hypericum and Seasonal-Affective-Disorder

Derived from the aerial parts of the plant, St. John's wort generally is used for depression, seasonal affective disorder, and anxiety. Products currently are standardized based on hypericin content, although the hyperforin and bioflavonoid contents are also believed responsible for activity. St. John's wort is metabolized primarily by the liver. Some studies comparing St. John's wort to standard antidepressants suggest that it may be as effective as imipramine or selective serotonin reuptake inhibitors (SSRIs) to treat mild to moderate depression. Results from another clinical trial indicate that the effectiveness of St. John's wort is comparable to paroxetine, an SSRI, in the treatment of moderate to severe depression and is well tolerated. But a meta-analysis shows that data are inconsistent. Studies also show possible efficacy in the management of anxiety and premenstrual syndrome, although additional research is necessary. St. John's wort can interact with many medications owing to induction of cytochrome P-450 3A4 and other mechanisms. Significant interactions include decreased efficacy of antiretrovirals, cyclosporine, tacrolimus, antiepileptics, irinotecan, and other chemotherapeutic agents. Serotonin syndrome may occur when St. John's wort is combined with sympathomimetics, antidepressants, or triptans. Frequently reported adverse events include nausea, headache, constipation, dizziness, confusion, fatigue, and dry mouth. St. John's wort should be used under medical supervision.

Topics: Antidepressive Agents; Clinical Trials as Topic; Depressive Disorder; Drug Interactions; Humans; Hypericum; Phytotherapy; Plants, Medicinal; Seasonal Affective Disorder; Virus Diseases

There is much more seasonal difference in higher latitudes than in lower latitudes. In a significant portion of the population of the northern United States, the shorter days of fall and winter precipitate a syndrome that can consist of depression, fatigue, hypersomnolence, hyperphagia, carbohydrate craving, weight gain, and loss of libido. If these symptoms persist in the winter, abate as the days grow longer, and disappear in the summer, the diagnosis of seasonal affective disorder (SAD) can be made. Many hypotheses exist regarding the biochemical mechanisms behind the predisposition toward this disease, including circadian phase shifting, abnormal pineal melatonin secretion, and abnormal serotonin synthesis. Although the mechanism(s) behind this disease is not fully known, one treatment appears to address each of the theories. Light therapy is a natural, non-invasive, effective, well-researched method of treatment for SAD. Various light temperatures and times of administration of light therapy have been studied, and a combination of morning and evening exposure appears to offer the best efficacy. Other natural methods of treatment have been studied, including L-tryptophan, Hypericum perforatum (St. John's wort), and melatonin.

Topics: Humans; Hypericum; Melatonin; Phototherapy; Phytotherapy; Seasonal Affective Disorder; Serotonin

The chemical composition of St. John's wort has been well-studied. Documented pharmacological activities, including antidepressant, antiviral, and antibacterial effects, provide supporting evidence for several of the traditional uses stated for St John's wort. Many pharmacological activities appear to be attributable to hypericin and to the flavonoid constituents; hypericin is also reported to be responsible for the photosensitive reactions that have been documented for St. John's wort. With regard to the antidepressant effects of St John's wort, hyperforin, rather than hypericin as originally thought, has emerged as one of the major constituents responsible for antidepressant activity. Further research is required to determine which other constituents contribute to the antidepressant effect. Evidence from randomised controlled trials has confirmed the efficacy of St John's wort extracts over placebo in the treatment of mild-to-moderately severe depression. Other randomised controlled studies have provided some evidence that St John's wort extracts are as effective as some standard antidepressants in mild-to-moderate depression. There is still a need for further trials to assess the efficacy of St John's wort extracts, compared with that of standard antidepressants, particularly newer antidepressant agents, such as the selective serotonin reuptake inhibitors (recent comparative studies with fluoxetine and sertraline have been conducted). Also, there is a need for further studies in well-defined groups of patients, in different types of depression, and conducted over longer periods in order to determine long-term safety. St John's wort does appear to have a more favourable short-term safety profile than do standard antidepressants, a factor that is likely to be important in patients continuing to take medication. Concerns have been raised over interactions between St John's wort and certain prescribed medicines (including warfarin, ciclosporin, theophylline, digoxin, HIV protease inhibitors, anticonvulsants, selective serotonin reuptake inhibitors, triptans, oral contraceptives); advice is that patients taking these medicines should stop taking St John's wort, generally after seeking professional advice as dose adjustment of conventional treatment may be necessary.

Topics: Adult; Bacterial Infections; Depressive Disorder; Drug Interactions; Female; Humans; Hypericum; Male; Phytotherapy; Plants, Medicinal; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Seasonal Affective Disorder; Virus Diseases

A sunlight deficiency, as is experienced at our latitude in winter, induces a seasonal affective disorder (SAD) or winter depression in some people. First line of treatment of this form of depression is bright-light therapy, as a type of substitution therapy. SAD is treated with similar success using antidepressant drugs like hypericum (St. John's wort). Phototherapy also has an antidepressive effect on non-seasonal depressions, albeit not quite as pronounced. When using phototherapy light is transformed into electric impulses in the retina. These impulses are transmitted to the hypothalamus and the central nervous structures controlling metabolism, hormones and the circadian rhythms. These processes are governed by very complex regulatory mechanisms. Feedback loop mechanisms induce constant adaptation of the photosensitivity of the retinal photoreceptors while also controlling the central nervous structures. New findings on the interaction and interweaving of depression, light, metabolism, hormones and circadian rhythms support the following hypothesis: The photodynamic impact of hypericum magnifies the effect of normal light, as if the patient were subject to continuous light therapy. The photosensitizing effect of hypericum is thus not only of interest as an undesirable side-effect but also for its therapeutic effects.

Topics: Combined Modality Therapy; Humans; Hypericum; Phototherapy; Plants, Medicinal; Seasonal Affective Disorder

Seasonal affective disorder (SAD) is a subgroup of major depression and characterized by a regular occurrence of symptoms in autumn/winter and full remission or hypomania in spring/summer. Light therapy (LT) and recently pharmacotherapy with specific antidepressants have been shown to be beneficial. Within the array of pharmacotherapy hypericum extract has also been found to be effective in a single-blind study (Martinez et al., 1994). In this 4 weeks treatment study 900 mg of hypericum was associated with a significant reduction in the total score of the Hamilton Depression Rating Scale. There was no significant difference when bright light therapy was combined with hypericum, compared to the situation without bright light therapy. Overall, hypericum was well tolerated and therefore the data suggest that pharmacological treatment with hypericum may be an efficient therapy in patients with SAD, which needs to be substantiated in further controlled studies.

Topics: Adult; Antidepressive Agents; Combined Modality Therapy; Female; Humans; Hypericum; Male; Middle Aged; Perylene; Phototherapy; Plants, Medicinal; Psychiatric Status Rating Scales; Quercetin; Seasonal Affective Disorder; Single-Blind Method; Xanthenes

Seasonal affective disorder (SAD) represents a subgroup of major depression with a regular occurrence of symptoms in autumn/winter and full remission in spring/summer. Light therapy (LT) has become the standard treatment of this type of depression. Apart from this, pharmacotherapy with antidepressants also seems to provide an improvement of SAD symptoms. The aim of this controlled, single-blind study was to evaluate if hypericum, a plant extract, could be beneficial in treating SAD patients and whether the combination with LT would be additionally advantageous. Patients who fulfilled DSM-III-R criteria for major depression with seasonal pattern were randomized in a 4-week treatment study with 900 mg of hypericum per day combined with either bright (3000 lux, n = 10) or dim (< 300 lux, n = 10) light condition. Light therapy was applied for 2 hours daily. We found a significant (MANOVA, P < .001) reduction of the Hamilton Depression Scale score in both groups but no significant difference between the two groups. Our data suggest that pharmacologic treatment with hypericum may be an efficient therapy in patients with seasonal affective disorder.

Topics: Adult; Aged; Antidepressive Agents; Combined Modality Therapy; Female; Humans; Hypericum; Male; Middle Aged; Perylene; Phototherapy; Pilot Projects; Plant Extracts; Plants, Medicinal; Psychometrics; Quercetin; Seasonal Affective Disorder; Single-Blind Method; Xanthenes

Topics: Depression; Humans; Hypericum; Naturopathy; Phototherapy; Phytotherapy; Plant Extracts; Referral and Consultation; Seasonal Affective Disorder

Topics: Antidepressive Agents; Female; Humans; Hypericum; Incidence; Male; Phototherapy; Phytotherapy; Plants, Medicinal; Prevalence; Seasonal Affective Disorder