Category Archives: St John’s wort

Beat the winter blues: Supplements and SAD

In Parts 1 and 2, I wrote about the impact of light therapy and diet on managing the symptoms of seasonal affective disorder (SAD) and its milder form, the ‘winter blues’. In Part 3 we’ll look at further nutritional support for this common disorder.

Doctor's Best Vitamin D3 2000iu
Evidence suggests that people with SAD who have low levels of vitamin D might benefit from supplementation.

Vitamin D

As there are fewer daylight hours in the winter months, levels of Vitamin D in the body can drop. While light boxes represent a promising treatment option for SAD, they do not provide UV light and so will not boost Vitamin D levels. Researchers have tested whether Vitamin D supplementation can improve mood during the winter months. A double-blind study found that mood improved in healthy people without SAD who received 400 or 800 IU per day of vitamin D for five days in late winter (1).

Another study tested the effects of supplementation with either 600 or 4000 IU of vitamin D every day for six months (2). Both dosages led to improved mood and general well-being in the participants, with those on the higher dose experiencing greater benefits.

Although additional research needs to be done before any conclusions can be made, the available evidence suggests that people with SAD who have low levels of vitamin D might benefit from supplementation.

Magnesium

The Western diet, high in animal produce and refined carbohydrates, leaves us vulnerable to deficiency in the mineral magnesium. This may affect mood, because conversion of tryptophan to mood-enhancing serotonin is dependent on sufficient levels of magnesium. Studies indicate that an insufficient level of magnesium can alter also levels of melatonin and upset the body’s biological clock, a pattern that is seen in SAD (3).

Supplementing with magnesium can be recommended to those with insufficient intake. I prefer the forms magnesium citrate or magnesium taurate, which are bioavailable, well-absorbed forms.

Omega-3

I wrote about the importance of omega 3 in optimising serotonin levels in Part 2. These oils appear to have a natural anti-depressant action, and their effect on mental health has been widely studied. While omega-3 can be supplied through oily fish in the diet, those who are concerned with levels of mercury in fish might want to try supplementing with a fish oil that has been screened for contaminants.

Omega 3
Omega 3 oils appear to have a natural anti-depressant action, and their effect on mental health has been widely studied.

St John’s Wort

St John’s Wort is widely recognised as an effective supplement for mood disorders, and one small randomised study has investigated its benefit for those with SAD (4). The blinded study tested the effects of a daily dose of 900mg of St John’s Wort over 4 weeks. It concluded that the supplement may be an efficient therapy for those with SAD, though further research is needed.

This herb is thought to increase serotonin levels by inhibiting serotonin reuptake, working in a similar way to conventional selective serotonin reuptake inhibitor (SSRI) antidepressants. If you are using a light box to relieve SAD or the ‘winter blues’, then you should check with your GP before taking St John’s Wort, as this herb can make your eyes more sensitive to light.

As winter approaches, the short days and long nights of the season can make life difficult for those with SAD. Even in its milder form, the ‘winter blues’, symptoms of low mood, fatigue and weight gain can make life miserable. The good news is that some fairly simply lifestyle adjustments can make a positive difference. Using a sunrise alarm clock in the mornings for instance can also help you get out of bed on the “right side”. The evidence for bright light therapy with an approved light box is compelling, and coupling this with nutritional support might just help you to banish those winter blues for good.

 

Written by Nadia Mason

References

1. Lansdowne AT, Provost SC. Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl) 1998.135:319–23.

2. Vieth R, et al. Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutrition Journal 2004. 3:8

3. Wester PO. Magnesium. Am. J. Clin. Nutr. 1987. 45 (5 Suppl): 1305–12. PMID 3578120

4. Durlach J, Pagès N, Bac P; Bara M, Guiet-Bara A, Agrapart C
Chronopathological forms of magnesium depletion with hypofunction or with hyperfunction of the biological clock. Magnesium research : official organ of the International Society for the Development of Research on Magnesium 2002.15(3-4):263-8.

5. Kasper S. Treatment of seasonal affective disorder (SAD) with Hypericum extract. Pharmacopsychiatry 1997. 30:89-93.

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St John’s wort may ease hot flushes

Many individuals are aware of the anti-depressant properties of St Johns Wort and I have previously written about the herb in this regard and in relation to Seasonal Affective Disorder (SAD).  New evidence now suggests that the herb may be useful during the menopause.



A recent study (1) was set up to compare the efficacy of St John’s wort with an inactive placebo in women who were experiencing hot flashes.  Hot flashes occur because of the decline of a hormone, oestadiol, during the menopause (in women who are perimenopausal) and also premenopausally and postmenopausally.  A total of 100 women participated in the clinical trial, the average age of the women was 50 years old.  Half of the women received the herb and half received the inactive placebo.  On the 8th week of treatment there was a statistically significant difference in hot flash frequency between the two groups, with the group receiving the herb experiencing fewer hot flushes than the placebo group.  In addition the women who received St John’s wort also had a decrease in the severity of hot flashes in the 4th and 8th week of treatment.  Among the women taking St John’s wort, the average number of hot flashes declined from around four per day at the start of the study, to less than two per day at week eight.  The authors conclude that St John’s wort can be used as an effective treatment for the hot flash symptoms of perimonopausal and postmenopausal women.



During my research I came across two other study papers (2,3) which looked at St John’s wort for menopausal symptoms, both papers were preliminary-small scale trials.  Both found the herb was useful in some regard.  One (2) found that women who received the herb reported significantly better menopause-specific ‘quality of life’ and significantly fewer sleep problems than women receiving placebo.  The other paper (3) found that St John’s wort aided psychological as well as hot-flash symptoms in menopausal women, the women also found that their sexual well-being improved after treatment with St John’s wort.


 


It is not precisely known how St John’s wort is acting.  The herb does contain estrogen-like plant compounds called phytoestrogens, and it could be that these compounds explain the benefits seen in this study – but further research would be needed in order to confirm this.  Further trials are also needed to see if the effects of the herb on hot-flashes and other menopausal symptoms, can be replicated on a larger scale, before firm recommendations for the use of St John’s wort in menopausal women can be made. 



Another reason that St John’s wort may be useful to women going through the menopause is for its anti-depressant action.  Many individuals would rather not take anti-depressant medication because of the various side-effects and the herb could be a valuable alternative.  This seems particularly relevant since a recent (4) study found that older women who take an antidepressant seem to have a small but noteworthy increased risk of stroke and death compared to older women not on an antidepressant medication.  This is quite worrying due to the increasing numbers of people taking anti-depressant medications.  Further investigations and research needs to be carried out in order to evaluate the risks, but I alsdo think that any investigation looking into alternatives is also worthwhile.  Please also read my previous posts relating to depression for useful ideas.



St John’s wort is generally considered safe when dosage instructions are followed, however it is always best to talk to a medical doctor prior to supplementing with this herb as it can have powerful effects and is also known to interact with certain medications. 



(1)Khadijeh A eta l.  2010.  Effect of St John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study.  Menopause.  February 2010 EPub ahead of print doi: 10.1097/gme.0b013e3181b8e02d
(2)Al-Akoum M et al.  2009.  Effects of Hypericum perforatum (St. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. 16(2):307-14.
(3)Grube B et al.  1999.  St. John’s Wort extract: efficacy for menopausal symptoms of psychological origin. Adv Ther. 16(4):177-86.
(4)Smoller JW et al.  2009.  Antidepressant Use and Risk of Incident Cardiovascular Morbidity and Mortality Among Postmenopausal Women in the Women’s Health Initiative Study.  Arch Intern Med.  169: 2128 – 2139.


Written by Ani Kowal

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More evidence backs the use of St John’s Wort in treating depression


At the beginning of September I wrote a piece about light therapy in the treatment of seasonal affective disorder (SAD).  A common feature of SAD is low mood and depression and many individuals suffering from these kinds of symptoms would really prefer to take a natural alternative to conventional anti-depressant medications.  One option to consider is the herb, St John’s wort (Hypericum perforatum). 



Historically St John’s wort has been used as a remedy for the treatment of depression and there is now quite a bank of medical and scientific evidence(1) confirming the effectiveness of this herb for aiding various mood disturbances.  St John’s wort is a shrubby perennial plant with bright yellow flowers, named after St John the Baptist.  Ancient Greeks and Romans believed that the herb could deter evil spirits but today it is mainly used as a natural, alternative to antidepressants.  The herb has been routinely used in Germany for many years where doctors and health practitioners frequently prescribe supplements for the treatment of depression.  The available supplements are made from the dried flowers of the plant. 



Last year I wrote about a well carried out review which concluded that for people suffering from mild to moderate depression, St John’s wort can provide effective relief, similar to that of standard antidepressants but with fewer side effects.



Last month a paper was published (2) which commented on the above mentioned review paper, the author wanted to delve into assessing whether St John’s wort was also an effective treatment for major depression.  The author concluded that “Hypericum (St John’s wort) extracts are more effective than placebo in people with major depression. They are similarly effective to standard antidepressants but with fewer side effects”.  This is really interesting data as it now seems that St John’s wort can be used effectively in mild, moderate and major depression.  The author comments that evidence for the use of this herb has been steadily increasing over the years and that most studies have shown that the herb is superior to placebo in alleviating depression.  He also states that this research suggests “good evidence to assume that the risks associated with this herbal medicine are significantly less than those of synthetic antidepressants. This conclusion is also supported by data from observational and other non-randomised studies.  The implications of all this are clear. St John’s wort extracts are effective antidepressants. Provided herb–drug interactions can be avoided, they are also safer than conventional drugs. Considering the current debate about the value of synthetic antidepressants, one wonders why they are not used more widely”. 


I wonder about the same thing!   The ‘herb-drug interactions’ that the author mentions are important to note – St John’s wort interacts with certain medications so it is vital to ALWAYS CHECK WITH YOUR DOCTOR BEFORE STARTING ST JOHNS WORT SUPPLEMENTS.



The antidepressant properties of St John’s wort are thought to be ascribed to the compounds hypericin and hyperforin that are contained within the herb.  It is not entirely known how the herb works to lift the mood but it seems to act on certain ‘feel-good’ brain chemicals (known as neurotransmitters) such as dopamine, serotonin and noradrenaline.



The typical recommended dose is usually around 300mg of St John’s wort extract three times a day for supplements standardised to contain 0.3% hypericin.  One a day supplements containing 900mcg hypericin are also available – but always check the manufacturers dosage instructions an ALWAYS check with a doctor before taking the herb.  It may take 4 weeks before you see any benefit.  Side effects are uncommon, however in people with fair skin it is advisable to avoid prolonged exposure to sunlight whilst taking the herb.



St John’s Wort also seems useful for the treatment of other mood disturbances such as anxiety, apathy, insomnia, stress and SAD, if you think you could benefit from taking St Johns wort I would suggest chatting with a health professional prior to undertaking a supplementation regimen.



Obviously depression is a multifactorial condition, if you are suffering with depression or low mood you may want to seek psychological help from a counsellor or therapist, look into relaxation techniques and read about other nutritional aids.  A key nutrient that can be very effective in treating depression is the omega 3 essential fatty acid EPA (eicosapentaenoic acid) which I hope to discuss in relation to depression soon.



(1) Linde K et al.  2008.  St John’s wort for major depression.  Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3
(2)Ernst E.  2009.  Review: St John’s wort superior to placebo and similar to antidepressants for major depression but with fewer side effects. Evid Based Ment Health.  12(3):78.
Written by Ani Kowal

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Humble herb appears to handle depression as effectively as conventional anti-depressant treatment

Last week I wrote about light box therapy, and other ideas, for improving mood in SAD (seasonal affective disorder).  A more conventional approach to SAD is pharmaceutical antidepressant therapy with, for example, SSRI (selective serotonin reuptake inhibitors) type antidepressants which include fluoxetine (Prozac) and paroxetine (Paxil, Seroxat).  However, these drugs come with certain side effects (including an increased risk of suicide attempts) and their effectiveness has also been questioned.  For these reasons, many individuals seek alternative ways of dealing with low mood.  One well recognised natural agent is the herb St John’s wort (Hypericum perforatum).  Historically this plant has been used as a remedy for the treatment of depression and there is now quite a bank of medical and scientific evidence(1) confirming the effectiveness of this herb for aiding various mood disturbances.



St John’s wort is a shrubby perennial plant with bright yellow flowers, named after St John the Baptist.  Ancient Greeks and Romans believed that the herb could deter evil spirits but today it is mainly used as a natural, alternative to antidepressants.  The herbal supplements are made from the dried flowers of the plant.  The herb has been routinely used in Germany for many years where doctors and health practitioners frequently prescribe supplements for depression.



Very recently a paper was published (1) reviewing the available evidence for the use of St John’s wort in the treatment of depression.  The review included 29 high quality studies (randomised and double-blind) from a variety of countries, the studies included a total of 5489 patients and ranged from 4 weeks to 12 weeks in length.  The researchers found that, for people suffering from mild to moderate depression, St John’s wort can provide effective relief, similar to that of standard antidepressants but with fewer side effects. 



The authors note, and it is important to state, that people suffering from depressive symptoms (including a low mood, loss of interest or pleasure in life and activities) who wish to use a St John’s wort product should ALWAYS consult a doctor.  The quality of products available on the market varies widely and the herb can interact with other medications so it is always best to check with a medical practitioner before embarking on a treatment plan.



The antidepressant properties of St John’s wort are thought to be ascribed to the compounds hypericin and hyperforin that are contained within the herb.  It is not entirely known how the herb works to lift the mood but it seems to act on certain ‘feel-good’ brain chemicals (known as neurotransmitters) such as dopamine, serotonin and noradrenaline.



The typical recommended dose is 300mg of St John’s wort extract three times a day for supplements standardised to contain 0.3% hypericin.  One a day supplements containing 900mcg hypericin are also available.  ALWAYS check with a doctor before taking the herb.  It may take 4 weeks before you see any benefit.  Side effects are uncommon, however in people with fair skin it is advisable to avoid prolonged exposure to sunlight whilst taking the herb.



The herbal supplement also seems useful for the treatment of other mood disturbances such as anxiety, apathy, insomnia, stress and SAD, if you think you could benefit from taking St Johns wort I would suggest chatting with a health professional prior to undertaking a supplementation regimen.
 



(1)Linde K et al.  2008.  St John’s wort for major depression.  Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3


Written by Ani Kowal

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