"Moosh🙂" <[email hidden]> wrote in message
"]news:[email hidden]...
Quoted message said:On Wed, 14 Apr 2004 10:50:43 GMT, GMCarter
<[email hidden]> posted:
Quoted message said:Moosh:) said:On Sat, 10 Apr 2004 09:49:53 GMT, GMCarter
<[email hidden]> posted:
>As per a recent thread, NY Times article:
>nytimes.com09DRUG.htmlOpen ↗
>
>Basically says what I was saying. Antidepressants are
>more marketing ploy that useful. Which is why SJW makes
>MUCH more sense in general for mild-to-moderate
>depression, than a probably addictive, definitely
>costly and likely toxic drug pushed by big pharma.
So a drug (SJW) with no guarantees of what is actually
in what you buy, is better then a drug which has had
much scientific investigation, and is guaranteed to
contain what it says?
Yes. SJW is not a drug: it is a botanical medicine.
What's the difference, except the vagueness?
Quoted message said:I think this is an important discussion to have as a
separate thread.
I believe many products DO have what is stated on the
label. See,
e.g., consumerlabs.comsjw.aspOpen ↗
But there is no legislative requirement, and legislative
requirement means what the consumers democratically decide
is necessary.
Umm! No - legislative requirements are what governments
decide are necessary, regardless of what the electorate
think.Governments are often prompted to such legislation by
lobby organisations, which are equally undemocratic and may,
in some cases, consist of self-appointed experts who think
that the government should 'do something', regardless of
public opinion - often it is *despite* public opinion. Both
governments and lobby organisations generally consider that
the general public doesn't know its [censored] from its elbow. I
work in government BTW, and get to see this first hand -
it's how democratic governments work.
Quoted message said:Quoted message said:Further, data comparing SJW to Prozac, Zoloft and other
antidepressants for mild-to-moderate depression found
virtual equivalency in efficacy with a much milder side
effect profile for SJW in comparison to the drugs.
And what is the active ingredient in SJW, and weren't
antidepressants recently shown to be no better than
placebo?
Hmm! Well, taking the last point first, your argument has
just fallen on its sword, since it would, if true, suggest
that pharmeceutical companies are marketing things that
don't work. As it happens, antidepressants do work - they
just have a few nasty side effects. St John's Wort also
works - it just has less side effects.
As for the active ingredient well, you're making the
assumption that the action of a plant can be identified with
a single component. This is true of some plants - but they
are in the vast minority, and even there the action of the
principle component is modified by other compounds such as
the flavonoids (e.g. Belladonna). In contrast, in many
plants the action of the whole extract is due to the synergy
of several components: in some cases the individual isolated
compounds may have no action at all, despite the crude
extract showing major activity. This is frequently a cause
of disappointment to pharmaceutical companies screening
various ethnobotanical drugs for activity.
Now although it's pretty much accepted that St John's Wort
demonstrates a very effective action in dealing with mild
depression (at least up to mild levels), the problem has
been in identifying the precise mechanism for the herb's
action. Early studies suggested that hypericin inhibited
both type A and B monoamine oxidase (MAO). Further, type A
MAO was inhibited to a greater degree than type B, although
the inhibition appeared almost irreversible for both types.
Now since MAO inhibitors have been used in conventional
medicine to treat depression, it was originally thought that
hypericin's activity explained the action of the herb. MAO
inhibition causes an increase in the levels of
neurotransmitters such as serotonin, adrenaline and
noradrenaline, depression being associated with low levels
of serotonin in the brain.
Unfortunately hypericin is demonstrably not responsible for
the antidepressant effects. This can be demonstrated, since
administering isolated hypericin to depressed patients does
not improve their condition; buying an extract standardised
to 0.3% hypericin is therefore pointless. Furthermore,
although hypericin shows MAO inhibition at high doses in
vitro, it does not show it at low doses or in vivo.
Recent research suggests that another compound, hyperforin,
is the more likely candidate for the active anti-depressant
principle. Hyperforin is a 5-HT serotonin reuptake
inhibitor, and therefore has an action similar to Prozac.
Nevertheless, the action of the extract may not be quite
that simple to explain. St John's Wort extracts have been
demonstrated to reduce the release of interleukin-6 (IL6).
Interleukins are involved in the immune response. IL-6 in
particular activates the hypothalamic-pituitary-adrenal
axis, resulting in increased production of corticotropin-
releasing hormone (CRH). This peptide stimulates
corticotropin release from the pituitary gland, resulting in
increased levels of adrenaline. Not too surprisingly,
increased levels of adrenaline are associated with stress,
which in turn may be linked to depression. This provides a
hypothetical link between St. John's Wort's known immune
system effects and its antidepressant effects. To compound
the picture, one study also suggests an inhibiting effect on
norepinephrine reuptake, and the extract also inhibits the
enzyme dopamine-b-hydroxylase in vitro.
Personally I suspect that the antidepressant action is not
due to any single compound, but several compounds acting
synergistically. There are at least ten compounds that may
contribute to the effect, including the naphthodianthrons,
flavonoids and bioflavonoids.
Quoted message said:The side effects are not really known, coz there is no
democratically decided requirement to report these.
There isn't a democratic requirement to report adverse
effects of drugs - scientific enquiry has nothing to do with
democracy.
Actually the side effects and contraindications are either
well known or else can be deduced from other data.
Do not use St John's Wort during pregnancy, due to its
emmenagogue and abortifacient effects[i]. It is probably
wise to discontinue using the herb two weeks prior to
surgery[ii]. Additionally in one case the herb interacted
with general anaesthesia induced by fentanyl, propofol, and
d-tubocurarine followed by succinylcholine to produce a
hypotensive episode
(60/20 mmHg) for ten minutes[iii]. This episode was
initially unresponsive to ephedrine and phenylephrine,
though it finally responded to epinephrine.
Hypericin may cause photosensitivity in some individuals,
leading to a form of dermatitis. It is therefore advisable
to avoid intense or prolonged exposure to sunlight. In
particular, St John's Wort should not be combined with
ultraviolet or solarium therapy, and it is contraindicated
from use with photosensitisers such as piroxicam or
tetracycline[iv]. Severe burning has been caused by using
the herb in an ultrasound gel and subsequently exposing the
treated skin to bright sunlight.
In a minority of cases the herb causes giddiness and
headache, which is probably due to mild serotonin syndrome.
This does not appear to be a serious effect, since it
rapidly disappears when the herb is discontinued. It would
be advisable, under the circunstances to use another herb.
St John's wort apparently has an inhibitory effect on
indinavir, a protease inhibitor used in the treatment of
HIV[v]. There have also been reports that St. John's Wort
may also stimulate the rejection of transplanted hearts.
Apparently St. John's Wort increases the activity of hepatic
microsomal drug-metabolizing enzymes (cytochrome
P450/CYP3A4), thus increasing the hepatic clearance of
numerous drugs including theophylline, digoxin, cyclosporine
and antiviral agents used in the treatment of HIV/AIDS
(protease inhibitors such as amprenavir, indinavir,
nelfinavir, ritonavir, saquinavir), and consequently
reducing their clinical efficiency[vi].
Now it has been deduced from this from this that the extract
may therefore render contraceptive drugs less effective.
There is however no experimental data to support this, and
it may be a deduction too far, particularly in light of the
folklore use of St John's Wort as an emmenogogue and
abortifacient. However, breakthrough bleeding has been
reported when the herb was taken concurrently with an
ethinylestradiol and desogestrel combination[vii].
Breakthrough bleeding has been reported in combination with
other oral contraceptives[viii].
St John's Wort should not be used simultaneously with
antidepressants such as the tricyclics (e.g. desipramine)
and SSRIs (e.g. fluoxetine)[ix]. Mild serotonin syndrome has
been caused by combining 300 mg of the herb, 2-3 times
daily, with the antidepressant nefazodone or the SSRI
sertraline[x]. This resulted in headache, sweating, tremor,
flushing, confusion, agitation, myalgia, and
gastrointestinal upsets. Serotonin syndrome was also seen
when St John's Wort was combined with trazodone, and the
herb may act additively with fluoxetine[xi]. It is therefore
advisable that patients using these drugs should not self-
medicate with St John's Wort. If it is decided to replace an
SSRI with St John's Wort, it is advisable to have a two to
three week washout period before commencing the herb; this
should be done under medical supervision.
A combination of a daily 600 mg dose of the herb with 20 mg
paroxetine (an SSRI), caused one woman to become groggy,
weak and lethargic[xii]. This appears to have been a
sedative/hypnotic overdose due to hyperforin weakly
inhibiting paroxetine binding.
St John's Wort also has an effect on anticoagulant drugs. In
several cases patients normalised on Warfarin experienced
lowered INR while using the herb, requiring the dose of
warfarin to be increased[xiii]. Similarly phenprocoumon had
a reduced plasma concentration when taken as a single dose
after ingesting three 300 mg tablets of the herb daily for
eleven days[xiv].
In fact as a general rule, it would be advisable to discuss
taking St John's Wort with your doctor if you are already
taking any pharmaceutical drugs. It is most inadvisable to
self-medicate with St John's Wort under these conditions.
It is possible to have an overdose of the herb - but then it
is also possible to overdose on peanut butter sandwiches. In
the case of St John's Wort, an overdose of the tincture is
recorded as having caused depression, exhaustion, mental
confusion, headache, dilation of the pupils, nausea,
diuresis, cough, an increase in heart rate, numbness,
muscular weakness, shivering, coldness and restless sleep.
However, this would represent a massive dose of the herb.
That do you for adverse effect?
Kevin
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[i] Brinker 2001, 178
[ii] Brinker 2001, 178
[iii] Brinker 2001, 182
[iv] Brinker 2001, 178, 184
[v] Brinker 2001, 180
[vi] Brinker 2001, 180-183
[vii] Brinker 2001, 181
[viii] Brinker 2001, 181
[ix] Brinker 2001, 179
[x] Brinker 2001, 179
[xi] Brinker 2001, 179
[xii] Brinker 2001, 179-180
[xiii] Brinker 2001, 181-182
[xiv] Brinker 2001, 182
