St. John's Wort Depression in Term Paper

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("St. John's Wort," 2006, NCAM: National Council of Alternative Medicine)

Research, at present, is inconclusive. The National Institutes of Health (NIH) conducted a 3-year study of 336 patients with major depression of moderate severity. The study randomly assigned patients to an 8-week trial. One-third of patients received a uniform dose of St. John's Wort, another third a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, and the final group received a placebo. The study participants who responded positively were followed for an additional 18 weeks. At the end of the first phase of the study, participants were measured on two scales, one for depression and one for overall functioning. There was no significant difference in rate of response for depression, but the scale for overall functioning was better for the antidepressant than for either St. John's Wort or placebo. ("Depression," 2000, National Institute of Health)

Another study, described in the Journal of American Medicine also involved adult outpatients with major depression who were randomly assigned to receive St. John's Wort, an SSRI or a placebo. Of this study: "On the 2 primary outcome measures, neither sertraline [the antidepressant] nor H. perforatum [St. John's Wort] was significantly different from placebo." (JAMA, 2002, pp.1814) but another study in the British medical journal BMC found "significantly" more patients taking St. John's Wort, compared with either a placebo group or a group taking SSRIs, "showed treatment response and remission." (Kasper, et.al, 2006) There is a difficulty in quantifying 'depressed mood' in such studies, although all of the comparative studies use the same mood inventory to measure levels of depression in test subjects.

How the drugs mode of action resolves of affects the health problem at the cellular and organ system level?

The method of interaction of St. John's Wort upon the brain and physical body chemistry of the depressed patient is uncertain, as even the herb's efficacy is uncertain, although some speculate it may impact serotonin levels.

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The herb has been found to unpleasantly exacerbate the side effects of other SSRIs if taken in conjunction with other antidepressants. ("St. John's Wort," 2006, NCAM: National Council of Alternative Medicine)

Side effects that can occur

St. John's Wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat physical conditions such as AIDS, heart disease, depression, seizures, certain cancers, birth control pills, and drugs to prevent the rejection of transplanted organs. ("St. John's Wort," 2006, NCAM: National Council of Alternative Medicine)

Pregnancy classification

St. John's Wort has not been tested on pregnant women. It has been found that taking the herb can interfere with the ability of birth control pills to prevent pregnancy. ("St. John's Wort," 2006, NCAM: National Council of Alternative Medicine)

Toxicity

St. John's Wort may cause increased sensitivity to sunlight. Other side effects can include anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction. ("St. John's Wort," 2006, NCAM: National Council of Alternative Medicine)

Cost of a one months supply

St. John's Wort varies in cost, although its cost is seldom above $20 dollars for a month's supply, which is well below the cost of even generic SSRIs.

Most common dosage in generic and name brand if available

Most St. John's Wort capsules contain about 300mg of the herb, and suggest taking the capsules three times a day, or a daily dose of 900mg.

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