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Genetic heart disease and st. john's wort
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Genetic heart disease and st. john's wort

  Is it safe for a 46-yr-old man who has terrible genetic heart disease (heart attack and double bypass surgery 5 years ago)to take St. John's Wort for depression?  He tried Prozac and didn't like it and would rather take a natural substance.  He is concerned about its effect on his heart and long term side effects.  How much can he take per day?
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Dear Judy,
Although St.John's wort is licensed in Germany for the treatment of anxiety,
depression, and insomnia, it is considered a dietary supplement in the USA and therefore has not been studied (efficacy nor safety.)
St.John's wort is the common name for the flowering plant Hypericum perforatum.  Although it has many ingredients that show biologic activity, the  active ingredient is generally considered to be the Hypericin.  In Germany the dosage of the herb is based on the hypericin content.  It is important to note that the amount of hypericin varies widely in different parts of the plant and is dependent on growth conditions and the time of year.
As far as human (clinical)trials go, there is a summary of some 23 trials of St.John's wort in 1,757 outpatients with mild to moderate depression that was published in the British Medical Journal (BMJ) in 1996 (the  reference is BMJ 313:253, 1996 in case you have access to a medical library where a librarian could easily obtain a copy of this journal article for you to read.)  Basically what the study concludes is that hypericum extracts was superior to placebo(no drug) and about as effective as standard antidepressents in two to four weeks time.  
In terms of adverse effects, no serious adverse effects have been reported with use of St.John's wort.  Some patients have complained of dry mouth, dizziness, constipation, other gastrointestinal symptoms, and confusion, however less than 2% of the patients in that trial I spoke of above actually stopped taking the herb because of adverse effects.  There have been one or two reports of significant photosensitivity reported in patients taking the herb for depression.
In conclusion, we need better, longer (than a few weeks) trials of the herb in order to establish the effectiveness and safety of St.John's wort for the treatment of depression.  Most importantly, at present the active ingredients, the potency, and the purity of the preparations sold in the USA are all unknown.
So Judy, if a person decides to try this herb for the treatment of his/her mild to moderate depression (patients with severe depression really should be on a drug and under care of a psychiatrist), he or she is doing so at their own risk.
Considering that the drug has been used widely in Germany and that little if any side effects have been reported, I certainly would not think it out of the question to give it a try.  HOWEVER, it really is pertinent that you discuss this with your physician who knows you, your history, your medicines, etc. and would be the best person to guide you in the trial as such.  Keep in mind Judy that most medications we have today were developed from plants and the only real difference between an antidepressent and St.John's wort may simply be that one has been studied by the FDA and the herb-NOT.  Thus you might say it safer to take the drug.  I will grant you that the antidepressents currently on the market are known to get in to your brain, whereas the St.John's wort is not well understood and it is unclear whether or not it crosses the blood brain barrier.  All that I am really saying is that St.John's wort may be more "natural" than a pharmaceutical drug, however this is not necessarily so as many drugs come from nature (plant extracts.)
I have not answered your question, which is unanswerable (the FDA does not study herbs and dietary supplements), but I have given you some ground on which to defend your trial at a "natural" way of treating depression.  
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.

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