St. John's Wort and Antidepressant Drug Interactions in the Elderly

Lantz, Melinda; Buchalter, E N; Giambanco, Vincent

doi:10.1177/089198879901200103

Cited by 196 publications

(71 citation statements)

References 32 publications

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“…Drugs that may be affected include indinavir, warfarin, ciclosporin, digoxin, theophylline and oral contraceptives. There have also been other reports of increased serotonergic effects in patients taking St John's wort concurrently with selective serotonin reuptake inhibitors (eg sertraline, paroxetine) (Gorden 1998 ;Lantz et al 1999).…”

Section: Drug Interactionsmentioning

confidence: 99%

St John's wort (Hypericum perforatum L.): a review of its chemistry, pharmacology and clinical properties

Barnes

Anderson

Phillipson

2001

Journal of Pharmacy and Pharmacology

694

462

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The chemical composition of St. John's wort has been well-studied. Documented pharmacological activities, including antidepressant, antiviral, and antibacterial effects, provide supporting evidence for several of the traditional uses stated for St John's wort. Many pharmacological activities appear to be attributable to hypericin and to the flavonoid constituents ; hypericin is also reported to be responsible for the photosensitive reactions that have been documented for St. John's wort. With regard to the antidepressant effects of St John's wort, hyperforin, rather than hypericin as originally thought, has emerged as one of the major constituents responsible for antidepressant activity. Further research is required to determine which other constituents contribute to the antidepressant effect.Evidence from randomised controlled trials has confirmed the efficacy of St John's wort extracts over placebo in the treatment of mild-to-moderately severe depression. Other randomised controlled studies have provided some evidence that St John's wort extracts are as effective as some standard antidepressants in mild-to-moderate depression. There is still a need for further trials to assess the efficacy of St John's wort extracts, compared with that of standard antidepressants, particularly newer antidepressant agents, such as the selective serotonin reuptake inhibitors (recent comparative studies with fluoxetine and sertraline have been conducted). Also, there is a need for further studies in well-defined groups of patients, in different types of depression, and conducted over longer periods in order to determine longterm safety. St John's wort does appear to have a more favourable short-term safety profile than do standard antidepressants, a factor that is likely to be important in patients continuing to take medication.Concerns have been raised over interactions between St John's wort and certain prescribed medicines (including warfarin, ciclosporin, theophylline, digoxin, HIV protease inhibitors, anticonvulsants, selective serotonin reuptake inhibitors, triptans, oral contraceptives) ; advice is that patients taking these medicines should stop taking St John's wort, generally after seeking professional advice as dose adjustment of conventional treatment may be necessary.

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Section: Drug Interactionsmentioning

confidence: 99%

St John's wort (Hypericum perforatum L.): a review of its chemistry, pharmacology and clinical properties

Barnes

Anderson

Phillipson

2001

Journal of Pharmacy and Pharmacology

694

462

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“…There are also con cerns about the pos si ble neg a tive ef fect of AM on con ven tional man age ment of mood dis or ders (17). Some stud ies re port that St John's wort combined with trazodone, sertraline, or nefazodone may cause sero to nin syn drome (18)(19)(20). It may also po tently af fect the ac tiv i ties of ma jor hu man drug-me tab o liz ing en zymes (21,22).…”

mentioning

confidence: 99%

Alternative Medicine Use by Individuals with Major Depression

2001

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, Mar ga ret L Rus sell, MD, PhD 3Ob jec tive: To de scribe the use of al ter na tive med i cine (AM) by per sons with ma jor de pres sion and to ex am ine the factors as so ci ated with AM use among these in di vid u als. Methods: We used data from the 1994-1995 and 1996-1997 Na tional Pop u la tion Health Sur veys. We se lected subjects who had ma jor de pres sion ac cord ing to the Com pos ite In ter na tional Di ag nos tic In ter view Short Form for Ma jor De pres sion (CIDI-SFMD). The prev a lence of AM and con ven tional health ser vice use by the sub jects was cal cu lated for each sur vey and was strat i fied by prov ince. We em ployed lo gis tic re gres sion to ex am i ne the fac tors as so ci ated with AM use. Re sults: There was a tem po ral trend to ward in creas ing use of AM among per sons with ma jor de pres sion. The prev alence of AM use among sub jects with ma jor de pres sion was 7.8% in 1994-1995 and 12.9% in 1996-1997. Fe male sex, hav ing more than 12 years' ed u ca tion, and hav ing 1 or more long-term med i cal con di tions were as so ci ated with an increased like li hood of us ing AM. The sex dif fer ence in AM use de pended on sub jects' age in 1996-1997. Con clu sion: Gen eral prac ti tio ners, men tal health spe cial ists, and AM pro vid ers should be aware of their pa tients' use of both con ven tional med i cal ser vices and AM be cause there may be in ter ac tions be tween con ven tional and al ter na tive treat ments. Com mu ni ca tion and, if pos si ble, co op er a tion may lead to im proved out comes in the man age ment of de pressive dis or ders.(Can J Psy chi a try 2001;46:528-533)

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“…St John's Wort affects levels of serotonin and noradrenaline in the central nervous system, therefore there is a theoretical risk of a serotonin syndrome reaction when taken with conventional antidepressants (Pepping, 1999). A recent paper has reported a possible serotonin syndrome in five separate patients taking St John's Wort and SSRI antidepressants (Lantz et al, 1999). Concomitant administration of St John's Wort and monoamine oxidase inhibitors should also be avoided.…”

Section: Drug Interactionsmentioning

confidence: 99%

The use of St John's Wort in the treatment of depression

Maidment

2000

Psychiatr. bull.

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Aims and MethodTo assess and update the data on the use of St John's Wort as an antidepressant. A Medline search was conducted for the period January 1985 to December 1999. The search included other aspects of the usage of St John's Wort, such as side-effects, mechanism of action and drug interactions.ResultsWhile two overviews and four clinical trials have recently been published, there is little data comparing St John's Wort against therapeutic doses of standard antidepressants.Clinical ImplicationsSt John's Wort is generally well tolerated, and an effective antidepressant. The current evidence indicates that it is less effective than standard antidepressants for severe depression. While some of the available data suggests equivalent efficacy as subtherapeutic doses of tricyclic antidepressants in mild to moderate depression this requires further confirmation. One recently published paper suggests that St John's Wort has equivalent efficacy to fluoxetine in mild to moderate depression. The appropriate therapeutic dose needs clarification.

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St. John's Wort and Antidepressant Drug Interactions in the Elderly

Cited by 196 publications

References 32 publications

St John's wort (Hypericum perforatum L.): a review of its chemistry, pharmacology and clinical properties

St John's wort (Hypericum perforatum L.): a review of its chemistry, pharmacology and clinical properties

Alternative Medicine Use by Individuals with Major Depression

The use of St John's Wort in the treatment of depression

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