2005-11-15- St. John’s Wort(俗稱金絲桃)與憂鬱症治療-美國國家衛生研究院另類醫學研究中心重要報告 (Taiwan Scientific Health News)

 

引言:

美國國家衛生研究院(NIH)的另類醫學研究中心(NCCAM)最近發表了一份重要的概要說明,內容提及St. John’s Wort(金絲桃)在治療憂鬱症方面的使用;意在協助消費者對於另類療法藥物在某種疾病或醫療狀況的使用上有一更充份的了解.

摘要:

l             St. John's wort是一種天然的草本植物,數個世紀以來極具醫療價值,其中包括用於治療憂鬱症.

l             St. John's wort的主要成份以及它為什麼有可能治療憂鬱症,至今科學界還不能完全明瞭其真正原因.

l             科學界業已證實St. John's wort在治療輕度與中度憂鬱症方面有一定程度的功效;然而,最近有些科學研究報告也顯示 St. John's wort在治療重度憂鬱症方面並沒有效果. 進一步擴大研究可以幫助我們更加了解St. John's wort在治療其它型態的憂鬱症方面是否也具有療效.

l             St. John's wort如果混合其它一些特定藥物使用,可能會引發不良副作用而危及病患,使用時必須謹慎小心.

l             最好隨時告知您的醫師現階段您所使用及考慮要接受的任何治療,包括您現今攝取的任何營養保健補品等以確知您有一個安全與調和性兼具的醫療照護. 

FAQ:

1. 什麼是St. John's wort(金絲桃)?

St. John's wort(拉丁文為Hypericum perforatum)是一種有著黃色花朵,非常耐活的植物,當中含有許多化學成份被認為是使這種草本植物具有藥效的主要來源(其中包括hypericinhyperforin兩種成份).  初步研究顯示St. John's wort的作用可能在於它可以防止腦神經細胞對於化學傳導物血清素的再吸收,或者是降低身體中免疫系統運作所需的一種特殊蛋白質的濃度.

2. 在醫療上, St. John's wort的使用範圍為何?

幾世紀以來,St. John's wort一直被用來作為治療精神失調與神經痛方面的疾病. 根據古代醫生與草本植物學家們的記載,它多半被視為是一種鎮靜劑及作為治療瘧疾與傷口,燒燙傷,昆蟲咬傷等的鎮痛軟膏. 直到今日, St. John's wort業已被證實在治療輕度與中度憂鬱症上有一定程度的療效.  

3. 何謂憂鬱症?

根據美國國家心理健康研究院(NIMH)的消息來源,每年全美國有將近一千九百萬人深受憂鬱症所苦;憂鬱症是一種心理狀況,影響層面及一個人的情緒,想法,生理健康及行為. 最常見的症狀包括如:

l             常常壟罩在悲傷的情緒當中

l             對以往喜愛的活動頓時變得失去興趣與樂趣

l             食慾和體重有顯著的改變

l             有嗜睡與失眠的狀況產生

l             易怒並顯現不尋常的遲鈍

l             失去活力與幹勁

l             常感到自己無用及有罪惡感

l             無法集中注意力或很難作任何決定

l             反覆有死亡或自殺的念頭

典型的憂鬱症包括以下三種型態,每一種型態都隨著個人而經歷程度不同的症狀.

l     重度憂鬱症(Major depression): 經常壟罩在悲傷的情緒中或對以往喜愛的活動頓時變得失去興趣與樂趣長達至少兩個星期以上. 此外,他們至少還具有其它四種不同的憂鬱症狀,症狀可能持續維持六個月以上.

l     輕度憂鬱症(minor depression): 病患經歷症狀與重度憂鬱症狀內容大致相同,然而患有較少種的憂鬱症狀,症狀維持時間至少大於兩個星期卻小於六個月.

l     輕鬱症或稱為低落性情感疾患(dysthymia): 一種較溫和卻長期慢性的憂鬱症型態,沮喪情緒足以維持至少兩年(孩童至少一年)並伴隨著至少其它兩種憂鬱症狀.

l     躁鬱症或稱為雙極性疾患(bipolar disorder): 病患常處於躁狂憂鬱狀態,週期性憂鬱症狀伴隨週期性躁狂症狀. 症狀包括不正常地極端興奮與過剩的精力,狂躁的思想,並時常有衝動及不適當的行為出現. 

4. St. John’s wort 為何會被用來作為治療憂鬱症的一種選擇?

有些服用醫生開立抗憂鬱症處方藥的病患,憂鬱症狀並未因此而減緩;另外有些病患甚至因而有不愉快的副作用產生;譬如口乾,噁心,頭痛或影響性功能及睡眠品質等. 因此有些人認為如St. John's wort一類的天然草本保健品因為自然又安全’,’不必醫生開立處方又較便宜’,所以就認為St. John's wort優於處方藥,這當然也是很不正確的觀念.

5. St. John's wort被用來治療憂鬱症至今有多普徧?

在歐洲, St. John's wort被醫生當作處方藥開立給患者服用的情形相當普徧. 在美國, St. John's wort不屬於醫生開立的處方藥,但是仍有為數不少的民眾對它有極高的興趣.  St. John's wort在美國所有天然草本保健品的銷售排行榜中,一直是名列前茅的.

6. St. John's wort以何種包裝形式來販賣?

它是以(1)膠囊的形式(2)可供泡茶的形式 -- 乾的加入St. John's wort煮開的沸水後,浸潤一些時候即可服用(3)萃取物的方式 -- 先將某些特定的化學物由St. John's wort中移除,而後即能在濃縮的St. John's wort萃取物裡保留想要保留的化學物.

7.在治療憂鬱症方面,St. John's wort 是否真的有效?

在歐洲,有些科學研究報告顯示使用某些特定的St. John's wort的萃取物來治療憂鬱症的確有療效;概觀大約23篇臨床研究報告顯示St. John's wort對於治療輕度與中度憂鬱症可能真的有幫助. 這些研究一共囊括了1,757位門診病患調查發現,St. John's wort比較病患僅僅服用寬心劑而已要來得有療效許多,比較服用一般標準的抗憂鬱症處方藥也少了許多副作用(Linde et al. British Medical Journal, 1996).

然而,最近一些新的研究報告發現,St. John's wort對於治療重度憂鬱症病患比較僅僅服用寬心劑或標準抗憂鬱症處方藥的病患並無特別的療效(Shelton et al. JAMA, 2001).

此外,美國國家衛生組織另類醫學研究中心(NCCAM),旗下的營養補充食品處(ODS),及美國國家心智健康研究院(NIMH) --也成立了一項大規模的研究,針對St. John's wort的萃取物謹慎地設計實驗用以發現St. John's wort是否對於治療重度憂鬱症患者具有療效; 結果所得到的結論是相同的,那就是St. John's wort對於治療重度憂鬱症病患比較僅僅服用寬心劑的病患並無特別的療效(Hypericum Depression Trial Study Group. JAMA, 2002; for further information, view the press release online at nccam.nih.gov/news/2002 or contact the NCCAM Clearinghouse).

8. 使用St. John's wort來治療憂鬱症具有任何風險嗎?

是的,St. John's wort來治療憂鬱症的確存在一些風險. 很多所謂的”天然”物質尤其是在大量攝取後或和患者現階段服用的其他藥物相互作用下,的確有可能對身體造成一些有害的後遺症.

由美國國家衛生研究院(NIH)所作的研究顯示St. John's wort有可能會和某些特定的藥物相互作用,譬如用來治療HIV感染的藥物(indinavir);另有研究報告顯示St. John's wort 還有可能和一些化療或抗癌的藥物(irinotecan)相互作用.

至今St. John's wort還不足以稱作是一被完全證實可以治療憂鬱症的治療方法;憂鬱症如果沒有尋求適當地治療,病情可能加重,有些病患甚而以自殺收場. 重要的是不論是你或你周圍的人患有此症時,最好先諮詢您的醫師.

一般而言,服用St. John's wort的副作用包括口乾,頭暈,腹瀉,噁心,對陽光非常敏感與常感疲勞.

9. 除此之外,使用St. John's wort還有可能會衍生其它問題嗎?

 

天然植物產品如St. John's wort被美國食品藥物管理局(FDA)歸類為營養保健食品. FDA對於藥物核准的要求比較營養保健食品要來的嚴格許多;和藥物不同的是,販賣營養保健食品標籤上並不要求註明劑量,安全性或效果如何等.(參考NCCAM fact sheet "What's in the Bottle? An Introduction to Dietary Supplements."). 

 

天然保健食品是否有療效或品質如何通常都難以預測.  不同的品牌不僅成份內容不逕相同,每一批作出來的產品是否一致更是啟人疑竇;標籤上的資訊更是有可能會誤導大眾或傳達不正確的訊息(參考 " NCCAM fact sheet "Herbal Supplements: Consider Safety, Too").

10. 美國國家衛生組織另類醫學研究中心(NCCAM)所作有關St. John's wort的大型臨床實驗除了針對憂鬱症外,是否也包括其它心理疾病?

是的,目前最新的研究計劃包括:

l             使用St. John's wort對於治療輕度憂鬱症(minor depression)的安全性與        療效

l             使用St. John's wort對於治療社交畏懼症(social phobia)的安全性

l             使用St. John's wort對於治療強迫症(obsessive compulsive disorder)的安全性

l             使用St. John's wort對於避孕藥的藥效影響

l             使用St. John's wort對於麻醉止痛劑的藥效影響

 

*St. John's Wort and the Treatment of Depression

http://nccam.nih.gov/health/stjohnswort/

 

 

On this page

 

Introduction

The National Center for Complementary and Alternative Medicine (NCCAM) has developed this fact sheet on the use of St. John's wort for depression. It is part of a series intended to help consumers make informed decisions about whether to use complementary and alternative medicine (CAM) for a disease or medical condition. NCCAM defines CAM as approaches to health care that are not currently part of conventional medicine as practiced in the United States.a

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Key Points

  • St. John's wort is an herb that has been used for centuries for medicinal purposes, including to treat depression.
  • The composition of St. John's wort and how it might work are not well understood.
  • There is some scientific evidence that St. John's wort is useful for treating mild to moderate depression. However, recent studies suggest that St. John's wort is of no benefit in treating major depression of moderate severity. More research is required to help us know whether St. John's wort has value in treating other forms of depression.
  • St. John's wort interacts with certain drugs, and these interactions can be dangerous.
  • It is important to inform all of your health care providers about any therapy that you are currently using or considering, including any dietary supplements. This is to help ensure a safe and course of care.

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a Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. To find out more, see the NCCAM fact sheet "What Is Complementary and Alternative Medicine?"

 

Frequently Asked Questions

1. What is St. John's wort?
St. John's wort (Hypericum perforatum in Latin) is a long-living plant with yellow flowers. It contains many chemical compounds. Some are believed to be the active ingredients that produce the herb's effects, including the compounds hypericin and hyperforin.

How these compounds actually work in the body is not yet known, but several theories have been suggested. Preliminary studies suggest that St. John's wort might work by preventing nerve cells in the brain from reabsorbing the chemical messenger serotonin, or by reducing levels of a protein involved in the body's immune system functioning.

2. For what medicinal purposes has St. John's wort been used?
St. John's wort has been used for centuries to treat mental disorders as well as nerve pain. In ancient times, doctors and herbalists (specialists in herbs) wrote about its use as a sedative and treatment for malaria as well as a balm for wounds, burns, and insect bites. Today, St. John's wort is used by some people to treat mild to moderate depression, anxiety, or sleep disorders.

3. What is depression?
Information on depression is available from the National Institute of Mental Health. Here is a brief overview.

Depression is a medical condition that affects nearly 19 million Americans each year. A person's mood, thoughts, physical health, and behavior all may be affected. Symptoms commonly include:

  • Ongoing sad mood
  • Loss of interest or pleasure in activities that the person once enjoyed
  • Significant change in appetite or weight
  • Oversleeping or difficulty sleeping
  • Agitation or unusual slowness
  • Loss of energy
  • Feelings of worthlessness or guilt
  • Difficulty "thinking," such as concentrating or making decisions
  • Recurrent thoughts of death or suicide

Depressive illness comes in different forms. The three major forms are described below. Each can vary from person to person in terms of symptoms experienced and the severity of depression.

  • In major depression, people experience a sad mood or loss of interest or pleasure in activities for at least 2 weeks. In addition, they have at least four other symptoms of depression. Major depression can be mild, moderate, or severe. If it is not treated, it can last for 6 months or more.

 

  • In minor depression, people experience the same symptoms as major depression, but they are fewer in number and are less disabling. Symptoms last at least 6 months but less than 2 years continuously.
  • In dysthymia, a milder, but more chronic form of depression, people experience a depressed mood for at least 2 years (1 year for children) accompanied by at least two other symptoms of depression.

 

  • In bipolar disorder, also called manic depression, a person has periods of depressive symptoms that alternate with periods of mania. Symptoms of mania include an abnormally high level of excitement and energy, racing thoughts, and behavior that is impulsive and inappropriate.

Some people still hold outdated beliefs about depression--for example, that the emotional symptoms caused by depression are "not real" and that a person can merely "will" himself out of it. Depression is a real medical condition. It can be treated effectively with conventional medicine, including by antidepressant drugs and certain types of psychotherapy (talk therapy).

4. Why is St. John's wort used as an alternative therapy for depression?
Some patients who take antidepressant drugs do not experience relief from their depression. Other patients have reported unpleasant side effects from their prescription medication, such as a dry mouth, nausea, headache, or effects on sexual function or sleep.

Sometimes people turn to herbal preparations like St. John's wort because they believe "natural" products are better for them than prescription medications, or that natural products are always safe. Neither of these statements is true (this is discussed further below).

Finally, cost can be a reason. St. John's wort costs less than many antidepressant medications, and it is sold without a prescription (over the counter).

5. How widely is St. John's wort used for treating depression?
In Europe, St. John's wort is widely prescribed for depression. In the United States, St. John's wort is not a prescription medication, but there is considerable public interest in it. St. John's wort remains among the top-selling herbal products in the United States.

6. How is St. John's wort sold?
St. John's wort products are sold in the following forms:

  • Capsules
  • Teas--the dried herb is added to boiling water and steeped for a period of time.
  • Extracts--specific types of chemicals are removed from the herb, leaving the desired chemicals in a concentrated form.

7. Does St. John's wort work as a treatment for depression?
There has been scientific research to try to answer this question.

In Europe, results from a number of scientific studies have supported the effectiveness of certain St. John's wort extracts for depression. An overview of 23 clinical studies found that the herb might be useful in cases of mild to moderate depression. The studies, which included 1,757 outpatients, reported that St. John's wort was more effective than a placebo (here, a "dummy" pill designed to have no effect) and appeared to produce fewer side effects than some standard antidepressants (Linde et al. British Medical Journal, 1996).

Other studies conducted recently have found no benefit from the use of St. John's wort for certain types of depression. For example, the results of a study funded by Pfizer Inc., a pharmaceutical company, found that St. John's wort, when compared with placebo, was not effective for treating major depression (Shelton et al. JAMA, 2001).

In addition, several components of the National Institutes of Health (NIH)--NCCAM, the Office of Dietary Supplements (ODS), and the National Institute of Mental Health (NIMH)--funded a large, carefully designed research study to find out whether St. John's wort extract benefits people with major depression of moderate severity. This clinical trial (a research study in people) found that St. John's wort was no more effective for treating major depression of moderate severity than placebo (Hypericum Depression Trial Study Group. JAMA, 2002; for further information, view the press release online at nccam.nih.gov/news/2002 or contact the NCCAM Clearinghouse).

 

 

Also, St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe and, in some cases, may be associated with suicide. Consult a health care practitioner if you or someone you care about may be experiencing depression.

People can experience side effects from taking St. John's wort. The most common side effects include dry mouth, dizziness, diarrhea, nausea, increased sensitivity to sunlight, and fatigue.

 

8. Are there any risks to taking St. John's wort for depression?
Yes, there are risks in taking St. John's wort for depression.

Many so-called "natural" substances can have harmful effects--especially if they are taken in too large a quantity or if they interact with something else the person is taking.

Research from NIH has shown that St. John's wort interacts with some drugs--including certain drugs used to control HIV infection (such as indinavir). Other research shows that St. John's wort can interact with chemotherapeutic, or anticancer, drugs (such as irinotecan). The herb may also interact with drugs that help prevent the body from rejecting transplanted organs (such as cyclosporine). Using St. John's wort limits these drugs' effectiveness.

Also, St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe and, in some cases, may be associated with suicide. Consult a health care practitioner if you or someone you care about may be experiencing depression.

People can experience side effects from taking St. John's wort. The most common side effects include dry mouth, dizziness, diarrhea, nausea, increased sensitivity to sunlight, and fatigue.

9. What are some other possible problems with using St. John's wort?
Herbal products such as St. John's wort are classified as dietary supplements by the U.S. Food and Drug Administration (FDA), a regulatory agency of the Federal Government. The FDA's requirements for testing and obtaining approval to sell dietary supplements are less strict than its requirements for drugs. Unlike drugs, herbal products can be sold without requiring studies on dosage, safety, or effectiveness. For more information, see the NCCAM fact sheet "What's in the Bottle? An Introduction to Dietary Supplements."

The strength and quality of herbal products are often unpredictable. Products can differ in content not only from brand to brand, but from batch to batch. Information on labels may be misleading or inaccurate. For more information on safety issues, see the NCCAM fact sheet "Herbal Supplements: Consider Safety, Too."

10. Is NCCAM funding research on St. John's wort, including for depression and other mental illnesses?

Yes. For example, recent projects supported by NCCAM include:

  • Safety and effectiveness of St. John's wort for the treatment of minor depression
  • Safety of St. John's wort for the treatment of social phobia
  • Effectiveness of St. John's wort for the treatment of obsessive compulsive disorder
  • Effects of St. John's wort on how well birth control pills work
  • Possible adverse interactions of St. John's wort and narcotic pain medications

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For More Information

NCCAM Clearinghouse

Toll-free in the U.S.: 1-888-644-6226
International: 301-519-3153
TTY (for deaf or hard-of-hearing callers): 1-866-464-3615

E-mail: info@nccam.nih.gov
Web site: nccam.nih.gov
Address: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg, MD 20898-7923

Fax: 1-866-464-3616
Fax-on-Demand service: 1-888-644-6226

The NCCAM Clearinghouse provides information about CAM and about NCCAM. Services include fact sheets, other publications, and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

CAM on PubMed
Web site: www.nlm.nih.gov/nccam/camonpubmed.html

CAM on PubMed, a database on the Internet developed jointly by NCCAM and the National Library of Medicine, offers citations to (and in most cases, brief summaries of) articles on CAM in scientifically based, peer-reviewed journals. CAM on PubMed also links to many publisher Web sites, which may offer the full text of articles.

National Institute of Mental Health (NIMH)
Web site: www.nimh.nih.gov
Toll-free: 1-800-421-4211
E-mail: nimhinfo@nih.gov
Address: 6001 Executive Blvd., Rm. 8184, MSC 9663, Bethesda, MD 20892-9663

NIMH is committed to reducing the burden of mental illness through research on mental disorders and the underlying basic science of brain and behavior. NIMH provides publications on depression and other illnesses.

Office of Dietary Supplements (ODS), NIH
Web site: ods.od.nih.gov
Address: 6100 Executive Blvd., Bethesda, MD 20892-7517

ODS, whose mission is to explore the potential role of dietary supplements to improve health care, promotes the scientific study of dietary supplements through conducting and coordinating scientific research and compiling and disseminating research results. Its public information is offered via its Web site only.

ClinicalTrials.gov
Web site: clinicaltrials.gov

ClinicalTrials.gov provides patients, family members, health care professionals, and members of the public access to information on clinical trials, primarily in the United States and Canada, for a wide range of diseases and conditions. It is sponsored by NIH and the FDA.

Computer Retrieval of Information on Scientific Projects (CRISP)
Web site: crisp.cit.nih.gov

CRISP is a searchable database of federally funded (including by NIH) biomedical research projects conducted at universities, hospitals, and other research institutions.

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Selected Sources

American Herbal Pharmacopoeia and Therapeutic Compendium. St. John's wort (Hypericum perforatum) Monograph. Herbalgram: The Journal of the American Botanical Council and the Herb Research Foundation. 1997;s (40):1-16.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Washington, DC: American Psychiatric Association, 1994.

National Institute of Mental Health. Fact Sheets on Depression--"The Invisible Disease: Depression," "Depression Research at the National Institute of Mental Health," and "The Numbers Count: Mental Disorders in America," available online at www.nimh.nih.gov or see "For More Information" above.

Hypericum Depression Trial Study Group. "Effect of Hypericum perforatum (St. John's wort) in major depressive disorder: A Randomized, Controlled Trial". Journal of the American Medical Association. 2002; 287:1807-14.

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