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St. John's Wort
St. John's Wort (Hypericum perforatum) has been used since ancient times to treat a variety of ailments, and has been shown to be effective in comparison to placebo, imipramine or desipramine (tricyclic antidepressants) and fluoxetine (a SSRI) in the treatment of depression, only better tolerated (19.8% vs 52.8% reported side effects on imipramine, 8% vs 23% on fluoxetine in one study). Its efficacy appears to be related to its content of hyperforin (a derivative present in variable strength, depending upon the producer). It is effective in three major biochemical systems relevant for antidepressant activity, namely the inhibition of the synaptic re-uptake system for serotonin (5-HT), noradrenalin (NA) and dopamine (DA). It is the only antidepressant capable of inhibiting the re-uptake of 5-HT, NA and DA with similar potencies. There is one study that suggests it may be effective in the treatment of obsessive-compulsive disorder and seasonal affective disorder, as well.
It is metabolized at least in part in the liver, and has been shown to affect certain drugs, such as digoxin and estrogens, perhaps via induction of the p-glycoprotein drug transporter or cytochrome p-450 system. Therefore the potential for herb-drug interactions must be kept in mind. The long-term safety of administration has not yet been studied.
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Wentworth, JM et al. St. John's wort, a herbal antidepressant, activates the steroid X receptor. J Endocrinol 2000 Sep;166(3):R11-16.
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Taylor LH et al. An open-label trial of St. John's wort in obsessive-compulsive disorder. J Clin Psychiatry 2000 Aug;61(8):575-8.
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