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The Informed Parent

St. John’s Wort and Other Herbal Medicines

by Peter W. Welty, M.D., F.A.A.P.
Published on Jul. 23, 2001

Much has been written about herbs and “natural products” lately. They have taken on a great deal of popularity. My chief concern about these products is that they are mistakenly thought of as “safe”, when the fact is that they can interact with many other medications, and need to be taken carefully.

Herbal preparations are not regulated by the Food and Drug Administration in the same manner as drugs. There are no requirements for the manufacturers of herbal preparations to prove the effectiveness or safety of their products. Furthermore, the companies that manufacture herbal preparations are not required to demonstrate “bioequivalence”. This means that variations can exist between various brands of the same herb. Quality control and assurance is not required in the herbal market, although this is undergoing review and change.

The American Academy of Pediatrics does not advocate the medicinal use of herbs for infants and children, since these preparations have not been routinely tested or researched in the pediatric population. Most of what we know about herbs, and many drugs in pediatrics, comes from research and generalizations in adults. Unfortunately, the reality is that herbs and herbal preparations in treating medical problems is a fast-growing business for adults, and, therefore, for children as well.

Take, for example, depression in adolescents. This is a very serious medical condition, and there are specific symptoms that lead to the diagnosis. Some of these symptoms are: depressed moods or an inability to enjoy regular activities, disturbances in regular sleep pattern, a change in appetite, a loss of interest in regular activities, feelings of guilt, a decrease in energy and activity level, poor concentration which may lead to decreased grades and even possible thoughts of suicide. The circumstances are serious enough to interfere with the adolescent’s home, school and community functioning.

St. John’s wort has been extensively used in the treatment of mild to moderate depression in ADULTS. It is the most popular drug for treating depression in Germany, where it is available by prescription. Clinical studies have demonstrated that St. John’s wort is superior to placebo in the treatment of mild to moderate depression, and may be as effective as conventional antidepressants in treating this disorder.

A potential concern regarding the use of St. John’s wort is seratonin syndrome. A sudden onset and rapid progression of some or all of the following symptoms characterize this syndrome: confusion, agitation, fever, sweating, diarrhea, tremor, or muscle spasms. The attacks may resemble a non-acute panic onset. Although mild, the symptoms could progress to coma and death.

The use of St. John’s wort alone, in its recommended dose, does not generally lead to the development of seratonin syndrome. When a child is taking other medications, such as another antidepressant, any stimulant, tryptophan, etc., the risk of developing this disorder increases. Patients should be cautioned to watch out for the development of seratonin syndrome. Contact the doctor immediately, should some of the symptoms develop.

St. John’s wort evokes concern in enhancing the metabolism of certain medications. Cholesterol-lowering drugs, certain antibiotics, HIV medications, pain pills, cardiovascular drugs and even the effectiveness of some oral contraceptives may be affected.

The best preparations of this herb contain a specific amount of hypericin, the active ingredient found in St. John’s wort. The optimal dose for adults appears to be a 300-mg tablet given three times daily. Like all antidepressants, it takes a few weeks to see the results.

The use of herbal preparations to treat medical problems is a new, relatively untested, market. Certainly the use of St. John’s wort has been successful in early research, but the long-term research results are not out yet. Additionally, the use of herbal preparation for children and adolescents has not been fully tested. Before embarking on a treatment plan of herbal medications for your adolescent, the child should have a thorough examination by the pediatrician. This is to evaluate any other medical problem and to determine the extent of the symptoms.

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