St. John's Wort is popular among
mildly depressed patients because it is an over the counter remedy, which
is cheaper than prescription drugs, and it has fewer side affects, such
as nausea, headache, diarrhea, and impaired sexual function, which
is common with prescription antidepressants.
Although the exact mechanism for how the body uses St. John's Wort is not known, there have been several proposed. One idea that is popular is that it works as a re-uptake inhibitor. In the brain, there are neurotransmitters which help the brain communicate with the body. One is serotonin, which is the transmitter in the brain responsible for communication among nerve cells, as well as the chemical in the brain which cause people to feel happy. The idea is that St. John's Wort inhibits the re-uptake of this chemical in the brain, causing it to be more abundant. The presence of this chemical makes people happy and reduces depression. This mechanism is also responsible for the function of the illegal drug ecstasy. The other theory behind the functioning of St. John's Wort has to do with the immune system. In this system, the substance IL-6 is responsible for the communication between cells, and leads to an increase in adrenal regulatory hormones, a culprit of depression. St. John's Wort may reduce the levels of this hormone to decrease depression.
St. John's Wort, however, is not free of side affects. It can often cause dry mouth, dizziness, gastrointestinal symptoms, sensitivity to sunlight, and fatigue. It can also have serious affects on newly developed cells, as noted by a study done at Loma Linda University, where St. John's Wort was found to "damage reproductive cells" at high concentrations in hamster oocytes. This is a warning that pregnant women, or those trying to get pregnant should not take this drug.
As well as these symptoms, St. John's Wort is also known to react with prescription drugs, which is why a physician should be consulted before use. One such example found by the National Institutes of Health is with the drug, Crixivan (indinavir), which is a protease inhibitor used to treat HIV. St. John's Wort was shown to interfere with the pathway used to metabolize this drug, by speeding it up, which in turn decreases the blood concentrations of all PI's used to treat HIV. Speeding up this pathway used by many prescription drugs, such as for heart conditions, seizures, depression, birth control, and anti-rejection of new transplants (cyclosporine), can cause major health problems by reducing their effects.
As well as the drug interactions, there have been questions about the usefulness of St. John's Wort for mild to moderate depression. According to a survey done in the May 2000 issue of Consumer Reports, the top method of treatment was prescription drugs. The next most effective treatments were exercise, diet, and meditation, with St. John's Wort being deemed to help little, if at all. This is strong evidence to support that lifestyle changes are a healthier, more effective, less dangerous way to combat mild to moderate depression. This report can be found at http://www.consumerreports.com .
Another study done by the LA Times
demonstrates a question of quality control. Does the quantity of
St. John's Wort listed on the bottle actually exist in each pill?
This study shows that the answer to that question
is no.
This study shows not only the dangerous variation from label to pill, but also that the American public is being ripped off. First of all, this is dangerous because the pills that have a higher concentration than the label says could be cause people to overdose. The pills that contain less than what the label says show that some Americans are spending money on products where 80% of it is missing. That is like buying an entire box of cereal, and not having enough to fill up a bowl for breakfast.
Because of these dangerous drug
interactions, lack of quality control, and side effects, both known and
unknown, the best policy that the FDA could take would be to ban advertising
them. They cannot prevent the drugs from being on the market, and
they cannot recall them without suspicion that the herbs are harmful, but
the FDA can limit the public's exposure, as well as reduce false advertising.
It is often this persuasive advertising which is responsible for the confusion
of the drug's purposes, limits, side effects, and interactions. By
eliminating the advertising, the public is more likely to seek physician's
assistance instead of trusting the media and false label claims.
