St John's Wort in Depression and Insomnia
Treatment of Depression and Insomnia with St John's Wort is Reviewed
Depression is characterised by depressed mood and/or loss of interest or pleasure in nearly all activities and a variety of other symptoms for periods longer than two weeks. Extracts of St. John's wort (botanical name Hypericum perforatum L.) are prescribed widely for the treatment of depression, especially in German and English speaking communities.
Recent Scientific Review and Evidence
Twenty-nine studies in 5489 patients with depression that compared treatment with extracts of St. John's wort for 4 to 12 weeks with placebo treatment or standard antidepressants were reviewed in a recent large scale analysis*. The studies came from a variety of countries, tested several different St. John's wort extracts, and mostly included patients suffering from mild to moderately severe symptoms. Overall, the St. John's wort extracts tested in the trials were superior to placebo. They were equally or more effective when compared with standard antidepressants, and had fewer side effects than these standard antidepressants. However, findings were more favourable to St. John's Wort extracts in studies form German-speaking countries. It was noted that these products had a long tradition and were often prescribed by western medicine practitioners in German-speaking communities. In studies from other countries St. John's wort extracts seemed less effective. This difference could be due to the inclusion of patients with slightly different types of depression. Nonetheless, it did lay some doubt on whether the smaller studies from German-speaking countries were flawed and reported overoptimistic results.
St John's Wort and Insomnia
Eventhough St John's Wort has been widely prescribed for insomnia. Its efficicacy in this particular indication is not as well documented as its use in mild to moderate depression. In fact, numerous studies have associated the use of St John's Wort with mild to moderate insomnia. Some health care providers avoid its use in patients with insomnia. Others use it as a supplement in patients who are suffering from depression and sleep disorder related to chronic arthritis.
Disclaimer:
Patients suffering from depressive symptoms who wish to use a St. John's wort product should consult a health professional. Using a St. John's wort extract might be justified, but important issues should be taken into account: St. John's wort products available on the market vary to a great extent. The results of the quoted review apply only to the preparations tested in the studies included, and possibly to extracts with similar characteristics. Side effects of St. John's wort extracts are usually minor and uncommon. However, the effects of other drugs might be significantly compromised.
*Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3.
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