St. 's Wort

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Topic: St 's Wort

Conf: Antidepressant Medications

From: Tom Hale(tom@...)

St. 's Wort in Breastfeeding :

St. 's Wort is an aromatic perennial that is found thoroughout Europe the US and parts

of Canada. It is a common weed found along many roadsides, woody areas, and pastures.

St. 's Wort contains approximately 10% of an astringent tannin, and 1% of a volatile oil.

A reddish dianthrone pigment "Hypericin"( hypericum red) is present at 0.5%. There is an

extensive literature on hypericin in the German literature, where purified products are

generally available on the market.

Most of the research on this plant has surrounded the Hypericin component. Hypericin, from

animal studies[1], is apparently a strong Monoamine oxidase inhibitor (MAOI)[2], although

its effect in humans is argued. In rat brain preparations, the MAOI component was basically

irreversibly bound to MAO. This is typically found with other MAO inhibitors such as

Parnate and Nardil. MAO inhibitors are significant antidepressants but because of major and

dangerous side effects are generally avoided by physicians. Hypericin is generally considered

an MAO inhibitor but new data seems to suggest that it may also be a strong serotonin

reuptake inhibitor(SSRI) as well [3]. Current studies seem to suggest that MAO inhibition is

negligible due to minimal plasma levels.

A great deal of current interest in this product surrounds its antiviral activity. It is presently in

FDA sanctioned Phase I studies for this potential. In addition, the FDA presently has a Phase

I study underway concerning the antidepressant potential of this drug. The results of these

studies are probably several year away.

Interestingly, its use as an antidepressant has been extensively studied and it has been found

to be almost equally effective as the tricyclic family of antidepressants. In these studies, 300

mg of hypericum extract orally three times daily has been found to be effective(please note,

extracts vary enormously in hypericin content). The recommended dose for pure hypericin is

0.2 to 1 mg per day. The time-to-peak interval was apparently 5.5 to 6 hours. The

elimination half-life varies individually from 10 to 37 hours.

Reported adverse effects on adults are rather rare and include photosensitivity, especially in

light skinned individuals. GI effects include nausea, stomach ache, pain, anorexia, and

diarrhea.

Breastfeeding:

At present we have no data on the transfer of hypericin to milk or the infant. Judging

by its chemistry, it likely pentrates milk. It is quite lipophilic and has a large volume

of distribution, which suggests that it could build up over a long period of exposure.

It is orally bioavailable and would be absorbed by the infant. One section of the FDA

is proposing to study the breastmilk levels but this has not yet been done.

At this point it is my impression that we should be

very cautious

with this product in

breastfeeding mothers.

The fact that hypericin is at least partially an MAO inhibitor

is quite concerning.

MAO inhibitors have a sorted past and are due cause for

concern. Because we presently have well studied and effective antidepressants such

as Zoloft(sertraline) and Paxil(paroxtine) which we believe transfer to the breastfeed

infant poorly,

I would urge breastfeeding mothers not consume

St. s Wort products until we know more.

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