Paula Viñas
José de Felippe Junior

Depressão

A depressão é uma doença que afeta o estado de humor, deixando a pessoa com predomínio anormal de tristeza. Tem sido uma doença bastante estudada nos últimos tempos, já que atinge de 5 a 10% da população, e pode levar ao suicídio. Para cada homem, 2 mulheres sofrem de depressão.

Existem dois tipos de depressão: unipolar e bipolar.

A depressão unipolar é caracterizada como um distúrbio afetivo, onde o paciente apresenta sintomas como tristeza, melancolia, perda da necessidade de sentir prazer, embotamento afetivo (deixa de fazer determinadas atividades, perda do convívio social, insônia ). A causa pode ser conhecida como em casos de falta de dinheiro, falecimento de um ente querido, diagnóstico de uma doença, ou pode não ter causa específica, fato que geralmente está ligado a fatores bioquímicos ou genéticos.

Já a depressão bipolar é uma oscilação entre depressão e mania, onde se enquadra a síndrome do pânico (fobia, medo) e o TOC (transtorno obssessivo compulsivo).

A depressão é o resultado de uma diminuição de neurotransmissores no cérebro (principalmente serotonina e noradrenalina).

No cérebro de uma pessoa normal, esses neurotransmissores podem seguir 3 caminhos diferentes:

1º - Interagir com os receptores localizados no terminal nervoso obtendo-se o efeito esperado.

2º - Pode ser recaptada e voltar ao local de armazenamento

3º - Sofrer metabolismo através da enzima monoaminooxidase

Os medicamentos utilizados hoje na depressão ou inibem a monoaminooxidade ou interferem na recaptação, aumentando assim a concentração dos neurotransmissores para poderem interagir nos seus respectivos receptores.

A depressão é muitas vezes vista com preconceito, considerada como falta de força de vontade, preguiça e até mesmo uma doença de pessoas fracas que não conseguem resolver seus próprios problemas. Essa mentalidade deve ser mudada, e indivíduos deprimidos devem ser incentivados a procurar tratamento, já que as estatísticas mostram que apenas 1 entre 4 deprimidos procuram ajuda.

Existem medicamentos da medicina convencional que podem provocar depressão :

Antibióticos : metronidazol, isoniazida, cicloserina, etionamida

Corticosteroide sistêmico : corticotropin, triancinolona, betametasona., hidrocortisona,

dexametasona, prednisona, metilprednisolona, prednisolona

Drogas gastrointestinais : cimetidine, ranitidine

Drogas para os olhos : levobunolol

Drogas para o Coração e Vasos Sanguíneos

Antiarrítmicos: procainamida, disopiramida

Betabloqueadores: timolol, nadolol, propanolol, metoprolol, acebutolol, atenolol, labetalol, pindolol

Diuréticos: clortiazida, hidroclortiazida, clortalidona

Outras: metildopa, clonidina, prazosin, reserpina

Drogas que afetam o sistema nervoso central

Barbituratos : fenobarbital, secobarbital, pentobarbital

Tranquilizantes e pílulas para a insônia:diazepam, alprazolan, lorazepan, buspirona, flurazepam, triazolan, clordiazepoxido,

Drogas neurológicas

Anticonvulsivantes: fenobarbital, fenitoina, clonazepam, primidona, etosuximide

Antiparkinsonianos: levodopa, selegiline,deprenil, bromocriptina, carbidopa/levodopa

Analgésicos / Narcóticos : ibuprofen, naproxen, fenilbutazona, sulindac, piroxicam, indometacina,

Diclofenac, pentazocina, naloxone, fenoprofen, meclofenamate, diflunisal

Outras : anfetaminas( durante a suspenção), disulfiram, metrizamida

Sinais e Sintomas da depressão

Geral

Emagrecimento

Cansaço – fadiga – astenia

Falta de vontade

Sente –se mal a maior parte do tempo

Dificuldade em pegar no sono

Acorda cansado pela manhã

Tendência a tristeza

Apatia / letargia / lassitude

Diminuição do interesse e do prazer

Humor deprimido

Pensamentos constantes de morte ou de doença

Diminuição da memória

Diminuição da atenção / concentração

Às vezes não encontro as palavras que quero falar

Tenho falhas ocasionais de memória sobre eventos importantes

Tenho diminuição da vontade

Só tenho vontade de ficar sentado e quieto no meu lugar

Falta de apetite

Falta de ar

Plantas que melhoram a depressão

Medicina Complementar na Itália

Alternative medicine in a sample of 655 community-dwelling elderly.

J Psychosom Res;50(3):147-54, 2001 Mar. Dello Buono M; Urciuoli O; Marietta P; Padoani W; De Leo D

Resumo: OBJECTIVE: Use and satisfaction with herbal/homeopathic remedies, acupuncture and relaxation techniques were examined in an Italian elderly population. METHODS: Data were collected as part of a survey on an elderly population, conducted in 1996--1997 in the urban centre of Padua, Italy. A total of 1362 elderly received a letter inviting them to participate and to accept the visit of an interviewer at home. Of these, 212 were unable to do so for insurmountable reasons and 666 gave consent to take part in the study with a response rate of 65%. Eleven participants were excluded from the study because cognitively impaired. RESULTS: Among the 655 respondents, overall use of at least one alternative medicine was 29.5%. Herbs/phytotherapeutics (47%) and acupuncture (34%) were the most frequently cited therapies. The use of alternative medical practices seems rather widespread among the elderly population in Padua, especially among females with depressive symptoms, pain and discomfort, but not suffering from chronic somatic disease. A percentage of 3.7% of the sample used exclusively alternative medicines; those subjects seemed to be younger, less likely to be physically ill and to report functional disorders and chronic somatic disease. CONCLUSION: Alternative medicines seem to have a complementary role for the elderly with self-perceived psychological symptomatology or disorders, particularly of depressive nature. They may constitute an attempt at self-treatment, probably concealing the difficulties encountered by the elderly subjects in seeking specialist advice for these problems.

Medicina Complementar nos Estados Unidos da América

Alternative therapies: Part I. Depression, diabetes, obesity.

Am Fam Physician;62(5):1051-60, 2000 Sep 1. Morelli V; Zoorob RJ

Resumo: Natural supplements are widely used in the United States and, while claims of their therapeutic effects abound, medical research does not always support their effectiveness. St. John's wort acts as a weak selective serotonin reuptake inhibitor with fewer side effects. S-Adenosylmethionine (SAMe) has enough of an antidepressant effect to warrant further research. More human studies are needed before garlic, bitter melon, soy and fenugreek supplements can be recommended for the management of diabetes, although chromium may be a promising treatment in some cases. Alpha lipoic acid is used in the treatment of diabetic neuropathy. The effects of ma huang/guarana combinations in obesity have not been well studied. These combinations may have potentially serious side effects but may also offer some benefit. The combination of hydroxycitric acid and garcinia has proved no more effective than placebo.

The effects of nutritional supplements on the treatment of depression, diabetes, and hypercholesterolemia in the renal patient.

J Ren Nutr;9(2):58-62, 1999 Apr. Duncan MG

Resumo: The independent use of nutritional supplements has increased dramatically over the past several years. St. John's Wort for the treatment of depression, chromium for improvement of abnormal glucose and insulin regulation, and garlic for hypercholesterolemia, are among the more popular nutritional supplements being used by the population at large for their respective conditions. Depression, diabetes, and hypercholesterolemia are common to the renal patient. However, the efficacy of St. John's Wort, chromium, and garlic for these problems in the patient with impaired renal function is not known. This article reviews the pharmacology, efficacy, safety, and pharmokinetics of these three food supplements in the nonrenal patient. There are encouraging data suggesting successful treatment in the otherwise normal individual. However, clinical studies examining the safety of these three supplements for the treatment of depression, diabetes, and hypercholesterolemia in the patient with renal disease are lacking and preclude recommendation of their use.

Medicina Complementar na Alemanha

Treatment of depression.

J Geriatr Psychiatry Neurol;7 Suppl 1:S3-5, 1994 Oct. Payk TR

Westfälisches Zentrum für Psychiatrie der Ruhr-Universität, Bochum, Germany.

Resumo: Depressions are the most common psychiatric diseases. For treatment, plant extracts have been used for thousands of years: examples are extracts from the (sleeping) poppy (opium), deadly nightshade (Atropa belladonna), Indian hemp (hashish), henbane (hyoscyamine), thorn apple (scopolamine), and St. John's wort (hypericum oil). In addition, psychotherapeutic measures, like playing music, dancing, playing theatre, and also the temple sleep, were used. In the 19th century, the introduction of brome (1826), codeine (1832), chloral hydrate (1869), and paraldehyde (1882), as well as the barbiturates (at the turn of the century) introduced significant improvements in pharmacotherapy. The modern thymoleptica therapy started in 1957 with the introduction of imipramine. Now about 40 active antidepressants are marketed. New drug developments should be characterized mainly by an improvement in tolerance.

Medicina Complementar na Nova Zelandia

Herbal medications for common ailments in the elderly.

Drugs Aging;15(6):423-8, 1999 Dec. Ernst E

País de publicação: NEW ZEALAND

Resumo: The popularity of herbal medicine is at an all time peak. This article provides an overview of systematic reviews of herbal treatments for conditions common in elderly individuals. According to this evidence, there is little doubt that Hypericum perforatum (St John's Wort) is well tolerated and effective for mild to moderate depression. Although widely used, Valeriana officinalis (valerian) has not been shown beyond reasonable doubt to be effective for insomnia. There is relatively compelling evidence that Ginkgo biloba (ginkgo) is effective in delaying the clinical course of dementias. It has been well documented that Aesculus hippocastanum (horse chestnut) seed extracts alleviate the subjective symptoms and reduce the objective signs of chronic venous insufficiency. Serenoa repens (saw palmetto) is effective in improving the symptoms of benign prostatic hyperplasia. Finally, yohimbine has been shown to be effective forerectile dysfunction. It is concluded that several plant-based medicines can be useful additions to our therapeutic repertoire for treating common conditions in the elderly. However, several uncertainties remain and, at present, prevent unreserved recommendations.

St John's wort: Prozac from the plant kingdom.

Trends Pharmacol Sci;22(6):292-7, 2001 Jun. Di Carlo G; Borrelli F; Ernst E; Izzo AA

Resumo: Conventional antidepressants are associated with a range of adverse drug reactions. The herb Hypericum perforatum (St John's wort) might offer another approach to the treatment of depression. Biochemical and animal studies suggest that the phloroglucinol derivative hyperforin is the main active ingredient of St John's wort, and inhibits the synaptosomal uptake of 5-HT, noradrenaline, dopamine, glutamate and GABA. St John's wort has been shown to alleviate symptoms of mild to moderate depression, and seems to offer significant advantages over conventional antidepressants because it is associated with fewer adverse reactions. However, important herb--drug interactions have been described. In view of its efficacy and safety records, St John's wort should be considered for the first-line treatment of mild to moderate depression.

Effectiveness and tolerance of the hypericum extract LI 160 in comparison with imipramine: randomized double-blind study with 135 outpatients.

J Geriatr Psychiatry Neurol;7 Suppl 1:S19-23, 1994 Oct. Vorbach EU; Hübner WD; Arnoldt KH

Resumo: In a double-blind comparative study, 135 depressed patients were treated in 20 centers. Inclusion diagnoses were typical depressions with single episode (296.2), several episodes (296.3), depressive neurosis (300.4), and adjustment disorder with depressed mood (309.0) in accordance with DSM-III-R. The dosage was 3 x 300 mg hypericum extract LI 160 or 3 x 25 mg imipramine daily. The treatment lasted for 6 weeks. Main assessment criteria were the Hamilton Depression Scale (HAMD), the Depression Scale according to von Zerssen (D-S) and the Clinical Global Impressions (CGI). In both treatment groups, a parallel reduction of the Hamilton score from 20.2 to 8.8 (LI 160, n = 67) or from 19.4 to 10.7 (imipramine, n = 68), and the transformed D-S point values from 39.6 to 27.2 (LI 160) and 39.0 to 29.2 (imipramine) were found. The analysis of CGI revealed comparable results in both treatment groups. Clinically relevant changes of the safety parameters were not found. In the LI 160 group fewer and milder side effects were found as compared to imipramine.

The experimental and clinical pharmacology of St John's Wort (Hypericum perforatum L.).

Mol Psychiatry;4(4):333-8, 1999 Jul. Nathan P

Resumo: Hypericum (St John's Wort) is a plant that has been used for centuries as a medicinal herb. Pre-clinical animals studies suggest that hypericum is effective in three major biochemical systems relevant for antidepressant activity, namely the inhibition of the synaptic re-uptake system for serotonin (5-HT), noradrenaline (NA) and dopamine (DA). It is the only antidepressant capable of inhibiting the re-uptake of 5-HT, NA and DA with similar potencies. The potencies for monoamine re-inhibition and chronic changes in receptors are also consistent with changes seen with known antidepressants. Behavioral studies suggest that hypericum is active in pre-clinical animal models of depression with comparable effects to known antidepressants. Supporting the pre-clinical pharmacology and efficacy, many clinical studies have shown that hypericum has superior efficacy compared to placebo and comparable efficacy to standard antidepressants in the treatment of mild-to-moderate depression. The advantage of hypericum over other antidepressants may result from its favorable side-effect profile. Although pre-clinical and short-term clinical studies demonstrate antidepressant activity, the lack of long-term use and efficacy, and the heterogeneity of patients, interventions, extract preparations from previous clinical studies suggests that more careful and controlled studies are needed to determine the long-term efficacy of hypericum in mild-to-moderate depression.

St. John's Wort (Hypericum perforatum): clinical effects on depression and other conditions.

Altern Med Rev;3(1):18-26, 1998 Feb. Miller AL

Resumo: St. John's Wort (Hypericum perforatum), a perennial flowering plant, has been used medicinally for thousands of years, and has most recently been identified as an effective treatment for mild to moderate depression. Clinical studies on the use of this plant for depression have utilized liquid tinctures and standardized solid extracts (0.3% hypericin--300 mg three times a day). Severe depression may also respond to this botanical, although it appears a larger dose is needed (600 mg solid extract three times a day). Hypericum has been favorably compared to numerous antidepressant drugs, the studies having revealed equivalent results and a much more favorable incidence of side effects. Studies have also demonstrated its efficacy in treating seasonal affective disorder. In vitro investigations of Hypericum show antiviral activity, although there is evidence these promising results might not occur in vivo. Traditional actions and uses include enhancement of wound healing, as well as anti-inflammatory and analgesic activity.

St John's wort for depression: a systematic review.

Arch Intern Med;160(2):152-6, 2000 Jan 24. Gaster B; Holroyd J

Resumo: To address whether St John's wort is useful for the treatment of depression we attempted to retrieve all English-language articles with data on the efficacy, safety, and availability of St John's wort. Randomized, controlled, double-blind trials were selected and assessed for methodological quality using a standardized checklist, and data on pharmacology, cost, regulation, and safety were extracted. Eight studies were identified, found to be of generally good methodological quality, and determined to provide a modest amount of data to suggest that St John's wort is more effective than placebo in the treatment of mild to moderate depression. The absolute increased response rate with the use of St John's wort ranged from 23% to 55% higher than with placebo, but ranged from 6% to 18% lower compared with tricyclic antidepressants. More data are required to assess both its use in severe depression and its efficacy compared with other antidepressants. Rates of side effects were low. As a dietary supplement, St John's wort is currently largely unregulated, but the Food and Drug Administration is reviewing plans to tighten its regulatory oversight.

Comparison of St John's wort and imipramine for treating depression: randomised controlled trial.

BMJ;321(7260):536-9, 2000 Sep 2. Woelk H

Resumo: OBJECTIVES: To compare the efficacy and tolerability of Hypericum perforatum (St John's wort extract) with imipramine in patients with mild to moderate depression. DESIGN: Randomised, multicentre, double blind, parallel group trial. SETTING: 40 outpatient clinics in Germany. Participants: 324 outpatients with mild to moderate depression. INTERVENTION: 75 mg imipramine twice daily or 250 mg hypericum extract ZE 117 twice daily for 6 weeks. MAIN OUTCOME MEASURES: Hamilton depression rating scale, clinical global impression scale, and patient's global impression scale. RESULTS: Among the 157 participants taking hypericum mean scores on the Hamilton depression scale decreased from 22.4 at baseline to 12.00 at end point; among the 167 participants taking imipramine they fell from 22.1 to 12.75. Mean clinical global impression scores at end point were 2.22 out of 7 for the hypericum group and 2.42 for the imipramine group. On the 7 point self assessments of global improvement completed by participants (score of 1 indicating [quot ]very much improved[quot ] and 7 indicating [quot ]very much deteriorated[quot ]) mean scores were 2.44 in the hypericum group and 2.60 in the imipramine group. None of the differences between treatment groups were significant. However, the mean score on the anxiety-somatisation subscale of the Hamilton scale (3.79 in the hypericum group and 4.26 in the imipramine group) indicated a significant advantage for hypericum relative to imipramine. Mean scores on the 5 point scale used by participants to assess tolerability (score of 1 indicating excellent tolerability and 5 indicating very poor tolerability) were better for hypericum (1.67) than imipramine (2.35). Adverse events occurred in 62/157 (39%) participants taking hypericum and in 105/167 (63%) taking imipramine. 4 (3%) participants taking hypericum withdrew because of adverse events compared with 26 (16%) taking imipramine. CONCLUSIONS: This Hypericum perforatum extract is therapeutically equivalent to imipramine in treating mild to moderate depression, but patients tolerate hypericum better.

Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: a double-blind, randomized pilot study.

Clin Ther;22(4):411-9, 2000 Apr. Brenner R; Azbel V; Madhusoodanan S; Pawlowska M

Resumo: BACKGROUND: Hypericum (St. John's wort) has been shown to be as efficacious and well tolerated as standard antidepressants in the treatment of depression but has not been compared with selective serotonin reuptake inhibitors (SSRIs). OBJECTIVE: This study compared hypericum and the SSRI sertraline in the treatment of depression. METHODS: In a double-blind, randomized study conducted in a community hospital, 30 male and female outpatients (19 women, 11 men; mean age, 45.5 years) with mild to moderate depression received 600 mg/d of a standardized extract of hypericum (LI 160) or 50 mg/d sertraline for I week, followed by hypericum 900 mg/d or sertraline 75 mg/d for 6 weeks. RESULTS: The severity of symptoms, as assessed by scores on the Hamilton Rating Scale for Depression (HAM-D) and the Clinical Global Impression scale, was significantly reduced in both treatment groups (P < 0.01). Clinical response (defined as a > or =50% reduction in HAM-D scores) was noted in 47% of patients receiving hypericum and 40% of those receiving sertraline. The difference was not statistically significant. Both agents were well tolerated. A post hoc power analysis indicated that failure to reach statistical significance between treatments resulted primarily from an absence of clinical differences rather than the small sample size. CONCLUSION: The hypericum extract was at least as effective as sertraline in the treatment of mild to moderate depression in a small group of outpatients.

St John's wort for depression: what's the evidence?

Hosp Med;62(5):274-6, 2001 May. Kelly BD

Resumo: There is a moderate amount of evidence to suggest that St John's wort is better than placebo in the short-term management of mild to moderate depressive illness, but there is increasing concern over reports of drug interactions. This article examines the scientific evidence and discusses relevant clinical issues.

Hypericum perforatum: nature's mood stabilizerIndian

J Exp Biol;38(11):1077-85, 2000 Nov. . Kumar V; Singh PN; Muruganandam AV; Bhattacharya SK

País de publicação: India

Resumo: Hypericum perforatum (HP), better known as St. John's Wort, has been used clinically for centuries. Modern usage is still quite diverse and includes kidney and lung ailments, insomnia and depression. Standardised extracts of HP are widely used in the treatment of psychovegetative disorders and especially for mild forms of depression. Several bioactive constituents of this plant may play important role in its well-known antidepressant activity, which are discussed in the present article. Furthermore, emphasis is also given on its botany, chemistry, pharmacology and clinical efficacy.

Experience with St John's Wort (Hypericum perforatum) in children under 12 years with symptoms of depression and psychovegetative disturbances.

Phytother Res;15(4):367-70, 2001 Jun. Hübner WD; Kirste T

Resumo: The value of an extract of Hypericum perforatum (St John's wort) for children with mild to moderate depressive symptoms was investigated for the first time in a multi-centre post-marketing surveillance study. One hundred and one children under 12 years were treated for a minimum of 4 weeks with an extension to 6 weeks with parental consent and medical practitioner recommendation. the dosage used ranged from 300 to 1800 mg per day. Compliance, tolerability and efficacy were assessed every 2 weeks by physicians and parents. Based on the data available for analysis, the number of physicians rating effectiveness as 'good' or 'excellent' was 72% after 2 weeks, 97% after 4 weeks and 100% after 6 weeks. The ratings by parents were very similar. There was, however, an increasing amount of missing data at each assessment point with the final evaluation including only 76% of the initial sample. Tolerability was good and no adverse events were reported. The results of this study suggest that Hypericum is a potentially safe and effective treatment for children with symptoms of depression.

St. John's Wort.

Int J Psychiatry Med;30(3):203-19, 2000. Monti DA; Greeson JM; Kunkel EJ

Resumo: OBJECTIVE: The objective of this article is to review the current knowledge of the pharmacology, sites of action, and therapeutic effectiveness of St. John's Wort. METHOD: The method used was a review of the available literature, using keywords to search the medline database. Bibliographies of the papers, thus obtained, were searched for further documents not referenced by medline. We reviewed papers from this collection. RESULTS: This review reveals that most of the available data on efficacy and safety of St. John's Wort involve its use in mild to moderate depression. Much, but not all of the prevailing opinion is positive. Nevertheless, the quality of therapeutic trials vary so greatly that definitive conclusions are not possible. Both the source and mode of St. John's Wort's therapeutic effect are unclear. We need further controlled studies of effectiveness, safety, and mode of action. In addition to its use in depression, there are reports suggesting possible therapeutic effects in other conditions such as certain malignancies and infections, but these are far too preliminary to permit any conclusions.

St. John's wort: interaction with cyclosporine increases risk of rejection for the kidney transplant and raises daily cost of medication

Med Klin (Munich);96(8):480-3, 2001 Aug 15. Beer AM; Ostermann T

Resumo: ANAMNESIS: A 55-year-old female kidney transplant patient has suffered from diabetes mellitus since being a child. A kidney transplantation was carried out in 1985, requiring a standard immunosuppressive regime of cyclosporine. Cyclosporine blood levels (trough levels) remained stable over the years. DRUG INTERACTION: In 1995 the female patient started self-medication with St John's wort because of medium reactive depression. The standardized St John's wort extract (sold under the brand name Neuroplant) was taken at a dose of 300 mg three times daily. Laboratory investigations between 1995 and April 2000 showed decreased cyclosporine blood concentrations. The mean cyclosporine blood concentration before the comedication with St John's wort was 210.0 ng/ml (95% confidence interval: 171.8-248.2 ng/ml), during the comedication 81.1 ng/ml (95% confidence interval: 60.8-101.4 ng/ml) and was without the herbal remedy 149.8 ng/ml (95% confidence interval: 61.2-238.5 ng/ml). Cyclosporine dosage during the comedication with St John's wort was increased to a mean dosage of 8.2 mg/kg body weight daily (95% confidence interval: 7.0-9.4 mg/kg). In April 2000 the interaction of St John's wort with cyclosporine was suspected and the patient's self-medication was stopped. After stopping treatment with St John's wort, cyclosporine blood levels remained within the therapeutic range. CONCLUSION: Apart from an increased risk of graft rejection, the interaction also had cost implications because the dosage of this expensive drug had to be increased. In the period from 1995 to April 2000 an amount of approximately 15,300.- [symbol: see text] (30,000.- DM) of cyclosporine medication was necessary to avoid transplant rejection. The trend of the graphs strongly suggests that the treatment with St John's wort was the cause of the drop in plasma cyclosporine. It is of particular interest since this long-term observation uniquely reveals the raise of costs.

Taking the edge off: why patients choose St. John's Wort.

J Fam Pract;48(8):615-9, 1999 Aug. Wagner PJ; Jester D; LeClair B; Taylor AT; Woodward L; Lambert J

Resumo: BACKGROUND: The number of visits to alternative medicine practitioners in this country is estimated at 425 million, which is more than the number of visits to allopathic primary care physicians in 1990. Patients' use of St. John's Wort (SJW) has followed this sweeping trend. The purpose of our study was to examine the reasons people choose to self-medicate with SJW instead of seeking care from a conventional health care provider. METHODS: We used open-ended interviews with key questions to elicit information. Twenty-two current users of SJW (21 women; 20 white; mean age = 45 years) in a Southern city participated. All interviews were transcribed, and descriptive participant quotes were extracted by a research assistant. Quotes were reviewed for each key question for similarities and contextual themes. RESULTS: Four dominant decision-making themes were consistently noted. These were: (1) Personal Health Care Values: subjects had a history of alternative medicine use and a belief in the need for personal control of health; (2) Mood: all SJW users reported a depressed mood and occasionally irritability, cognitive difficulties, social isolation, and hormonal mood changes; (3) Perceptions of Seriousness of Disease and Risks of Treatment: SJW users reported the self-diagnosis of [quot ]minor[quot ] depression, high risks of prescription drugs, and a perception of safety with herbal remedies; and (4) Accessibility Issues: subjects had barriers to and lack of knowledge of traditional health care providers and awareness of the ease of use and popularity of SJW. Also of note was the fact that some SJW users did not inform their primary care providers that they were taking the herb (6 of 22). Users reported moderate effectiveness and few side effects of SJW. CONCLUSIONS: SJW users report depression, ease of access to alternative medicines, and a history of exposure to and belief in the safety of herbal remedies. Users saw little benefit to providing information about SJW to primary care physicians.

Hypericum for depression. An update of the clinical evidence.

Eur Neuropsychopharmacol;9(6):501-5, 1999 Dec Stevinson C; Ernst E

Resumo: This review is aimed at providing an updated evaluation of the clinical evidence regarding Hypericum perforatum (St. John's wort) as an antidepressant, based on recently published randomised controlled trials. Computerised literature searches revealed six trials published since the metaanalysis by Linde et al. (1996) [Linde, K., Ramirez, G., Mulrow, C.D., Pauls, A., Weidenhammer, W., Melchart, D., 1996. St. John's wort for depression--an overview and meta-analysis of randomised clinical trials. Br. Med. J. 313, 253-258]. The results of these studies provide further evidence that hypericum is superior to placebo in treating mild or moderate depression. However, there is still insufficient evidence to assess the efficacy of hypericum in comparison with conventional, particularly modern, antidepressants. Furthermore, there remains a lack of trials assessing long-term effects, other types of depression and different preparations and doses. It is concluded that recent clinical trials strengthen the case for hypericum as an antidepressant, but more work needs to be done to answer the remaining questions.

Neuropharmacology of St. John's Wort (Hypericum).

Ann Pharmacother;32(11):1201-8, 1998 Nov Bennett DA; Phun L; Polk JF; Voglino SA; Raffa RB.

Resumo: OBJECTIVE: To review preclinical information related to possible antidepressant mechanism(s) of action of St. John's wort in order to address the issue of whether its purported clinical effectiveness has a rational pharmacologic basis. DATA SOURCES: Primary and review articles were identified by a MEDLINE search (1966-January 1998) and through secondary sources. Many of the original German articles had English abstracts, but where necessary, German articles were translated into English. The results of a new screen of hypericin activity at receptor and uptake sites are summarized. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from the data sources were evaluated and all information deemed relevant was included in this review. DATA SYNTHESIS: The neuropharmacology of St. John's wort has been examined in only a few studies. A mechanism similar to that of the synthetic antidepressants, such as the selective serotonin-reuptake inhibitors or monoamine oxidase (MAO) inhibitors, might play a role, but other mechanisms are possible. CONCLUSIONS: Hypericum extracts have only weak activity in assays related to mechanisms of the synthetic antidepressants, that is, inhibition of MAO, catechol O-methyltransferase, or serotonin reuptake. It has been postulated that the clinical efficacy of St. John's wort could be attributable to the combined contribution of several mechanisms, each one too weak by itself to account for the overall effect. The recent demonstration of a significant affinity of hypericin for sigma receptors presents new possibilities for consideration.

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 2:77-80, 1997 Sep. Wheatley D

Resumo: Up to now, the antidepressant efficacy of the extract of St. John's wort, LI 160, has been compared to imipramine and maprotiline, demonstrating similar antidepressant efficacy in mildly to moderately depressed patients, treated either with LI 160 or the respective synthetic comparator. In the study reported here, LI 160 (total daily dose: 900 mg) was compared with the sedating tricyclic amitriptyline (total daily dose: 75 mg) in a controlled, randomized, multicentre trial. At the end of the 6-week study, the major target variable, the Hamilton Depression Scale response rate, exhibited no statistically significant difference between the groups, although a tendency for a better response rate was seen in the amitriptyline group. The secondary efficacy parameters, decreases in the total Hamilton Depression and Montgomery-Asberg scores, showed a significant advantage for amitriptyline, but only at week 6. With regard to tolerability, LI 160 was clearly superior to amitriptyline, particularly in relation to anticholinergic and Central Nervous System adverse events. Thus, 37% of the LI 160 treated patients reported adverse events, compared to 64% in the amitriptyline group. This considerable superiority in tolerability for LI 160 in relation to amitriptyline, could confer an advantage in improving compliance for antidepressant pharmacotherapy.

Placebo-controlled double-blind study examining the effectiveness of an hypericum preparation in 105 mildly depressed patients.

J Geriatr Psychiatry Neurol;7 Suppl 1:S9-11, 1994 Oct. Sommer H; Harrer G

Resumo: One hundred and five outpatients with mild depressions of short duration were treated in a double-blind study with either 3 x 300 mg hypericum extract or placebo. The therapy phase was 4 weeks. The effectiveness was judged according to the Hamilton Depression Scale after 2 and 4 weeks. The values of the mean basic score in these periods fell from 15.8 to 9.6 or 7.2 in the active group, and in the placebo group, from 15.8 to 12.3 and 11.3. The differences between active and placebo groups were statistically significant with P < .05 and P < .01 achieved after 2 and 4 weeks, respectively. In the active group, 28 of 42 patients (67%) and, in the placebo group, 13 of 47 patients (28%) responded to treatment. Notable side effects were not found.

Multicenter double-blind study examining the antidepressant effectiveness of the hypericum extract LI 160.

J Geriatr Psychiatry Neurol;7 Suppl 1:S15-8, 1994 Oct. Hänsgen KD; Vesper J; Ploch M

Resumo: Seventy-two depressive patients of 11 physicians' practices were treated in a double-blind study for a period of 6 weeks either with hypericum extract LI 160 or with placebo. Inclusion criterion was a major depression in accordance with DSM-III-R. The changes were assessed using four psychometric scales (HAMD, D-S, BEB, CGI). After 4 weeks of therapy, the statistical evaluation revealed a significant improvement in all four psychometric tests in the active group as compared to the placebo group. After switching the placebo group to active treatment (5th to 6th week of therapy), significant improvements were found in the original placebo group. No serious side effects were observed.

Modulation of cytokine expression by hypericum extract.

J Geriatr Psychiatry Neurol;7 Suppl 1:S60-2, 1994 Oct. Thiele B; Brink I; Ploch M

Resumo: The effect of hypericum extract LI 160 on the stimulated cytokine expression was investigated in vitro in a whole blood culture system. Blood samples were taken from five healthy volunteers and four depressive patients. The release of interleukin-6 (IL-6), interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) was measured quantitatively after an incubation time of 24 hours on microtiter plates. A massive suppression of the interleukin-6 release was found for PHA-stimulated hypericum extract. Possible relations to the antidepressive effects of hypericum extract are discussed.

Hypericum treatment of mild depressions with somatic symptoms.

J Geriatr Psychiatry Neurol;7 Suppl 1:S12-4, 1994 Oct. Hübner WD; Lande S; Podzuweit H

Resumo: In a randomized, placebo-controlled, double-blind study, 39 patients with depression with somatic symptoms were treated with hypericum extract LI 160. The therapy lasted for 4 weeks; the dosage was 300 mg three times daily. At the onset of the study as well as after 2 and 4 weeks, the following criteria were analyzed: HAMD, B-L, CGI, and vegetative symptoms. The results show a significant improvement in the active treatment group at the 5% level as compared to placebo. Seventy percent of the patients treated with LI 160 were free of symptoms after 4 weeks. Typical symptoms of the depression such as lack of activity, tiredness, fatigue, and disturbed sleep, were especially responsive. In no case were any undesirable side effects observed.

Phytochemicals as means to induce sleep

Z Arztl Fortbild Qualitatssich;95(1):33-4, 2001 Jan. Volz HP

Resumo: Phytopharmacons are widely used in Germany. Whereas St. John's wort extracts are prescribed for the treatment of mild forms of depression and kava-kava for unspecified anxiety syndromes, hop, balm, lavender, passiflora and valerian are traditionally administered against nervousness and sleep disturbances. Controlled clinical trials are only available for valerian. However, no sleep inducing potential of valerian was observed, only a certain positive effect on daytime mood. Therefore, the mentioned phytopharmacons cannot

Efeitos colaterais da Erva de São João

Algumas centenas de pessoas são afetadas pelos fitoterápicos; não é por ser planta que não faz mal, alertam os farmacologistas. Assim, o Hypericum perfuratum, anti – depressivo muito usado pelos clínicos, pode piorar quadros de insuficiência cardíaca, por interferir com a digoxina, pode interagir com o inibidor de protease anti- HIV, “indinavir”, diminuindo a eficácia do tratamento da AIDS. O hipericum não deve ser usado em conjunto com o “Prozac” ou Cloridrato de fluoxetina.

Sildenafil ( “Viagra”) for St. John Wort-induced sexual dysfunction.

J Sex Marital Ther;26(4):357-8, 2000 Oct-Dec. Assalian P

Consumer use of St. John's wort: a survey on effectiveness, safety, and tolerability.

Pharmacotherapy;20(5):568-74, 2000 May. Beckman SE; Sommi RW; Switzer J

Resumo: Despite its poorly described pharmacology, effectiveness, and safety, use of St. John's wort (SJW) is largely unsupervised and unexplored, and can potentially lead to adverse outcomes. We conducted a telephone survey of 43 subjects who had taken SJW to assess demographics, psychiatric and medical conditions, dosage, duration of use, reason for use, side effects, concomitant drugs, professional consultation, effectiveness, relapse, and withdrawal effects. Most subjects reported taking SJW for depression, and 74% did not seek medical advice. Mean dosage was 475.6+/-360 mg/day (range 300-1200 mg/day) and mean duration of therapy was 7.3+/-10.1 weeks (range 1 day-5 yrs). Among 36 (84%) reporting improvement, 18 (50%) had a psychiatric diagnosis. Twenty (47%) reported side effects, resulting in discontinuation in five (12%) and one emergency room visit. Two consumers experienced symptoms of serotonin syndrome and three reported food-drug interactions. Thirteen consumers experienced withdrawal symptoms and two had a depressive relapse. These data suggest the need for greater consumer and provider awareness of the potential risks of SJW in self-care of depression and related syndromes.

Benefits and risks of the hypericum extract LI 160: drug monitoring study with 3250 patients.

J Geriatr Psychiatry Neurol;7 Suppl 1:S34-8, 1994 Oct. Woelk H; Burkard G; Grünwald J

Resumo: Effectiveness and acceptance of a 4-week treatment with hypericum extract LI 160 were investigated by 663 private practitioners. The results of the 3250 patients (76% women and 24% men), were recorded using data sheets. The age of the patients ranged from 20 to 90 years (mean 51 years). Of the patients, 49% were mildly depressed, 46% intermediate, and 3% severely depressed. In about 30% of the patients, the situation normalized or improved during the therapy. Undesired drug effects were reported in 79 (2.4%) patients and 48 (1.5%) discontinued the therapy. Most frequently noted side effects were gastrointestinal irritations (0.6%), allergic reactions (0.5%), tiredness (0.4%), and restlessness (0.3%)

Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: a multicenter double-blind study.

J Geriatr Psychiatry Neurol;7 Suppl 1:S24-8, 1994 Oct. Harrer G; Hübner WD; Podzuweit H

Resumo: A randomized, double-blind study examining the effectiveness and tolerance of a standardized hypericum preparation when compared to maprotiline was performed in a group of 102 patients with depression, in accordance with ICD-10, F 32.1. The study was conducted in the offices of neurology and psychiatry specialists. The patients received, over a period of 4 weeks, either 3 x 300 mg of the hypericum extract or 3 x 25 mg maprotiline pills of identical appearance. Effectiveness was determined using the Hamilton Depression Scale (HAMD), the Depression Scale according to von Zerssen (D-S), and the Clinical Global Impression Scale (CGI). The total score of the HAMD scale dropped during the 4 weeks of therapy in both treatment groups by about 50%. The mean values of the D-S scale and the CGI scale showed similar results, and after 4 weeks of therapy, no significant differences in either treatment group were noticed. The onset of the effects occurred up to the second week of treatment, but were observed earlier with maprotiline than with the hypericum extract. On the other hand, maprotiline treatment resulted in more cases of tiredness, mouth dryness, and heart complaints.

Kava-kava

Doctors' prescription behaviour regarding dosage recommendations for preparations of kava extracts.

Pharmacoepidemiol Drug Saf;12(5):417-21, 2003 Jul-Aug. Dietlein G; Schröder-Bernhardi D

Resumo: BACKGROUND: There are many publications on the use of kava extracts as a treatment alternative to tricyclic antidepressants and benzodiazepines, but little has been done to investigate the potential adverse effects that may be associated with prolonged or high-dose usage. OBJECTIVES: To investigate the extent to which physicians comply with the recommended daily dose (RDD) of an antidepressant such as kava and the consequences of this behaviour with regard to the safety and efficacy of frequently prescribed kava extracts (Trade names: Antares, Laitan and Kavasporal forte). METHOD: The analysis was carried out using the patient database MediPlus, which provides anonymous access to a representative and valid panel of physicians and patients in Germany. RESULTS: Prescriptions for Antares showed that the RDD of 1 tablet per day was exceeded in 58.2% of the cases, while those for Laitan showed that the RDD of 1 capsule per day was significantly exceeded in 75.6% of the cases; a one-off prescription was issued in 66% of the cases. As a result, the required effect diminished very quickly. Prescriptions for Kavasporal forte showed that the daily dosage of 2 capsules per day complied with the recommendations in only 49.1% of the cases; in 38.8% of the cases, the dosage dropped below the respective recommendation. As a consequence, the lower-dosed Kavasporal forte was prescribed for longer periods than the higher-dosed Antares and Laitan. CONCLUSIONS: In the case of a low-dosage recommendation, we saw a trend to over-dose in prescribing behaviour, which increases the risk of undesirable adverse reactions. On the other hand, we saw a trend to under-dose in the case of a higher dosage recommendation. This fact may explain the unexpected inefficacy of the therapy. These trends affected the duration of therapy, whereby a dosage lower than the RDD was prescribed for a longer period than a dosage higher than the RDD.