Does St. John's wort actually work?

[jayman]

Hey, everyone! I am debating this guy about alternative medicine and I could use some help. I am trying to find good credible sources about the efficacy of St. John's wort. Does it work?



Here is the guy's e-mail:

I think you are wrong.

1. Whether something works or not is not dependent the existence of scientific studies. It either works or it doesn't.

2. Some alternative medicines have been proven. I provided an example yesterday.
http://www.mayoclinic.com/health/st-johns-wort/NS_patient-stjohnswort

Depressive disorder (mild-to-moderate)
St. John's wort has been extensively studied in Europe over the last two decades, with more recent research in the United States. Short-term studies (1-3 months) suggest that St. John's wort is more effective than placebo (sugar pill), and equally effective as tricyclic antidepressants (TCAs) in the treatment of mild-to-moderate major depression. Comparisons to the more commonly prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac?) or sertraline (Zoloft?), are more limited. However, other data suggest that St. John's wort may be just as effective as SSRIs with fewer side effects. Safety concerns exist as with most conventional and complementary therapies.

http://www.bmj.com/cgi/content/full/321/7260/536
Objectives: To compare the efficacy and tolerability of Hypericum perforatum (St John's wort extract) with imipramine in patients with mild to moderate depression.
Design: Randomised, multicentre, double blind, parallel group trial.
Efficacy
The main efficacy results are shown in table 2. The two treatments were therapeutically equivalent with regard to overall effect on depression. All secondary analyses of efficacy supported the conclusions of the primary analysis, although in one exploratory parameter (the anxiety-somatisation subscale of the Hamilton scale) hypericum had a significant advantage. Rates of response to treatment were essentially similar (table 3).

3. Your statement about alternative medicines being called medicine is also not true. (he's referring to me making the statement "If an alternative medecine were to be proven effective and safe, it would stop being called 'alternative' and simply be called medecine.")

http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-stjohnswort.html
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.[/SIZE]

If anyone can help me out with this issue, it would be greatly appreciated.

Thank you,
Josh

 

[macdoc]

Are you trying to deny the study results???

Many treatments are biological based or originally sourced that way including one of the most efficacious for malaria - Lorenzo's oil is another famous situation.

There was another just recently.

http://www.cjnews.com/index.php?option=com_content&task=view&id=14486&Itemid=86

Medicine is as much black art as it is science and human are extremely complicated and also diverse in their responses.

The first rule is "do no harm" and alternatives actually perform better in that regard

For the small nuggets of value on the alternative there is a planet load of nonsense but it cannot be ignored and must be subject to trials just as any other "treatment".

Predators abound in traditional or alternative and a degree of healthy skepticism needs be applied to both when claims are made. Still traditional is far more rigourous in oversite tho that may provoke some argument on the drug side .

St. John's is a poor choice of field to battle on - it would like arguing about willow bark as being effective.
Good luck - no help here.

 

[BenBurch]

It is effective to a degree but modern SSRIs and Tricyclics are more effective.

Also there is significant difference in strengths and that is a real problem when you use an herb as a drug.

Worse there are drug interactions with this herb and you need to be careful.

BUT if you had a known strength preparation and your pharmacist has checked for interactions, and it works for you...

Has this been recognized 50 years ago I feel it would have saved many lives.

 

[Skeptic Ginger]

Does St John's Wort work?

As far as the research to date, no.

 

[macdoc]

Are you claiming the study cited bogus???

2. Some alternative medicines have been proven. I provided an example yesterday.
http://www.mayoclinic.com/health/st-...nt-stjohnswort

Depressive disorder (mild-to-moderate)
St. John's wort has been extensively studied in Europe over the last two decades, with more recent research in the United States. Short-term studies (1-3 months) suggest that St. John's wort is more effective than placebo (sugar pill), and equally effective as tricyclic antidepressants (TCAs) in the treatment of mild-to-moderate major depression. Comparisons to the more commonly prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac?) or sertraline (Zoloft?), are more limited.

 

[paximperium]

St. John's wort may be effective.

A total of 29 trials (5489 patients) including 18 comparisons with placebo and 17 comparisons with synthetic standard antidepressants met the inclusion criteria. Results of placebo-controlled trials showed marked heterogeneity. In nine larger trials the combined response rate ratio (RR) for hypericum extracts compared with placebo was 1.28 (95% confidence interval (CI), 1.10 to 1.49) and from nine smaller trials was 1.87 (95% CI, 1.22 to 2.87). Results of trials comparing hypericum extracts and standard antidepressants were statistically homogeneous. Compared with tri- or tetracyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), respectively, RRs were 1.02 (95% CI, 0.90 to 1.15; 5 trials) and 1.00 (95% CI, 0.90 to 1.11; 12 trials). Both in placebo-controlled trials and in comparisons with standard antidepressants, trials from German-speaking countries reported findings more favourable to hypericum. Patients given hypericum extracts dropped out of trials due to adverse effects less frequently than those given older antidepressants (odds ratio (OR) 0.24; 95% CI, 0.13 to 0.46) or SSRIs (OR 0.53, 95% CI, 0.34-0.83)

http://www.cochrane.org/reviews/en/ab000448.html

 

[ReverendClog]

Macdoc wrote

Medicine is as much black art as it is science and human are extremely complicated and also diverse in their responses.

The first rule is "do no harm" and alternatives actually perform better in that regard

.
Medicine is a 'black art' is it?, would you like to justify that remark?.
Is it more or less a 'black art' than the 'science' of climate prediction?.

 

[Foolmewunz]

Does St John's Wort work?

As far as the research to date, no.

From what I've read the conclusions are that it is effective in very mild cases of depression. One doctor, looking at one of the tests, said that by "very mild" he meant the kind of blahs you get when a nice walk in the park will pick you up.

As with any "natural" remedy, the problem is that you have no control of the actual dosage because it's sold as a food additive. No warnings other than mild ones and no one mentions that the key effewct(MAOI), in larger doses, has caused BP increase to the point of blood vessels in the brain actually bursting.

Where's the list of things you shouldn't eat if you're taking an MAOI on a bottle of StJW? You won't find one. Yet that list is extensive.

As always, as long as the natural remedies folks get away with marketing their juju as supplements or additives, I stay clear of them unless I've seen clinical tests. Or, unless I know that the active ingredients won't have serious negative effects if Mr. Natural messed up the dosage (fish oil would be a good example).

 

[JJM]

{snip} I stay clear of them unless I've seen clinical tests. Or, unless I know that the active ingredients won't have serious negative effects if Mr. Natural messed up the dosage (fish oil would be a good example).

You also need to know that Mr. Natural has not deliberately added a real drug, or inadvertently contaminated the product with something. See "Natural Causes" by Dan Hurley.

 

[cj.23]

Does St John's Wort work?

As far as the research to date, no.

What database are you using? I have just looked through the studies I can access and seems to be effective. The biochemistry looks right too?

However, bear in mind it does interact with a lot of medicines, and in particular will negate the contraceptive pill. A lot of lasses seem to get pregnant through not knowing this. Also "avoid bright lights" is plastered all over the NHS warning literature - sensitizes optic nerve I think.

cj x

 

[macdoc]

Medicine is a 'black art' is it?, would you like to justify that remark?.
Is it more or less a 'black art' than the 'science' of climate prediction?.

Your turn of phrase on prediction shows your lack of comprehension on climatology.

Oddly tho there are similarities as outcomes are in ranges and there is a chaotic aspect to both. There is fairly low values of accuracy at a fine scale ( read individual ) for any given event profile so as with epidemiology individual predictions are poor but widescale are representative of risk as a whole.

There are few completely predictable outcomes in medicine as the the human body is complex, changes constantly and each is an individual unlike water molecules.

Ask yourself why "bedside manner" is considered important and why placebos are effective and you'll understand the black art aspect.

A human body is more like a complex reef system and responses vary with time place and components and the practitioner must assess each as an individual circumstance for best course.
SOME courses of treatment - antibiotics for instance - have fairly predictable outcomes for certain conditions yet a small few may die from what others tolerate or respond to perfectly well and there is very little in the way of information to know how any one individual will respond.

Foolish analogy for you to undertake anyways....agenda driven...glaringly transparent and of zero relevance to the OP.

 

[RationalVetMed]

A human body is more like a complex reef system and responses vary with time place and components and the practitioner must assess each as an individual circumstance for best course.

Speak for yourself dearie - reef system indeed; I'll have you know that my body is a temple.

I take it that you guys have 'history'.

Yuri

 

[macdoc]

I'm sure the biota that cohabits views it the same way. They DO outnumber your body cells after all.

 

[Zeuzzz]

It does work. You just have to wait two about two weeks for any effects. Some studies say its better than SSRI's, though many people will dispute this no doubt. I think its fair to say thats there less chance of getting bad side effects with SJW, though just like SSRI's it wont work for everyone.

 

[paximperium]

It does work. You just have to wait two about two weeks for any effects. Some studies say its better than SSRI's, though many people will dispute this no doubt. I think its fair to say thats there less chance of getting bad side effects with SJW, though just like SSRI's it wont work for everyone.

While it is generally well tolerated, there is accumulating evidence of clinically significant interactions of St. John's wort and drugs, particularly when used with medications metabolized by the cytochrome P-450 system. The frequency by which individuals with emotional illness seek alternative treatments necessitates an understanding of the risks inherent in the use of this herb. Education and interest on the part of physicians will improve disclosure and facilitate communication with patients.

http://psy.psychiatryonline.org/cgi/content/full/44/4/271

Frankly, I treat St. John's wort as any other herbs that seems to have an actual biochemical effect. Unreliable and frankly subject to as much quality control of chewing gum...actually less.

If its active ingredient was actually effective and safe; I very much doubt that Big Pharma wouldn't have purified it and sold it for mucho profit by now.

 

[macdoc]

If its active ingredient was actually effective and safe; I very much doubt that Big Pharma wouldn't have purified it and sold it for mucho profit by now.

I don't think you quite realize that without a patent to protect their interest - Big Pharma wants nothing to do with readily available biologicals.

It's becoming gov labs task to sort out the valuable from the dross to come up with cost effective treatments for population without being under the patent hammer.

If you look at artemisinin you'll see an interesting history.

 

[Gord_in_Toronto]

The National Center for Complementary and Alternative Medicine -- the Woo Woo organization staffed by believers and paid for with US taxpayer dollars (Motto - "We've Never Investigated any sCAM that Did Not Need More Research") says:

NIH-funded study shows that an extract of the herb St. John's wort was no more effective for treating major depression of moderate severity than placebo.

http://nccam.nih.gov/research/results/stjohnswort/

 

[JJM]

{snip} If you look at artemisinin you'll see an interesting history.

See http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Yes, the history of artemisinin is instructive. The source (artemisia sp.) does not always produce the drug. Therefore, without knowledge of the active ingredient to use for standardizing the dose, one could be taking an inactive herb. Also, the various folk preparations may not have contained the drug. In addition, it shows that more than 100 folk remedies for malaria are ineffective. Finally, artemisia contains thujone, which should not be ingested.

If one isolates an active ingredient from a natural product, that can be patented. I suspect, in this case, the problem with finding an active ingredient is due to a lack of a convenient model for testing the stuff. Sure, one can screen for an SSRI; but that will not detect something that works by a new pathway for treating the illness.

Databases that review herbs are often biased by the enthusiasm of the authors for herbs. The bias is manifest in how selective one is when accepting "evidence." A bunch of poor studies do not add-up to a good one, even in a meta-analysis.

 

[paximperium]

I don't think you quite realize that without a patent to protect their interest - Big Pharma wants nothing to do with readily available biologicals.

That must explain why all those Pharma reps are not exploring the jungles looking for products...oh wait, they are.

And do you know that they can patent any purified product if they actually discovered it?

Do you know that they're actually selling purified fish oil(Omega 3s) as a prescription? Odd...

It's becoming gov labs task to sort out the valuable from the dross to come up with cost effective treatments for population without being under the patent hammer.

Yeah...so?

If you look at artemisinin you'll see an interesting history.

Artemisinin? What about it? It is like any other herbal product. It works to a degree but whoop, synthetic derived versions work better.

With a grant from the Bill and Melinda Gates Foundation, a partnership between the Institute for OneWorld Health, Amyris Biotechnologies, sanofi-aventis, and the University of California, Berkeley is using synthetic biology to help reduce the cost of artemisinin, making life-saving artemisinin combination therapies more accessible to people in the developing world.

http://www.artemisininproject.org/

 

[macdoc]

While Novartis could not patent Artemisinin, because as a plant, , it was a naturally occurring substance,

They can of course go after synthetic versions but so can governments and the druggies are reading the writing on the wall......

Drug giant GlaxoSmithKline pledges cheap medicine for world's poor

Head of GSK shocks industry with challenge to other 'big pharma' companies

http://www.guardian.co.uk/business/2009/feb/13/glaxo-smith-kline-cheap-medicine

Brazil already faced them down AIDs and they buckled.

Hopefully now we will see a better cost spectrum both for research and employment of biologicals and synthetics.

Cuba has a strong program on non-patent compounds. Necessity and mother of invention n'all

One can hope open source drug development will proliferate.

http://www.futurepundit.com/archives/002580.html

More eyes, more minds on problem solving and not all profit driven tho the latter has served us well in the main.- tho perhaps not so much the marketing departments.