Marplan

Recently, the British Medical Journal published a review of 23 randomized studies which showed that the herb, St. John's wort, is an effective treatment* for mild to moderate depression.

In our article on the subject, we reported that St. John's wort's extensive use in Germany has not resulted in published case reports of any serious adverse reactions (see HealthFacts, September 1996). Yet a HealthFacts reader called our attention to a researcher who cautions people about mixing St. John's wort with drugs that have a similar mechanism of action, specifically antidepressant and diet drugs.

In a telephone interview, Daniel Mowrey, Ph.D., director of the American Phytotherapy Research Laboratory in Salt Lake City, Utah, said, Taking 2-4 capsules daily of St.John's wort is no problem, but if you take it with the new weight loss drug, Redux, or another popular diet drug combination commonly referred to as 'fen-phen,' then adverse reactions can occur. (The term fen-phen refers to the combination of two drugs, fenfluramine and phentermine, sold, respectively, under the brands names of Pondimin and Ionaminsee HealthFacts, August 1996.)

He acknowledged the lack of published studies in which participants combine St. John's wort with diet drugs, But we can safely assume that any substance [like St. John's wort] that works on neurotransmitter levels of the brain, particularly serotonin, is going to have an interaction with similar acting drugs.

Prozac slowly restores the levels of serotonin in the brain; whereas fen-phen raises the levels and thus reduces craving for fattening foods. People frequently take St. John's wort with these prescription drugs, according to Dr. Mowrey.

Plants are fairly i ocuous, and most people would not experience adverse effects, he said, But a small percent will be sensitive. The problem is that there are so many different kinds of St. John's wort and efforts to standardize usually wind up making it stronger.

He made a distinction, however, between the reaction to Prozac or other antidepressants and the greater risk presented by diet drugs: Combining St. John's wort with Prozac would not be so serious, though it can cause central nervous system imbalances with short-term ill effects like anxiety, depression, nausea, sleep disorders, that quickly disappear when treatment is withdrawn. Diet drugs, however, increase the odds of this happening and may even cause side effects to occur with greater severity because they raise the levels of serotonin in the brain.

Similar warnings apply to the combination of diet drugs with other herbs, such as passion flower and valerian root. Also, combining one of these herbs with an older class of antidepressants called MAO inhibitors (e.g., Nardil, Parnate, Marplan) present the possibility of similar adverse reactions. Extensive research on how St. John's wort works has been conducted in Germany and to a lesser extent in Italy and France, said Dr. Mowrey.

Ten years ago, Dr. Mowrey authored a book called The Scientific Validation of Herbal Medicine. He is currently working on a revision, called The Herbal Desk Reference, to be published next year by Keats Publishing Company of New Canaan, Co ecticut.

COPYRIGHT 1996 Center for Medical Consumers, Inc.
COPYRIGHT 2004 Gale Group