1. St. Johns Wort and Depression By: Darrell Zellars

2. What is Depression? Depression is a medical condition that affects about 1 in 10 U.S. adults. Mood, thoughts, physical health, and behavior all may be affected. The symptoms and severity of depression can vary from person to person. Depression can be treated with conventional medicine, including antidepressants and certain types of psychotherapy. Day 1

3. Different types of Depression Major depression,—severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes Day 1

4. Different types of Depression Persistent depressive disorder—depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years. Day 1

5. Different types of Depression Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations). Day 1

6. Different types of Depression Postpartum depression, which is much more serious than the "baby blues" that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth Day 1

7. Different types of Depression Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy. Day 1

8. Different types of Depression Bipolar disorder, also called manic-depressive illness, is not as common as major depression or persistent depressive disorder. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression). Day 1

9. Signs and Symptoms of Depression Persistent sad, anxious, or "empty" feelings Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or helplessness Irritability, restlessness Loss of interest in activities or hobbies once pleasurable, including sex Fatigue and decreased energy Difficulty concentrating, remembering details, and making decisions Insomnia, early-morning wakefulness, or excessive sleeping Overeating, or appetite loss Thoughts of suicide, suicide attempts Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment. Day 2

10. What is St. Johns Wort St. John’s wort, a plant that grows in the wild, has been used for centuries for health purposes. However, consumers need to be aware of serious concerns about its safety and effectiveness. This fact sheet summarizes scientific research on St. John’s wort for depression and suggests sources for more information. Day 2

11. What is St. Johns Wort St. John's wort is a shrubby plant with clusters of yellow flowers that have oval, elongated petals. Scientists believe it is native to Europe, parts of Asia and Africa, and the western United States. The plant gets its name because it is often in full bloom around June 24, the day traditionally celebrated as the birthday of John the Baptist. Both the flowers and leaves are used as medicine. Day 2

12. About St. Johns Wort Although St. John’s wort (Hypericum perforatum) has been used for centuries for mental health conditions and is widely prescribed for depression in Europe, the herb can have serious side effects. In addition, current evidence that St. John’s wort is effective for depression is not conclusive. It is also important to note that in the United States, the Food and Drug Administration has not approved its use as an over-the-counter or prescription medicine for depression. Day 2

13. The types of forms of St. Johns Wort St. John's wort can be obtained in many forms: capsules, tablets, tinctures, teas, and oil-based skin lotions. Chopped or powdered forms of the dried herb are also available. Most products are standardized to contain 0.3% hypericin. Day 2

14. How to take St. Johns Wort Pediatric Most studies on St. John's wort have been conducted in adults. However, one study (more than 100 children under age 12) indicated that St. John's wort may be a safe and effective way of treating mild-to-moderate symptoms of depression in children. Never give your child St. John’s wort without medical supervision. Children being treated with St. John's wort should be carefully monitored for side effects, such as allergic reactions or upset stomach. You should not try to treat depression in a child without a doctor’s help, because depression can be a serious illness. Adult Dry herb (in capsules or tablets): The usual dose for mild depression and mood disorders is 300 mg (standardized to 0.3% hypericin extract), 3 times per day, with meals. St. John's wort is available in time-release capsules. St. John’s Wort is also available as a liquid extract or a tea. Ask your doctor to help you find the right dose. It may take 3 - 4 weeks to feel any effects from St. John's wort. Don’t stop taking St. John’s wort all at once, because that may cause unpleasant side effects. Gradually lower the dose before stopping. Day 2

15. How does St. Johns Wort help with Depression? St. John's wort has also shown promise in treating the following conditions, a few of which are related to depression. Premenstrual syndrome (PMS): An early study suggests that St. John's wort may help relieve physical and emotional symptoms of PMS in some women, including cramps, irritability, food cravings, and breast tenderness. Menopause: Two studies suggest that St. John's wort, combined with black cohosh, helps improve mood and anxiety during menopause. Seasonal affective disorder (SAD): Used alone, St. John's wort has improved mood in people with SAD, a type of depression that occurs during the winter months because of lack of sunlight. SAD is usually treated with light therapy, and there is some evidence that using St. John's wort together with phototherapy works even better. Eczema, wounds, minor burns, hemorrhoids: St. John's wort has antibacterial properties and may also help fight inflammation. Applied topically (to the skin), it may relieve symptoms associated with minor wounds and skin irritation. Obsessive compulsive disorder, social phobia: One early open-label study found that taking St. John's wort 450 mg two times a day for 12 weeks improved OCD symptoms. But two other studies found that St. John’s wort didn’t help OCD. Day 3

16. How does St. Johns Wort help with Depression? Study results on the effectiveness of St. John’s wort for depression are mixed. A 2009 systematic review of 29 international studies suggested that St. John’s wort may be better than a placebo (an inactive substance that appears identical to the study substance) and as effective as standard prescription antidepressants for major depression of mild to moderate severity. St. John’s wort also appeared to have fewer side effects than standard antidepressants. The studies—conducted in German-speaking countries where St. John’s wort has a long history of use by medical professionals—reported more positive results than those done in other countries, including the United States. Two studies, both sponsored by NCCAM and the National Institute of Mental Health, did not have positive results. Neither St. John’s wort nor a standard antidepressant medication decreased symptoms of minor depression better than a placebo in a 2011 study. The herb was no more effective than placebo in treating major depression of moderate severity in a large 2002 study. Preliminary studies suggest that St. John’s wort may prevent nerve cells in the brain from reabsorbing certain chemical messengers, including dopamine and serotonin. Scientists have found that these naturally occurring chemicals are involved in regulating mood, but they are unsure exactly how they work. The Placebo Effect The placebo effect describes improvements that are not related specifically to the treatment being studied. For example, a recent reanalysis of the 2002 study on St. John’s wort for major depression showed that the study participants’ beliefs about whether they were taking a placebo or St. John’s wort influenced their depression more so than what they actually received. Even how a clinician talks with patients may lead to a positive response unrelated to the treatment. To understand the usefulness of any intervention, rigorous studies are needed to compare the product or practice being tested with comparable but inactive products or practices.

17. Side Effects of St. Johns Wort St. John’s wort is known to affect how the body uses and breaks down a number of drugs and can cause serious side effects. Serotonin is a brain chemical targeted by antidepressants. Combining St. John’s wort and certain antidepressants can lead to a potentially life-threatening increase in serotonin levels—a condition called serotonin syndrome. Symptoms range from tremor and diarrhea to very dangerous confusion, muscle stiffness, drop in body temperature, and even death. Psychosis is a rare but possible side effect of taking St. John’s wort, particularly in people who have or are at risk for mental health disorders, including bipolar disorder. Taking St. John’s wort can weaken many prescription medicines, such as: – Antidepressants – Birth control pills – Cyclosporine, which prevents the body from rejecting transplanted organs – Digoxin, a heart medication – Some HIV drugs including indinavir – Some cancer medications including irinotecan – Warfarin and similar medications used to thin the blood. Other side effects of St. John’s wort are usually minor and uncommon and may include upset stomach and sensitivity to sunlight. Also, St. John’s wort is a stimulant and may worsen feelings of anxiety in some people. Day 2

18. References Source: St. John's wort | University of Maryland Medical Center http://umm.edu/health/medical/altmed/herb/st- johns-wort#ixzz3CfQVlNjn University of Maryland Medical Center Follow us: @UMMC on Twitter | MedCenter on FacebookSt. John's wort | University of Maryland Medical Centerhttp://umm.edu/health/medical/altmed/herb/st- johns-wort#ixzz3CfQVlNjn@UMMC on TwitterMedCenter on Facebook http://nccam.nih.gov/health/depression.htm http://www.nimh.nih.gov/health/topics/depression/index.s html http://www.nimh.nih.gov/health/topics/depression/index.s html http://nccam.nih.gov/health/stjohnswort/sjw-and- depression.htm http://nccam.nih.gov/health/stjohnswort/sjw-and- depression.htm http://umm.edu/health/medical/altmed/herb/st-johns- wort http://umm.edu/health/medical/altmed/herb/st-johns- wort

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