Questions and Answers with NAM Chris Gadd, editor, HIV & Aids Treatment Directory
St John’s Wort
I’ve been diagnosed with depression but don’t want
to take any more drugs. Is it true St John’s Wort can be beneficial?
St John’s Wort is a popular herbal remedy used to treat depression.
It’s made from an extract of the plant Hypericum perforatum and the
active ingredients are hypericin and hyperforin. Some clinical studies have
shown it may be effective in treating mild depression. Others have shown it
may have fewer or less severe side effects than conventional antidepressants
such as fluoxetine (Prozac), but more research is needed to prove that it
really works.
So is St John’s Wort better than antidepressants my GP could
prescribe?
Some people may prefer to take St John’s Wort over conventional medicines,
but herbal remedies are not as strictly regulated. It’s difficult to
be certain about the benefits and risks of St John’s Wort relative to
other options until more research has been done. Many people think herbal
remedies are better for them or safer than conventional medicines because
they are ‘natural’. This is not necessarily true as they do not
have to undergo the same degree of testing and could easily be harmful to
some people. They may also be dangerous taken in large doses or combined with
other medicines. Different preparations of St John’s Wort may contain
different levels of the active ingredients and switching between them can
alter the levels of the ingredient in the body and change its effects.
What are the risks of taking it?
The main risk of taking St John’s Wort is interactions with other medicines,
as it can alter the activity of enzymes in the liver that break drugs down.
St John’s Wort can reduce levels of many antiretrovirals in the blood.
You must not take St John’s Wort if you are taking a protease inhibitor
or a non-nucleoside reverse transcriptase inhibitor (NNRTI). If you do, the
levels of the protease inhibitor or the NNRTI will become too low in your
blood. This will put you at risk of your HIV treatment failing and the development
of drug resistance. The risk of an interaction can persist for up to two weeks
after stopping a course of St John’s Wort. St John’s Wort also
interacts with many other drugs. You should discuss the risks of taking it
with your doctor to check whether it’s safe for you to do so.
I’m on antiretrovirals. Does that mean I’ll have to take
anti-depressants that my doctor prescribes?
There are a wide range of conventional drug treatments available for depression.
Many of these, such as fluoxetine (Prozac) and paroxetine (Seroxat), do not
have dangerous interactions with antiretroviral drugs. These would be a safer
option if you are currently taking antiretrovirals. Some antidepressants may
slightly increase the concentration of ritonavir (Norvir) in the blood. Your
doctor should monitor you closely if you start antidepressants to ensure you
are not experiencing side effects because of the raised ritonavir levels.
Remember to let your HIV doctor and the doctor prescribing your antidepressants
know about all the drugs you are taking. Although you may get some side effects
from the antidepressant that your doctor prescribes, there are many options
available and you may be able to switch to a different drug if you have any
problems.
Is there anything else I can do?
Treatments that don’t involve drugs can be used to alleviate depression
in some people. These include psychotherapy and cognitive behavioural therapy.
However, these have limited availability on the NHS.
It’s also worth bearing in mind that efavirenz (Sustiva) can trigger
depression in some patients, although this can fade away after a short time.
If you are taking efavirenz, it might be worth talking to your HIV doctor
about whether switching drugs may help you feel better (see feature, pg 40).
• NAM provides information to help you think about your use of HIV treatments,
but this is not intended to replace discussion with your doctor.
