hypericum and Dementia

Topics: Complementary Therapies; Controlled Clinical Trials as Topic; Crataegus; Dementia; Depression; Drug Contamination; Ginkgo biloba; Heart Failure; Herbal Medicine; Humans; Hypericum; Intermittent Claudication; Male; Phytotherapy; Plant Extracts; Prostatic Hyperplasia; Serenoa; Treatment Outcome; United States

Because use of herbal remedies is increasing, a risk-benefit profile of commonly used herbs is needed. This article provides a clinically oriented overview of the efficacy and safety of ginkgo, St. John's wort, ginseng, echinacea, saw palmetto, and kava. Wherever possible, assessments are based on systematic reviews of randomized clinical trials. Encouraging data support the efficacy of some of these popular herbal medicinal products, and the potential for doing good seems greater than that for doing harm. The published evidence suggests that ginkgo is of questionable use for memory loss and tinnitus but has some effect on dementia and intermittent claudication. St. John's wort is efficacious for mild to moderate depression, but serious concerns exist about its interactions with several conventional drugs. Well-conducted clinical trials do not support the efficacy of ginseng to treat any condition. Echinacea may be helpful in the treatment or prevention of upper respiratory tract infections, but trial data are not fully convincing. Saw palmetto has been shown in short-term trials to be efficacious in reducing the symptoms of benign prostatic hyperplasia. Kava is an efficacious short-term treatment for anxiety. None of these herbal medicines is free of adverse effects. Because the evidence is incomplete, risk-benefit assessments are not completely reliable, and much knowledge is still lacking.

Topics: Anxiety; Dementia; Depression; Echinacea; Female; Ginkgo biloba; Humans; Hypericum; Intermittent Claudication; Kava; Male; Memory Disorders; Panax; Phytotherapy; Plant Preparations; Prostatic Hyperplasia; Respiratory Tract Infections; Risk Assessment; Serenoa; Tinnitus

Older people with dementia are often prescribed numerous medications. Use of herbal therapies in addition to these conventional drug therapies may lead to interactions that result in an adverse drug event. We have conducted a systematic review to identify all studies that examined interactions between herbal and conventional drug therapies (i.e. prescription or over-the-counter). Using a MEDLINE search of English-language studies published between 1980 and 2000, we limited our search to those herbal therapies most likely to be used for the treatment of dementia (memory loss and decreased concentration) and related symptoms. We identified 28 articles that describe interactions between these herbal (i.e. St. John's wort, ginkgo biloba, kava, valerian, and ginseng) and conventional drug therapies. Of these articles, 11 examined St. John's wort, four examined ginkgo biloba, five examined kava, one examined valerian, and seven examined ginseng. We identified a series of potential interactions between herbal and conventional drug therapy that place older people at risk for an adverse drug event. Health care professionals need to be aware of these potential interactions.

Topics: Aged; Dementia; Drug Interactions; Ginkgo biloba; Herb-Drug Interactions; Humans; Hypericum; Kava; MEDLINE; Panax; Plants, Medicinal; Valerian

Topics: Animals; Antidepressive Agents; Anxiety; Clinical Trials as Topic; Dementia; Depression; Ginkgo biloba; Humans; Hypericum; Hypnotics and Sedatives; Kava; Nursing; Patient Education as Topic; Phytotherapy; Plants, Medicinal; United States

Given the need for disease-modifying therapies for dementia, drug repurposing appears to be a promising approach, at least as a risk reduction treatment. Preclinical studies suggest that antidepressants-in particular selective serotonin reuptake inhibitors-have beneficial effects on dementia-related biomarkers and functional outcomes, although clinical data are inconclusive. The present case-control study aimed to evaluate the effects of antidepressant drug classes and individual compounds with different treatment durations on the risk of developing dementia.. Analyses are based on data from the German Disease Analyzer database (owned and maintained by IQVIA) and included 62,317 subjects with an incident dementia diagnosis (ICD-10: F01, F03, G30, F06.7) and controls matched by age, sex, and physician between January 2013 and December 2017. Logistic regression analyses adjusting for health insurance status and comorbid diseases associated with dementia or antidepressant use were performed to investigate the association between dementia incidence and treatment with 4 major antidepressant drug classes and 14 of the most frequently prescribed individual substances.. In 17 of 18 comparisons, long-term treatment (≥ 2 years) with any antidepressant was associated with a lower incidence of dementia than short-term treatment. Tricyclic and herbal antidepressants were associated with a decrease in dementia incidence, especially with long-term treatment. The lowest risks for dementia on an individual substance basis were identified for long-term treatment with escitalopram (odds ratio [OR] = 0.66; 95% CI, 0.50-0.89) and Hypericum perforatum (OR = 0.6; 95% CI, 0.51-0.70).. Long-term treatment with tricyclic antidepressants, Hypericum perforatum, or escitalopram may be associated with reduced incidence of dementia. If antidepressant therapy is well tolerated, continuation-even if depressive symptoms have resolved-may be considered even beyond the purpose of relapse prevention. Future combined analyses of multinational registries and long-term clinical trials are needed to substantiate these findings.

Topics: Aged; Aged, 80 and over; Antidepressive Agents; Antidepressive Agents, Tricyclic; Case-Control Studies; Citalopram; Dementia; Depression; Female; Germany; Humans; Hypericum; Logistic Models; Male; Plant Extracts; Retrospective Studies; Risk Factors; Selective Serotonin Reuptake Inhibitors; Time Factors

Topics: Adolescent; Aged; Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Child; Dementia; Drug Labeling; Humans; Hypericum; Plant Extracts; United States; United States Food and Drug Administration