Treating depression with St. John’s wort
St. John’s wort is a plant (Hypericum perforatum) which grows wild in many temperate climates. It contains many chemicals, including hypericin, pseudohypericin, hyperforin, and flavonoids. St. John’s wort has been used for centuries to treat wounds due to its antibacterial properties and for “nervous disorders”. Modern research has shown St. John’s wort can help reduce symptoms of mild anxiety and mild depression; yet, researchers are unclear how it actually works in the brain. Some research has shown hypericum is the active ingredient in St. John’s wort and hypericum can be purchased as a purified chemical. Nonetheless, some research has shown that other chemicals may contribute to the effects of St. John’s wort on anxiety and depression.
There is not a consensus in the studies of St. John’s wort for depression. The majority studies have shown a benefit for mild depression. Some recent studies have shown it has no benefit. Overall, it must be recalled that St. John’s wort is only recommended and shown to be helpful in mild depression. More severe forms of depression, treatment-resistant depression, and bipolar depression are rarely helped by herbal remedies. Other treatments for depression are discussed below.
St. John’s wort has been used as a treatment for a variety of conditions, but there is not convincing evidence that it is at all helpful for ADHD, depression in children, obsessive-compulsive disorder, nerve pain, peri-menopausal symptoms, bipolar disorder, seasonal affective disorder, or social phobia. Indeed, St. John’s wort can be harmful if used in individuals with bipolar disorder or with AIDS (HIV-infection). It can set off a manic episode, confusion or other harmful symptoms.
In addition, St. John’s wort can have interactions with many medications, particularly the monoamine oxidase inhibitors (MAOI’s), serotonin reuptake inhibitors (SSRI’s), and oral contraceptives. St. John’s wort can cause dangerous adverse effects by altering blood levels of numerous medications, including digoxin, blood thinners, immune suppressants used in treating autoimmune diseases, protease inhibitors and other medications used to treat AIDS, sedatives, benzodiazepines – like alprazolam, zolpidem, clonazepam, diazepam, medications used to treat migraines – like sumatriptan, zolmitriptan, as well as antifungals, calcium channel blockers, theophylline, and antifungal agents.
Treating severe depression requires the most effective interventions possible. Medications can be helpful, but overall current antidepressants can take up to 6 weeks to begin to work. Numerous research studies have shown that 60-70% of patients do not respond to the first antidepressant they take. Approaches to treating depression that does not respond to the initial medication vary. Sometimes a higher dose of the same medication can be effective. The next step is often to change to a different antidepressant; however, there is not convincing evidence that changing classes works better. Another class of medications is referred to as MAOI’s (monoamine oxidase inhibitors). These medications have been helpful in treatment resistant cases, but still more than half of the patients do not improve significantly. Another strategy is to augment the antidepressant with a different medication. Recently, there has been promising evidence that atypical antipsychotics, although they have multiple side effects and risks, but this must be balanced against their potential benefit. After several unsuccessful medication trials or in a severely depressed individual, ECT (electroconvulsive therapy or “shock” therapy) may be considered. ECT has been the most effective treatment for over 70 years, although science doesn’t understand how it actually works. Still, not everyone responds to ECT and it can be very intimidating to undergo ECT. Some patients have significant side effects of memory loss (30-55%), cognitive impairment (35%) and headache (70%). A more recent advance in treatment has been the use of TMS (rapid transcranial magnetic stimulation). rTMS essentially works by creating a magnetic field in the brain which generates an electrical current. Unfortunately, the clinical use of rTMS has not lived up to the promise of early research. A radical approach to treating depression has been the use of DBS (deep brain stimulation). In this surgical procedure, small holes are drilled through the skull and long electrodes are surgically inserted into the brain. This surgical procedure remains experimental and only a small number of clinical trials are ongoing nationwide.
A powerful new treatment for depression has recently become available. Research at NIMH, Mt. Sinai, and University of California-San Diego have shown that low doses of ketamine given intravenously can have rapid and powerful antidepressant effects. It has been described as “the fastest, strongest, and longest-lasting anti-suicidal intervention ever demonstrated in a controlled trial” by Dr. David Feifel, MD, PhD at UCSD. Now ketamine infusion therapy for treatment-resistant depression is available from Neuro-Luminance Corp.The first clinic has opened in Centennial, CO. Visit www.KetamineInfusionCenters.com to learn more.