with tryptophan supplementation in advanced non-small-cell lung cancer patients

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Shi-Lian Hu^a, Hua Wang^a, Wei-Ping Xu^a, Shi Yin^a, Qi Zhang^a, Gan Shen^a and Wei Wei^b

^aAnhui Provincal Hospital, Hefei 230001, Anhui Province, China

^bInstitute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, Anhui Province, PR China