![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by dj on August 15, 2000, at 19:52:30
CamW,
Maybe you can comment on the credibility of the following, which is from a supposedly credible source.
The following are from a newsletter for Enzymatic Therapy which manufactures and distributes more than 200 nutritional supplements, herbal extracts, and natural medicines. All Enzymatic Therapy
formulations, from raw materials to finished products, are lab-tested for purity, potency, and bioavailability.- http://www.enzy.comNutrition Newsbytes
Your link to nutrition discoveriesIN THE NEWS
ST. JOHN'S WORT AND ZOLOFT? TREAT DEPRESSION EQUALLY WELL
A new study indicates St. John's wort is as effective as the prescription
drug Zoloft? for the treatment of mild to moderate depression.The double-blind randomized, single-center trial was performed on 30 male
and female outpatients in a community hospital. Researchers gave patients
either 600 mg/day of a standardized hypericum extract or 50 mg/day of
sertraline (Zoloft) daily for one week. This regimen was followed by giving
subjects either 900 mg per day of St. John's wort or 75 mg/day of
sertraline for six weeks. Both regimens significantly reduced the severity
of depressive symptoms, as measured with scores on the Hamilton Rating
Scale for Depression (HAM-D) and the Clinical Global Impression scale.
Clinical response, defined as a 50% reduction or more in HAM-D scores, was
noted in 47% of patients receiving hypericum and 40% of those receiving
sertraline. The difference was not statistically significant.The study appears in volume 22, issue number 4 of the journal Clinical
Therapeutics. The article is entitled, "Comparison of an Extract of
Hypericum (LI 160) and Sertraline in the Treatment of Depression: A
Double-Blind, Randomized Pilot Study."and
HERBAL COMBINATION BOOSTS MENTAL POWER
Even healthy, middle-aged adults who live and work in a fast-paced and
demanding work environment can benefit from the herbal combination of
stabilized Panax ginseng and Ginkgo biloba.A unique combination of the two herbs has been shown to significantly
enhance fast, accurate thinking and short-and long-term memory, and reduce
mental fatigue.The 14-week, double-blind, placebo-controlled, randomized, multi-center
study looked at the cognitive effects of the herbal combination in 256
healthy volunteers between ages 38 and 66. The volunteers performed a
battery of tests using the Computerized Cognitive Assessment System, a
validated testing method accepted by the FDA and used to assess the effect
of cognitive enhancing products. The study showed the group of volunteers
receiving the active herbal combination had statistically significant
improvement in cognitive function (average of +7.5%) compared to the
control group.Results of the study were presented at a National Institute of Mental
Health seminar and announced June 6, 2000, at a press conference at The
Rockefeller University in New York City.
Posted by Cam W. on August 15, 2000, at 21:53:11
In reply to St. John's Wort and Zoloft comparison and...CamW?, posted by dj on August 15, 2000, at 19:52:30
dj - Yes, SJW does work for "mild to moderate" depression, but not severe, atypical or psychotic depressions.
There are some interesting methodological problems with the first study cited:
1) The sample size of the study is very small (N=30), so it is hard to get any accurate statistics from the results.
2) The Zoloft dose is fairly low, with 100mg daily being a fairly standard adult dose.
3) Both SJW and Zoloft can take up to 8 weeks to exert their full effect. The study was only six weeks long.
4) I've always hated a 50% reduction in HAM-D scores as a measure of antidepressant efficacy. For example, if someone who is severely depressed and has a high HAM-D score, a 50% reduction can mean that the depressive symptoms are still significant. These patients, being outpatients, are probably not severely depressed, though.
5) There is no mention of how many people finished the study and how many dropped out. There is almost always an attrition rate in any study.
6) The response rates of both are rather low. You usually expect 2/3 of depressed people to respond to an antidepressant. Neither drug was particularily effective.
7) Was there a placebo arm to this study? It would be interesting to see how many placebo responders that there were.
I do not disagree that SJW and Zoloft work for mild to moderate depression, but I would want to use Zoloft for more severe depressions.
Herbal Combination of Ginseng and Ginkgo.
Long term studies recommend that ginseng be used no longer than 8 months. I can't remember the exact reason, but I think it had something to do with liver problems (I could be wrong).
Ginkgo does work, but you have to have decreased blood perfusion (widespread blood flow problems) to the brain to see any significant results with it. In other words you have to have cognitive deficits to notice any improvements when taking tha drug.
Really, is 7.5% a significant increase in cognitive function? The same could probably be done by doing crossword puzzles for a month. A portion of that would be placebo effect. Also, people often do better on cognitive batteries the second time they take them because they are more familiar with the format. This is probably (hopefully) minimized with FDA-approved cognitive batteries.There are probably some slight, but noticeable gains in some people. The 7.5% is an average. This means that some people could have had a decrease in cognitive function.
I do not have a problem with herbal products in general. It is just that many people equate natural with safe and this is dangerous. Anything one takes to alleviate or prevent a medical condition must be considered a drug (even water, when used to flush out the cold virus) and all drugs (even water) have risks. This is especially the case when one mixes herbs with allopathic (convensional) drugs. We still do not know all of the interactions that can occur. Also, most people do not tell their doctor of herb use and this can also lead to drug-herb interaction problems or efficacy problems.
One last comment. Yes, many herbs do have a medicinal effect, but look at the price one pays for them. Most herb companies do not do much, if any, testing of their product, yet herbs are as expensive (sometimes more) than tested and effective allopathic medication. Where does this cost saving on the part of herbal companies end up? In the pockets of the owners and shareholders of herbal companies. And you thought that multinational drug companies were the only crooks.
The views expressed by this poster are his own and cannot be generalized to the entire medical (or herbal) community ;^) - Cam
Posted by dj on August 16, 2000, at 5:55:37
In reply to Re: St. John's Wort vs Zoloft » dj, posted by Cam W. on August 15, 2000, at 21:53:11
As always, your comments are well-considered and thoughtful. Should you come up with any further references to any dangers posed by ginseng I'd appreciate it if you would post them as I am currently using a brand that combines with ashwganda which is supposed to be the Indian equivalent. Any notable insights you have on it would be of interest.
> Long term studies recommend that ginseng be used no longer than 8 months. I can't remember the exact reason, but I think it had something to >do with liver problems (I could be wrong).
> I do not have a problem with herbal products in general. It is just that many people equate natural with safe and this is dangerous. Anything one takes to alleviate or prevent a medical condition must be considered a drug (even water, when used to flush out the cold virus) and all >drugs (even water) have risks.
I certainly agree with you on that.
>
> One last comment. Yes, many herbs do have a medicinal effect, but look at the price one pays for them. Most herb companies do not do much, if any, testing of their product, yet herbs are as expensive (sometimes more) than tested and effective allopathic medication. Where does this cost saving on the part of herbal companies end up? In the pockets of the owners and shareholders of herbal companies. And you thought that >multinational drug companies were the only >crooks.No disagreement there, either. However, if a herbal company is credible, does test their product and it is useful and more subtle in its effects than ADs and can be purchased at a reasonable price (by discount through chains)then I believe it is worth considering. Regardless, either route is a hassle in too many ways, too often and the rewards often go disproportionatly to the shareholders rather than clientele.
Sante!
dj
Posted by JohnL on August 16, 2000, at 6:04:35
In reply to St. John's Wort and Zoloft comparison and...CamW?, posted by dj on August 15, 2000, at 19:52:30
Cam's analysis is excellent. I agree completely, with the exception of one thing....SJW is actually good for severe depression. But the doses needed are 2 to 3 times higher than stated on the bottle.
Below is some good reading, though a bit long. The Researcher's comments and my own personal comments at the bottom sum it up quickly.
Effectiveness and tolerance of the hypericum extract LI 160 in comparison
with Imipramine: Randomized double-blind study with 135 outpatients .AU: Vorbach-EU; Hubner-WD; Arnoldt-KH
AD: Psychiatrische Klinik im Elisabethenstift, Darmstadt, Germany.
SO: J-Geriatr-Psychiatry-Neurol. 1994 Oct; 7 Suppl 1: S19-23Description:
135 patients, aged 18-75 years, 71 males and 64 females, were given
indistinguishable tablets of either hypericum extract LI 160 0.9 mg
(standardized hypericin content) x 3 or Imipramine 25 mg x 3 for six weeks a
randomised double-blind trial.Inclusion criteria were typical depression according to DSM-III R with a single
episode (296.2) or recurrent episodes (296.3), neurotic depression (300.4) and
adjustment disorder with depressed mood (309.0).Exclusion criteria were severe depression requiring inpatient treatment,
schizophrenia or marked agitation requiring additional medication; a known
history of attempted suicide or acute suicidal state, chronic alcohol and drug
dependency xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
psychotropic drugs, was not permitted. In addition, the patients must not have
been taking xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxarch
purposes within the previous 3 months.There was a washout phase of at least 2 weeks before the start of the study. All
non-psychotropic drugs were permitted and recorded on specific data sheets.
The patients had a thorough medical checkup with neurological status and
routine Lab-parameters at the start and end of the study.
They were questioned specifically about possible side effects.
Target parameters were the Hamilton Depression Scale (HAMD), the von
Zerssen Depression Self-rating Scale (D-S) and the Clinical Global
Impressions (CGI).Results
HAMD score
The mean HAMD fell from 20.2 to 8.8 in the hypericum group and from 19.
to 10.7 in the Imipramine group. The reduction of HAMD score was
significant with p< 0.001 in both groups. There were no statistically
significant differences between the groups.
D-S score
The mean D-S score fell from 39.6 to 27. 2 on hypericum and from 39.0 to
29.2 on Imipramine.CGI score
The CGI score for therapeutic effect rose from 1.3 to 3.1 in the hypericum
Group and from 1.2 to 2.7 in the Imipramine group.
The CGI score for change in status was slightly more positive in the hypericum
group than in the Imipramine group; 41% were greatly improved,
35% much improved, 12% slightly better and 12% experienced no change.
None of the hypericum patients experienced worsening of their condition. The
comparative results for Imipramine were 34% greatly improved, 27% much
improved, 17% slightly better, 17% unchanged, 3% somewhat worse and 2%
much worse.
The CGI score on change of illness severity also showed a trend towards better
results with hypericum. 81.8% were classified as having improved on
hypericum while 62.5% had improved on Imipramine. 18.2% were unchanged
or the same compared to 34.4% in the Imipramine group. None of the
hypericum patients and two of the Imipramine patients experienced worsening
of their condition.Effect on severe depressions:
In the subgroup with patients with a HAMD > 21 (severe depressions) there
was a statistically significant trend towards superiority of hypericum
(p< 0.05) The mean score fell from 25 to 9 in the hypericum group and from 24
to 14 in the Imipramine group (see Figure 2).ADRs
Adverse drug effects (ADRs) occurred in 8 patients on hypericum (11.9%).
Most frequent symptoms were dry mouth (4 cases) and dizziness (2 cases). 11
patients mentioned ADRs on Imipramine. Most frequent were dry mouth (9
cases), dizziness and anxiety (3 each) and constipation (2 cases). 10 of 11
symptoms were said to be mild with hypericum and 15 were classified as mild,
4 as moderate and 3 as severe on Imipamine.There were no changes in laboratory parameters or clinical status.
The researchers' comments:
The clinical efficacy of Imipramine has been demonstrated in more than 1000
therapeutic studies.The normal dose of Imipramine for outpatients is 50-150 mg/day. This study
used a dose of 75 mg because:
1. It is generally agreed upon that 50 mg is a sufficient dose for outpatient
treatment, especially with older subjects, who often require lower doses
because of slower elimination.
2. With a higher dose there would be a risk that it would be obvious which
patients were receiving which drug because of the typical side-effects on
Imipramine. This would interfere with the double-blind structure.This study did show Imipramine to have similar effects and side-effects as in
previous studies.Hypericum was clearly superior to Imipramine in terms of patient tolerance
and fewer side effects.The dose of hypericum was high in this study (2.7 mg hypericin daily). The
Authors conclude that more studies are needed to determine the dose-response
effect with hypericum in order to find the optimum dose of treatment for
different conditions.Personal Comments: Note LI160 is the same as Kira, Movana, Perika, or
Ricola containing .3% hypericin and minimum 3%hyperforin. The dose
used in this study was 2700mg which is nine 300mg doses per day. The
usual dose is just three 300mg doses per day. This dose was effective in
severe depression-not limited to mild or moderate. Any study needs
100 or more participants to be scientifically relevant. This study had
135 participants.
Posted by Cam W. on August 16, 2000, at 6:40:45
In reply to Re: St. John's Wort and Zoloft comparison, posted by JohnL on August 16, 2000, at 6:04:35
John - Thanks, I hadn't come across that article. The sample size is small, but the results warrant a further clinical investigation. BTW - Judging from the literature, it seems that a fuzzy bunny and a box of Oreos is a better antidepressant therapy than imipramine (although the drug truly does work). Just wash your hands after playing with the bunny and before eating the Oreos. - Cam
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.