Sunday, August 18, 2019

St. John’s Wort & Seasonal Affective Disorder (SAD)

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How St. John’s Wort Or Hypericum Extract Affects Seasonal Affective Disorder (SAD) And EEG Of Old Persons?

St. John’s Wort or Hypericum perforatum extract has been evaluated in SAD or Seasonal Affective Disorder patients. Its effect has been tested on sleep and quality of EEG or Electroencephalogram of older patients.

SAD or Seasonal Affective Disorder is a type of major depression with typical set of symptoms in a particular season. Light therapy is effective in SAD.

Hypericum extract therapy was found with antidepressant effect in SAD patients in this first study of its type. Assumptions of sensitization of hypericum by light gained more weight as a by product of this study. The favorable effect of hypericum on melatonin and cortisol secretion was also inferred to by this study.

Next study tested the effect of st. john’s wort extract treatment on sleep and EEG of older persons. Researchers concluded that hypericum therapy should be free of sedative effect. Additionally the onset time of sleep (the time one takes to sleep) is shortened and there is slight increase in the duration of deep sleep.

Benefit Of St. John’s Wort In Seasonal Affective Disorder (1994):

This has been a small and first study of hypericin on Seasonal Affective Disorder.

What Is SAD Or Seasonal Affective Disorder?

Seasonal affective disorder is a type of major depression with regular and time bound occurrence of symptoms in autumn and winter and full remission in spring and summer season. There are four specific features of SAD.

  1. Time related connection between onset of symptoms.
  2. Full remission during spring season or change of depression symptoms to mania or hypomania.
  3. Past history of two or three years of seasonal relationship of depression.
  4. Presence of seasonally dependent episodes of affective change are more common than any other non-seasonal affective disorder.

SAD And Light Therapy:

Light therapy has been proven to be effective in SAD. A standard intensity of 2500-3000 lux of light has been found effective. This intensity of light is four to five time stronger than average indoor light.

The best time for light therapy is the morning and it is applied from the distance of 90 cm. and for two hours. This light is filtered for ultraviolet and infrared rays to minimize adverse effects. Light therapy needs to be continued for two months without omission.

Many times antidepressant drugs are also prescribed along with light therapy.

St. John’s Wort In SAD:

20 SAD patients fulfilling DSM-3-R criteria were taken into this study of 4 weeks duration. All patients were given hypericin 2.7 mg in three divided doses daily. Half of patients were given light therapy with 3000 lux intensity and other group received only dim light with 300 lux intensity for two hours daily.

The clinical efficacy of st. john’s wort was demonstrated on HAMD scale, Supplementary HAMD scale, Hypomania scale, Expectation scale, Profile of Moods states, the von Zerssen Self-Rating Scale (Bf-S), von Zerssen´s Depression Scale (D-S), and Visual Analog scales.

Researchers concluded in this first ever trial of st. john’s wort for Seasonal affective disorder that hypericum has antidepressant effect in SAD patients. The previous assumption that antidepressant effect of st. john’s wort is increased by light therapy has been validated. This might be possible due to light sensitizing effect of st. john’s wort And perhaps nocturnal secretion of melatonin and cortisols might got affected favorably by using hypericum.

However there is a definite need for a larger study with placebo controlled group to affirm this study because this is rather a small and optimistic study.

Martinez, S. Kasper, S. Ruhrmann, and H.4. Möller

SO: J Geriatr Psychiatry Neurol 1994; (supl1) PP 29-33

How St. John’s Wort Affects EEG Of Older Persons (1994):

Sleep is an actively restful physiological stage that has characteristic changes in brain and nervous system. These changes are recorded in EEG, EMG (Electromyogram) and EOG (ElectroOculogram) studies.

Sleep is characterized by REM (Rapid Eye Movement) and NREM (Non Rapid Eye Movement) phases. NREM sleep has four subphases like NREM 1,2,3 and 4. NREM 3 and 4 stage is characterized by slow waves with frequency below 4 hertz.

The characteristic sleep pattern in depressive illness is fitful and frequent early waking. Slow wave sleep duration is reduced and the interval between onset of sleep and REM sleep is also shortened. Increased cholinergic neurotransmitter activity and reduced aminergic activity is the neurophysiological basis of sleep.

This double blind study is conducted with 12 patients to study the effect of hypericum on sleep and to compare it with the effect of tricyclic antidepreesants and nonselective MAO inhibitors. Antidepressant drugs prolong REM latency and shorten REM sleep.

Therapy with st. john’s wort didn’t have any significant effect on the duration of sleep. Rather there is slight shortening of REM latency period i.e. 10 minutes that is seen only at the beginning of therapy. After 4 weeks of treatment, this slight shortening of REM latency was not seen. These findings suggest that there is no danger of drowsiness or sedative effect with st. john’s wort therapy.

There was no effect on the proportion of REM and NREM sleep duration. The most significant effect is on the slow wave pattern of delta waves. This slow wave pattern duration is increased and it is the most restful part of sleep. Other researchers like Kupfer et al also reported that the prognosis (chance of betterment) is more favorable with those depression patients that has more slow wave pattern duration in sleep.

Conclusively it can be said based on this study that there is no danger of sedation with st. john’s wort and the time duration for onset of sleep is also shortened and there is slight increase in the duration of deep sleep period.

Au: Schulz and M. Jobert

So: J Geriatr Psych in. try Neurol 1994; 7(suppl 1): PP 39-43

Arjun
As a native Indian and an Ayurvedic holistic healer, Arjun writes in the lane of herbal healing and home remedies. Certification: BAMS (Bachelor of Ayurvedic Medicine & Surgery With Modern Medicine).

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