July  2009 Newsletter

In this issue

• St John's Wort - Useful or Placebo?
• The Herbal Bear Classes

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Possible clues appear when one carefully examines the clinical studies that have been conducted.  Herbalists suggest the use of St. John's Wort for mild to moderate depression.  It is recognized among herbalists that St. John's Wort is not effective for severe depression, yet many of the published studies, which are quoted in the news media,  were conducted on patients whose depression was severe and clinical.  Certainly a study of the efficacy of St. John's Wort's effectiveness on severe depression can be considered useful, if the patients are under medical care.  But the conclusion that St. John's Wort is ineffective on all depression is not sound when the subjects of a study are not normally considered candidates for the herbal use of St. John's Wort.

The usual herbal preparation of St. John's Wort is using the fresh un-opened flower buds and tincturing them in an alcohol/water solution.  However, some studies that are published used either dried plant material, in teas or in tablets.  In certain cases of herbal preparations - there is a vast difference between the efficacy of the fresh plant preparation and a dried plant product.  Many herbalists believe that only fresh St. John's Wort preparations are useful for treating depression.   Even with discrepancies between uses and application, there seems to be clinical indications that St. John's Wort can be useful for those with mild to moderate depression.¹

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Herb and Drug Interactions of St. John's Wort

One issue of concern that has been well documented in the part ten years is that caution must be used with St. John's Wort when taking other over the counter or prescription drugs. St. John's Wort increases an enzyme in the liver (CYP-450) that helps the liver break down certain drugs so that they may be excreted from the body.  The liver normally has this enzyme present, and the rate of drug metabolism is considered when a medication is prescribed. This is why you you may see a prescription written as "take ever four hours".  St. John's Wort, and other substances such as alcoholic beverages (beer wines and liquors) can increase the CYP-450 enzyme and thereby reduce the concentrations of certain medications in your body.

1 Studies on St John's Wort:

Linde K, Berner MM, Kriston L. St. John's wort for depression. Cochrane Database of Systematic Reviews. Oct. 2008 8;(4):CD000448.
Hypericum extract for treatment of depression: 1: Harefuah. 2009 Mar;148(3):183-5, 210, 209.
Long-term effects of St. John's wort (Hypericum perforatum) treatment: a 1-year safety study in mild to moderate depression. Phytomedicine. 2009 Apr;16(4):277-83. Epub 2009 Mar 18.