Psychiatric News September 17, 2004
Volume 39 Number 18
© 2004 American Psychiatric Association
p. 34
New Use Suggested For St. John's Wort
Joan Arehart-Treichel
An herb that has been used for at least 2,000 years for various medical
conditions may help people who suffer from somatoform disorders.
A bushy plant with yellow flowers grows wild in northern California,
southern Oregon, and Colorado. However, its history is European and ancient.
Greek and Roman legends mentioned it. Early Christian mystics named it after
St. John the Baptist. And it was reputed to have various healing powers and to
protect people from evil.
Yet, St. John's wort is making medical news again.
While a large clinical trial failed to demonstrate that St. John's wort can
counter major depression (Psychiatric News, May 19, 2001), some
trials have suggested that it might have some efficacy for less-severe
depression.
Though the jury is still out on its effectiveness in mild depression, a new
study suggests that the herb may be an effective and safe treatment for
somatoform disorders.
The study was headed by Thomas Mueller, M.D., a specialist in neurology,
psychiatry, and psychotherapy at Ruhr-University Bochum in Germany. Results
appeared in the July/August Psychosomatic Medicine.
During 1999 and 2000, 11 general practitioners, seven psychiatrists, and
two internists in Germany enrolled 184 individuals with multiple unexplained
somatic symptoms in this study. All met ICD-10 criteria for
somatization disorder, undifferentiated somatoform disorder, or somatoform
autonomic dysfunction. None of the subjects scored above 12 on the Hamilton
Rating Scale for Depression, which excluded those with serious comorbid
depression.
The subjects were randomly assigned to a treatment arm that consisted of
300 mg of St. John's wort extract twice a day or a placebo twice a day. Both
investigators and subjects were blinded as to which subject received which
intervention.
Subjects' somatoform symptoms were assessed with six instruments both at
the start of the study an at two, four, and six weeks, when the study ended.
One of the instruments used, for example, was the Somatoform Disorders
Screening Instrument. It was developed to diagnose and assess treatment
outcome of somatoform disorders using ICD-10 and DSM-IV
criteria.
On each of the six tests, St. John's wort was found to be superior to a
placebo—a highly significant difference statistically. Forty-five
percent of the subjects getting the herb were classified as responders,
whereas only 21 percent of subjects getting a placebo were so
classified—again, a highly significant difference. Finally, tolerability
of St. John's wort was found to be equivalent to that of a placebo. The only
adverse event that appeared to be possibly caused by the herb was
nightmares.
These results, Mueller and his colleagues concluded, suggest that St.
John's wort "may be a useful therapeutic alternative in the acute
treatment of mildly to moderately severe somatoform disorder." They
cautioned, however, that "efficacy conclusions from this trial cannot be
extrapolated automatically to patients suffering from more severe and more
chronic somatization syndromes. It further remains open whether 600 mg of St.
John's wort daily is the optimal dose and if higher dosages may result in
increased efficacy."
Mueller told Psychiatric News, "This study underlines the
efficacy of herbal therapy in mild psychiatric disorders."
The study was financed by a grant from Lichtwer Pharma GmbH in Berlin,
Germany, which manufactures St. John's wort
medication.
| |
St. John's wort in bloom.
Picture Quest/Image Ideas
|
|
"This is a very exciting study that suggests that St. John's wort may
be effective in treating a very challenging cohort of patients, those with
somatoform disorders," said Mark Rapaport, M.D., chair of the psychiatry
department at the University of California at Los Angeles, in an interview
with Psychiatric News. He is one of the principal investigators in a
major NIMH study examining the possible value of the herb in the treatment of
minor depression. "The findings are encouraging to all of us interested
in identifying alternative treatments for psychiatric syndromes."
However, he noted, there are several important caveats in interpreting the
current study. "The St. John's wort used in this study is from a
specific company, Lichtwer, with a long history of outstanding quality control
and a consistent approach to the processing of St. John's wort. Individuals
going to health food stores and purchasing St. John's wort are not likely to
find the same consistency in the quality of the product. Another concern.. .is
recent data suggesting that St. John's wort may induce metabolism of
cytochrome P-450 3A4, and so the addition of St. John's wort to medically
compromised individuals should be done with physician oversight."
Richard Brown, M.D., of Kingston, N.Y., who presented a course about herbs
and depression at this year's APA annual meeting, described the study as
"excellent" and noted that it evaluated "a neglected
diagnostic group frequently seen in medical settings." He said that it
raises several questions for future research, "such as the possible
effect of higher doses of St. John's wort in this population or the
relationship of somatization disorder to posttraumatic stress disorder and
depression."
An abstract of the report, "Treatment of Somatoform Disorders
With St. John's Wort: A Randomized, Double-Blind, and Placebo-Controlled
Trial," is posted online at
<www.psychosomaticmedicine.org/content/abstract/66/4/538>.
Information on the NIMH study of St. John's wort in minor depression can be
accessed at
<www.clinicaltrials.gov/ct/show/NCT00048815?order=1>."
Psychosom Med 2004 66 538[Abstract/Free Full Text]
Get information about faster international access.
Privacy Policy
Copyright © 2004
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
| 
