Herbal Supplements: Talking With Your Patients
Herbal Supplements: Talking With Your Patients
Purported uses: mild to moderate depression, seasonal affective disorder, anxiety
Evidence to date: Hyperforin is the major constituent in St. John's wort (SJW) responsible for its antidepressant activity by selectively inhibiting serotonin, dopamine, and norepinephrine reuptake in the central nervous system. Most studies have shown SJW to be superior to placebo in the treatment of mild to moderate depression, as effective as sertraline or other SSRIs, and have fewer side effects than standard antidepressants.
Adverse effects/safety considerations: Similar to the side effects of SSRIs, it may cause GI upset, rashes, headache, and photosensitivity. If taken concomitantly with SSRIs, it may interact and result in serotonin syndrome.
Drug interactions: SJW's ability to induce the cytochrome P450 system, particularly 3A4, -2C9, -2C19, and/or intestinal P-glycoprotein, reduces plasma concentrations of a variety of drugs, including the immunosuppressants cyclosporine and tacrolimus; antiretrovirals indinavir and nevirapine; antigcoagulants warfarin and phenprocoumon; cardiotonic digoxin; antiarrhythmics ivabradine and talinolol; calcium channel blockers nifedipine and verapamil; statins simvastin and atorvastatin; oxycodone; omeprazole; oral contraceptives; cancer drugs imatinib and irinotecan; benzodiapenes alprazolam, midazolam, and quazepam; and antidepressants buspirone, bupropion, and amitriptyline. It has been to shown to cause serotonin syndrome when combined with SSRIs (paroxetine, sertraline, venlafaxine, nefazodone) and receptor antagonists. It may also interact with fexofenadine, chlorzoxazone, lopinavir, methadone, and theophylline.
St. John's Wort (Hypericum Perforatum)
Purported uses: mild to moderate depression, seasonal affective disorder, anxiety
Evidence to date: Hyperforin is the major constituent in St. John's wort (SJW) responsible for its antidepressant activity by selectively inhibiting serotonin, dopamine, and norepinephrine reuptake in the central nervous system. Most studies have shown SJW to be superior to placebo in the treatment of mild to moderate depression, as effective as sertraline or other SSRIs, and have fewer side effects than standard antidepressants.
Adverse effects/safety considerations: Similar to the side effects of SSRIs, it may cause GI upset, rashes, headache, and photosensitivity. If taken concomitantly with SSRIs, it may interact and result in serotonin syndrome.
Drug interactions: SJW's ability to induce the cytochrome P450 system, particularly 3A4, -2C9, -2C19, and/or intestinal P-glycoprotein, reduces plasma concentrations of a variety of drugs, including the immunosuppressants cyclosporine and tacrolimus; antiretrovirals indinavir and nevirapine; antigcoagulants warfarin and phenprocoumon; cardiotonic digoxin; antiarrhythmics ivabradine and talinolol; calcium channel blockers nifedipine and verapamil; statins simvastin and atorvastatin; oxycodone; omeprazole; oral contraceptives; cancer drugs imatinib and irinotecan; benzodiapenes alprazolam, midazolam, and quazepam; and antidepressants buspirone, bupropion, and amitriptyline. It has been to shown to cause serotonin syndrome when combined with SSRIs (paroxetine, sertraline, venlafaxine, nefazodone) and receptor antagonists. It may also interact with fexofenadine, chlorzoxazone, lopinavir, methadone, and theophylline.