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[2008 updates are highlighted in red]
| Description: |
St. John’s wort has been used as an antidepressant for more than 2,000 years. It is so named because it blooms around the time of the feast day of St. John the Baptist (June 24). The red pigments in its buds and flowers are associated with the blood of St. John the Baptist. Depression is a relatively common symptom in people with MS. |
| Rationale: |
In the past, it was believed that St. John’s wort may produce antidepressant effects by inhibiting an enzyme known as MAO (monoamine oxidase). This does not appear to be the case. Rather, it may affect the brain levels of some mood-related neurochemicals, including serotonin, noradrenaline, and dopamine. |
| Evaluation: |
St. John’s wort may be effective for treating mild-moderate depression. In a 1996 report, a combined analysis of 23 different clinical studies involving 1,757 people reported that St. John’s wort appeared to be effective for treating mild-moderate depression. Subsequently, some studies have questioned the potency of the antidepressant effect of St. John’s wort. There is no evidence that St. John’s wort is effective for treating severe depression. It is unclear how the effectiveness of St. John’s wort compares to that of the newer antidepressants known as selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac®), paroxetine (Paxil®), and sertraline (Zoloft®). |
| Risks: |
Although St. John’s wort is usually well tolerated, there are several important factors related to its use. People who are concerned they may have depression should not attempt to diagnose and treat this condition on their own. St. John’s wort may produce fatigue, and consequently may worsen MS fatigue or increase the sedating effects of some medications. St. John’s wort may cause a sensitivity of the skin and nerves to sunlight (“photosensitivity”), especially in those who are fair-skinned. It should be avoided by women who are pregnant or breastfeeding because of possible side-effects. Finally, St. John’s wort may alter the levels of multiple drugs, including anticonvulsants, antidepressants, heart medications, blood-thinning medications, and oral contraceptives. |
| Costs: |
St. John’s wort is inexpensive. |
| Committee opinion: |
In the opinion of the Committee, St. John’s wort is an inexpensive, generally safe herb that may be effective for treating mild-moderate depression. People with MS should not attempt to diagnose and treat their own depression. Although usually well tolerated, this herb may produce side-effects and may interact with some medications. |
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