DEPRESSION-EMOTIONS
NEW ADVICE ON ST JOHN’S WORT
St John’s Wort (Hypericum perforatum) has been incredibly
successful as a herbal antidepressant. The mode of action
for hypericum extracts is thought to be similar to that
of conventional serotonin re-uptake inhibitors. It has generally
been shown to be associated with substantially fewer adverse
effects than synthetic antidepressants. However, recent
reports have raised the possibility of important interactions
between hypericum extracts and various prescribed drugs.
At least 8 cases have been reported that suggest that hypericin
extracts are potent inducers of hepatic enzymes. In all
the cases plasma concentrations of the concomitant medication
were reduced, and all the co-medications are metabolised
by hepatic cytochrome P450 microsomal oxidase enzymes. The
co-medications in the cases were: Theophylline, Cyclosporin,
Warfarin, and Ethinyloestradiol+ desogestrel. Other important
interactions have also been reported. Concomitant use of
hypericum extracts in 5 patients while they were on a stable
dose of serotonin re-uptake inhibitors (4 on sertraline,
1 on nefazazodone) resulted in symptoms characteristic of
central serotonin excess.
Ernst.E
LANCET 2000, 354 (9195) 2014-6
A PRAYER A DAY KEEPS DEPRESSION AT BAY
A survey of 474 university students found that those who
prayed daily were less likely to suffer depression and had
lower anxiety levels than those who rarely prayed. They
also had higher self-esteem and were more likely to be able
to cope with stress.
The findings are reported in the Br. J. Health
Psychology, 12th Nov. 1999.
THE TIMES, 12th November 1999.
CONTRACEPTIVE PILL INCREASES RISK OF MENTAL ILLNESS
Studies have shown that the contraceptive pill can lower
the levels and metabolism of certain vitamins and minerals
in the body, including zinc, copper, folic acid, vitamins
B6 and B12. These nutrients are essential to control emotions
and moods, and deficiencies could account for the depression
and increased risk of suicide amongst women taking the pill.
J. NUTRIT. & ENVIRON. MED. 1998, 121-7
IRON DEFICIENCY AND MENTAL HEALTH
Scientists in America investigated the status of iron in
schoolchildren and compared the results with school records
to determine possible associations between nutritional deficiencies
and academic ability. Analysis of the data showed an increased
risk of mild to moderate mental retardation in children
who were anaemic during infancy.
AM. J. CLIN. NUTRIT. 1999, 69, 1, 115-9
STEROIDS AND DEPRESSION
Glucocorticoids are important in the pathogenesis of depression,
but this potentially serious effect is often overlooked
in clinical practice.
Placebo controlled studies have reported that a third of
patients taking glucocorticoids experience significant mood
disturbance and sleep disruption. Up to 20% of patients
on high dose glucocorticoids report psychiatric disorders
including depression, mania, psychosis, or a mixed affective
state. A recent double blind placebo controlled trial of
corticosteroid administration in healthy individuals showed
that 75% of subjects developed disturbances in mood and
cognition, which reversed when steroids were stopped.
Dysregulation of the hypothalamo-pituitary axis in depression
is one of the oldest and most consistent findings in biological
psychiatry. A large scale meta-analysis of over 140 studies
using the low dose dexamethasone test illustrated that persistent
adrenocortical hyperactivity is a robust indicator of poor
prognosis and a weaker predictor of suicide in depression.
From the physician’s point of view medical disorders
which feature sustained overdrive of the hypothalamo-pituitary
axis carry an unexpectedly high risk of mood disorders.
Patients with Cushing’s disease, stroke, or chronic
alcoholism, and those taking long term steroid treatment
have a reported prevalence of depression above 50%.
Underactivity of the axis may also be associated with a
range of psychiatric disorders, the most expensively investigated
being post-traumatic stress disorder.
Overall, data from conditions of both exogenous and endogenous
steroid excess provide support for a glucocorticoid theory
of depression. Several vexing questions remain however.
The therapeutic potential of antiglucocorticoid drugs has
recently been explored in patients with mood disorders.
Encouraging results with steroid synthesis inhibitors used
in the treatment of depression in patients with Cushing’s
disease led to several successful controlled trials in primary
depressive disorder. Furthermore, a re-examination of the
actions of conventional antidepressants hints at a mechanism
which involves reduction in activity of the hypothalamo-pituitary
axis.
BMJ no. 7127 pp244-5
CHRONIC FATIGUE SYNDROME AND SEASONAL AFFECTIVE DISORDER
A study was carried out to determine seasonal symptom patterns
in patients with chronic fatigue syndrome (CFS) and patients
with seasonal affective disorder (SAD). Symptoms that confirm
with the Centres for Disease Control and Prevention (CDC)
case definition of CFS were rated as moderate to very severe
during the winter months by varying proportions of patients
(from 43% for lymph node pain or enlargement, to 79% for
muscle, joint, or bone pain). Retrospective monthly ratings
of mood, social activity, energy, sleep duration, amount
eaten, and weight change showed a coherent pattern of winter
worsening. It was also found that a subgroup of patients
with CFS shows seasonal variation in symptoms resembling
those of SAD, with winter exacerbation. Light therapy may
provide patients with CFS an effective treatment alternative
or adjunct to antidepressant drugs.
Terman, M. et al
AMER. J. MED. 1998, 105 (3A) 115S-124S
