Abstract
For many herbal remedies, precise information concerning composition, dose standardisation, clinical activity, interactions with other drugs and side effects is lacking. One of the best-researched herbal agents is St John's wort (hypericum). It has been shown to be an effective and safe antidepressant in more than 50 double-blind trials that involved comparisons with both placebo and standard antidepressants including selective serotonin reuptake inhibitors (SSRIs). Its mode of action, which involves reuptake inhibition of serotonin, noradrenaline and dopamine, is comparable to those of chemical antidepressants. Like the chemical antidepressants, it suffers from a “lag-period” of 3–4 weeks before it becomes fully effective and must be taken for at least 6 months to effect a lasting remission. It has been used in seasonal affective disorder (SAD) with good effect. Rarely, photosensitivity may occur, but only in cases of pathological sun allergy. Like chemical antidepressants, hypericum interacts in the metabolism of a number of other drugs, notably anticoagulants, theophylline preparations, oral contraceptives, antimigraine drugs, and HIV drugs. This may result in reduced effectiveness of both drugs and such combinations are therefore best avoided. A number of clinical trials have shown kava kava to be an effective anxiolytic and sleep-inducer, particularly in patients under stress. However, following reports of liver toxicity, it has been withdrawn from sale pending further investigation of these reports. On the other hand, valerian would appear to be a safe hypnotic for long-term use, although not for an immediate effect. Valerian increases deep (delta) sleep strikingly and beneficially and, by so doing, may augment the immune system. Ginkgo biloba enhances memory and the peripheral circulation. In double-blind trials, its efficacy has been demonstrated even in Alzheimer's disease, and it does not appear to have any appreciable side effects. Herbal remedies have much to offer in the treatment of psychiatric disorders and merit further scientific investigation.
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References
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edition, revised. American Psychiatric Association, Washington, DC
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edition. American Psychiatric Association, Washington, DC
Baldwin D, Thomas SC, Birtwhistle J (1997) Effects of antidepressant drugs on sexual function. Int J Psych Clin Prac 1:47–58
Bennett DA Jr, Phun L, Polk JF, Voglino SA, Zlotnik V, Raffa RB (1998) Neuropharmacology of St John's Wort (Hypericum). Ann Pharmacother 32:1201–1208
Bhate H, Gerster G, Graczca E (1989) Orale Pramedikation mit zubereitungan aus piper methysticum bei operativen eingriffen in epiduralanasthesie. Erfahrungsheilkunde 6:339–345
Bove GM (1998) Acute neuropathy after exposure to sun in a patient treated with John's Wort. Lancet 352:1121–1122
Brenner R, Azbel V, Madhausoodanan S, Pawlowska M (2000) Comparisons of an extract of hypericum (Li 160) and sertraline in the treatment of depression: A double-blind, randomized pilot study. Clin Ther 22:411–419
Brockmoller J, Reum T, Bauer S, Kerb R, Hubner WD, Roots I (1997) Hypericin and pseudohypericin: pharmacokinetics and effects on photosensitivity in humans. Pharmacopsychiatry 30(Suppl 2):94–101
Butterweck V, Wall A, Lieflander-Wulf U, Winterhoff H, Nahrstedt A (1997) Effects of the total extract and fractions of Hypericum perforatum in animal assays for antidepressant activity. Pharmacopsychiatry 30(Suppl 2):117–124
Chatterjee SS, Bhattacharya SK, Wonnemann M, Singer A, Muller WE (1998) Hyperforin as a possible antidepressant component of hypericum extracts. Life Sci 63:499–510
Coffey T (1993) The history and folklore of North American wild flowers. Houghton Miflin, Boston, pp 64–66
Cohen AJ, Bartlik (1998) Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 24:139–145
Connor KM, Watkins LL, Davidson JRT (2000) A study of an herbal anxiolytic. Presented at the 39th annual Meeting of the American College of Neuropsychopharmacology, 2000
Cott JM (1995) Natural product formulations available in Europe for psychotropic medication. Psychopharmacol Bull 31:745–751
Cott JM (1997) In vitro receptor binding and enzyme inhibition by hypericum perforatum extract. Pharmacopsychiatry 30(Suppl 2):108–112
DeFuria MD (1996) Taxol: Clinical development and commercializaton. Phytomedicine 3 (Suppl.1): 4
Donath F, Quispe Bravo S, Diefenbach K, Fietz I, Roots I (1996/97) Polysomnographic and subjective findings in insomniacs under treatment with placebo and valerian extract (LI 156). Phytomedicine 3(Suppl 1):75
Donath F, Quispe Bravo K, Diefenbach I, Maurer A, Fietze I, Roots I (2000) Critical evaluation of valerian extract on sleep structure and sleep quality. Pharmacopsychiatry 33:47–53
Drew AK, Myers SP (1997) Safety issues in herbal medicine. Med J Aust 166:538–541
Dunbar GC, Cohn IF, Feighner JP (1991) A comparison of paroxetine, imipramine and placebo in depressed outpatients. Human Psychopharmacology 11:283–291
Ereshefsky L (2000) Advance in psychotropic CYP interactions. New Clinical Drug Evaluation Unit (NCDEU) annual meeting Boca Raton, National Institute of Mental Health USA
Escher M, Desmeules J (2001) Hepatitis associated with kava, a herbal remedy for anxiety. BMJ 322:139
Farnsworth NR, Wagner H (1996/97) 2nd International congress on phytomedicine. Phytomedicine 3(Suppl1):1–304
Grigson G (1958) The Englishmans flora. Hart-Davis McGibbbon, London, pp 83–89
Grunze H, Walden J (1999) Kawain limits excitation in CA 1 pyramidal neurons of rats by modulating ionic currents and attenuating excitatory synaptic transmission. Hum Psychopharmacol Clin Exp 14:63–66
Guy W. ECDEU Assessment Manual for Psychopharmacology-3/4Revised (DHEW Publ No ADM 76-338). Rockville, MD, U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs, pp. 218-222
Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55
Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62
Hansel R, Haas H (1984) Therapie mit phytopharmaka. Springer Verlag, Heidelberg & New York
Hansel R, Keller K, Rimpler H, Schneider D (eds) (1994) Hagers handbuch der pharmazeutischen praxis 6th ed, Drogen E-O. Springer-Verlag, Berlin Heidelberg New York, pp 201–221
Hansgen KD, Vesper J, Ploch M (1994) Multi-center double-blind study examining the antidepressant effectiveness of hypericum extract LI 160. J Geriatr Psychiatry Neurol 7(Suppl 1):15–18
Harrer G, Hubner WD, Podzuweit H (1994) Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: a multi-center double-blind study, J Geriatr Psychiatry Neurol 7(Suppl 1):24–28
Hofmann R, Winter U (1993) Therapeutische moglichkeiten mit einem hochdosierten standardisierten kava-kava-paparat (antares 120) bei angsterkrangungen. V. Phytotherapiekongress, Bonn, Nov 3-5
Kinsler E, Kromer J, Lehmann (1991) Wirksamkeit eines kava-spezial-extraktes bei patienten mit angst-, spannungs-, und erregungszustanden nicht-psychotischer genese. Arzneim Forsch/Drug Res 41:584–588
Laakmann G, Schule C, Baghai T, Kieser M (1998) St John's Wort in mild to moderate depression: The relevance of hyperforin for the clinical efficacy. Pharmacopsychiatry 31:54–59
Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF (1997) A placebo-controlled, double-blind, randomized trial of an extract of ginkgo biloba for dementia. JAMA 278:1327–1332
Leathwood PD, Chaufford F (1983) Quantifying the effects of mild sedatives. J Psychiatr Res 17:115–122
Lehmann E, Kinsler E, Friedemann J (1996) Efficacy of a special kava extract (piper methysticum) in patients with states of anxiety, tension and excitedness of non-mental origin: A double-blind placebo-controlled study of four weeks treatment. Phytomedicine 3:113–119
Leuschner J (1996/7) Preclinical toxicological profile of hypericum extract LI 160 (abstract) Int J Phytother Phytopharmacol 3(Suppl 1):34–38
Lindahl O, Lindwall L (1989) Double blind study of a valerian preparation. Pharmacol Biochem Behav 32:1065–1066
Linde K, Ramirez G, Mulrow CD, Pauls A, Weidenhammer W, Melchart D (1996) St John's wort for depression—An overview and meta-analysis of randomised clinical trials. BMJ 313:253–258
Lohse MJ, Muller-Oerlinghausen B (1994) In: Schwabe U, Paffrath D (eds) Arznieverordnungsreport, Stuttgart: 354–370
Mendels J, Johnston R, Mattes J, Riesenberg R (1993) Efficacy and safety of b.i.d. doses of venlafaxine in a dose-response study. Psychopharmacol Bulletin 29:169–174
Mohs RC. Rosen WG, Davis KL (1983) The Alzheimer's Disease Assessment Scale: an instrument for assessing treatment efficacy. Psychopharmacol Bull 19:448–450
Moller HJ (1996) Differences observed between Europe and USA with comparators, ACNP 35th Annual meeting, Puerto Rico
Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389
Monthly marketing data institute for medical statistics (1997) IMS, Frankfurt: December
Muller WE, Rolli M, Schafer C, Hafner U (1997) Effects of hypericum extract (LI 160) in biochemical models of antidepressant activity. Pharmacopsychiatry 30(Suppl 2):102–107
Muller WE, Singer A, Wonnermann M (1998) Hyperforin represents the major re-uptake inhibiting constituent of St John's Wort, Poster American College of Psychopharmacology annual meeting, Puerto Rico.
Nahrstedt A, Butterweck V (1997) Biologically active and other constituents of the herb of Hypericum perforatum. Pharmacopsychiatry 30(Suppl 2):129–134
Oyama Y, Fuchs PA, Katayama N, Noda K (1994) Myricetin and quercetin, the flavonoid constituents of ginkgo biloba extract, greatly reduce oxidative metabolism in both resting and Ca-loaded brain neurons. Brain Res 635:125–129
O'Breasail AM, Arguarch S (1998) Hypomania and St John.s Wort Can J Psychiatry 43:746–747
Ozturk Y, Aydin S, Ozturk N, Bayer K. (1996/97) Effects of certain hypericum species on the central nervous system of mice (abstract), Int J Phytother Phytopharmacol 3(Suppl2):102
Ozturk Y (1997) Testing of antidepressant effects of hypericum species on animal models Pharmacopsychiatry 30(Suppl 2):125–128
Philipp M. Kohnen R, Hiller IO (1999) Hypericum extract versus imipramine or placebo in patients with moderate depression: Randomized multicenter study of treatment for eight weeks. BMJ 319:1534–9
Porcher FP (1863) Resources of the fields and forests: Medical, economical and agricultural: prepared and published by order of the surgeon-general. Richmond VA. Reprint (1970), Arno Press, New York
Rosenberg C, Damsbo N, Fuglum E, Jacobsen LV, Horsgard S (1994) Citalopram and imipramine in the treatment of depressive patients in general practice: A Nordic multicentre clinical study. Int Clin Psychopharmacol 9(Suppl 1):41–48
Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA (1984) Seasonal affective disorder: A description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry 41:72–80
Schneck C (1998) St John's Wort and hypomania. J Clin Psychiatry 59:12
Schneider B (1992) Ginkgo-biloba-extrakt bei peripheren arteriellen verschlusskrankheiten. Arzneim Forsch/Drug Res 42:428–436
Schrader E (2000) Equivalence of St. Johns wort extract (Ze 117) and fluoxetine: A randomized, controlled study in mild-moderate depression Int Clin Psychopharmacology 15:61–8.
Schrader E, Meier B, Brattstrom A (1998) Hypericum treatment of mild-moderate depression in a placebo-controlled study. A prospective, double-blind, randomized, placebo-controlled, multicentre study. Human Psychopharmacology 13:163–169
Schulz V, Hansel R, Tyler VE (1998) Rational phytotherapy. Springer-Verlag, Berlin, Heidelberg
Schulz V, Jobert M (1994) Effects of hypericum extract on the sleep EEG in older volunteers. J Geriatr Psychiatry Neurol 7(Suppl 1):S49–S43
Schwartz GE, Loew DM (1983) Assessment of psychopathology by significant others. In: Crook T, Ferrio S, Bartus R (eds) Assessment in geriatric psychopharmacology. Mark Powley Associates, New Canaan CT, pp 111–117
Segraves RT (1998) Antidepressant-induced sexual dysfunction. J Clin Psychiatry 59(Suppl 4):48–54
Singh YN (1992) Kava: An overview. J Ethnopharmacol 37:13–45
Sommer H, Harrer G (1994) Placebo-controlled double-blind study examining the anti-depressant effectiveness of a hypericum preparation in 105 mildly depressed patients J Geriatr Psychiatry Neurol 7(Suppl):9–11
Smith DA (1997) Side-effects of psychotropic drugs. In: Wheatley D, Smith DA (eds) Psychopharmacology of cognitive and psychiatric disorders in the elderly. Chapman & Hall, London, pp 36–54
Stein JD, Hollander E (1994) Sexual dysfunction associated with the drug treatment of psychiatric disorders. CNS Drugs 2:78–86
Stevinson C, Ernst E (1999) Safety of hypericum in patients with depression. CNS Drugs 2:125–132
Terman M, Terman JS, Quitkin FM, McGrath PJ, Stewart JW, Rafferty B (1989) Light therapy for seasonal affective disorder: A review of efficacy. Neuropsychopharmacolgy 2:1–22
Teufel-Mayer R, Gleitz J (1997) Effects of long-term administration of hypericum extracts on the affinity and density of the central serotinergic 5-HT1A and HT2A receptors. Pharmacopsychiatry 30(Suppl 2):113–116
Volz HP (1995) Die anziolytische wirksamkeit von kava-spezialextrakt WS 1490 unter langzeithetherapie-eine randomisierte doppelblindstudie. Z Phytother Abstract-bande: 9
Volz HP, Hansel R (1994) Kava-kava und kavain in der psychopharmakotherapie. Psychopharmakotherapie 1:33–39
Volz HP, Kieser M (1997) Kava-kava extract WS1490 versus placebo in anxiety disorders-a randomised placebo-controlled 25-week outpatient trial. Pharmacopsychiatrt 30:1–5
Vorbach EU, Arnoldt KH, Hubner WD (1997) Efficacy and tolerability of St John's Wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD-10. Pharmacopsychiatry 30(suppl):81–85
Vorbach EU, Hubner WD, Arnoldt KH (1994) Effectiveness and tolerance of the hypericum extract LI 160 in comparison with imipramine: Randomised double-blind study in 135 outpatients. J Geriatr Psychiatry Neurol 7(Suppl):19–23
Walden J, von Wegerer J, Winter U, Berger M, Grunze H (1997) Effects of kawain and dihydromethisticin on field potential changes in the hippocampus. Prog Neuropsychopharmacol Biol Psychiatry 21:697–706
Warnecke G, Pfaender H, Gerster G, Gracza E (1995) Wirksamkeit von kava-spezialextrakt beim klimakterischen syndrom. Z Phytother 11:81–86
Wheatley D (1992) Prescribing short-acting hypnosedatives. Drug Safety 7:106–115
Wheatley D (1993a) The Wheatley Stress Profile. Stress Medicine 9:5–9
Wheatley D (1993b) Sleep in anxiety and depression associated with stress. Stress Medicine 9:127–129
Wheatley D (1997a) LI 160, an extract of St John's Wort, versus amitriptyline in mildly to moderately depressed outpatients—A controlled 6-week clinical trial. Pharmacopsychiatry 30(Suppl):77–80
Wheatley D (1997b) Stress, anxiety and depression. Stress Medicine 13:173–177
Wheatley D (1998a) Hypericum extract: Potential in the treatment of depression. CNS Drugs 6:431–440
Wheatley D (1998b) Sex, stress and sleep. Stress Medicine 14:245–248
Wheatley D (1998c) Mirtazapine, a new dual action antidepressant. Prescriber 9:97–99
Wheatley D (1998d) Sexual dysfunction and sleep disturbance. Psychiatry in Practice 17:10–12
Wheatley D (1999a) Hypericum in seasonal affective disorder (SAD). Curr Med Res Opin 15:33–37
Wheatley D (1999b) Ginkgo biloba in the treatment of sexual dysfunction due to antidepressant drugs. Human Psychopharmacology 14:511–513
Wheatley D (2001a). Kava-kava in the treatment of generalized anxiety disorder. Primary Care Psychiatry 7:97–100
Wheatley D (2001b) Stress-induced insomnia treated with kava and valerian singly and in combination. Human Psychopharmacology 16:353–356
Winterhoff H, Butterweck V, Nahrsted A, Schulz V, Wall A (1995) Pharmacologische untersuchungen zur antidepressiven virkung von hypericum perforatum L. In: Loew D, Rietbrook N (eds) Phytopharmaca im forschund Klinischer anwendung. Steinkopf, Darmstadt, pp 39–56
Woelk H, Burkhard G, Grunwald J (1994) Hypericum extract LI 160: Drug monitoring with 3250 patients. J Geriatr Psychiatry Neurol 7(Suppl 1):34–38
Woelk H, Kapoula O, Lehrl S (1993) Berhandlung von angst-patienten. Z Allg Med 69:271–277
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Wheatley, D. (2004). Current Role of Herbal Preparations. In: Preskorn, S.H., Feighner, J.P., Stanga, C.Y., Ross, R. (eds) Antidepressants: Past, Present and Future. Handbook of Experimental Pharmacology, vol 157. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18500-7_11
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