St. John's Wort for Unexplained Fatigue
For up to 50 percent of people who consult their doctors complaining
of fatigue, no physical basis can be found, and no definitive
treatment exists. Many physicians and researchers believe that,
at least in some cases, unexplained fatigue may be a somatic (physical)
symptom of masked depression. St. John's wort (Hypericum perforatum
L., Clusiaceae) has been shown to be effective in alleviating
symptoms of tiredness and fatigue in depressed patients (Hübner
et al., 1993). Researchers designed a small, uncontrolled,
open pilot study to assess the effects of St. John's wort in 20
people suffering from fatigue of unexplained origin, in order
to formulate a hypothesis upon which future, controlled research
in this area could be based (Stevinson et al., 1998).
The study participants (17 women and 3 men) all had fatigue that
had persisted for at least two weeks, but none considered themselves
depressed. Levels of perceived fatigue were established at baseline
with visual analog scales (VAS) that were completed both by participants
and by the people closest to them (usually their partners). Subjects
also completed another 14-item fatigue scale, a 12-item General
Health Questionnaire (GHQ), and the Hospital Anxiety and Depression
scale (HAD). Results were assessed using the same scales after
two weeks and again at the end of the six-week treatment period.
After two weeks of treatment with standardized St. John's wort
extract, subjects' perceived fatigue was significantly less than
that recorded at baseline. After six weeks, fatigue was reduced
significantly further. Even though none of the participants considered
themselves depressed or anxious, baseline scores indicated that
nine were depressed or borderline depressed at the beginning of
the study, and that 14 were suffering from anxiety or borderline
anxiety. According to the HAD, fatigue improved in seven of the
nine participants who were classified as depressed, but in only
three of the 10 who were classified as not depressed. By the end
of the study, only three subjects could be classified as depressed/borderline,
and only five as anxious/borderline.
The authors noted, "The possibility exists . that the improvements
in fatigue in this study are an indirect result of the specific
effects of Hypericum on depression, with the perceived
reduction in fatigue a consequence of the improvement in mood."
They suggested that future research should focus on subjects reliably
diagnosed as "non-depressed" in order to determine whether
the herb has any direct effects on fatigue.
The dosage of St. John's wort used in the trial was one tablet
three times daily of extract standardized to contain 300 mcg total
hypericin per tablet (Kira®, manufactured by Lichtwer Pharma
UK Ltd). One participant withdrew from the trial because of dizziness,
which persisted after discontinuation of St. John's wort. No other
adverse effects were reported. - Evelyn Leigh
[Hübner W-D, Lande S, Podzuweit H. Hypericum treatment of
mild depressions with somatic symptoms. Journal of Geriatric
Psychiatry and Neurology 1994; 7(suppl 1): S12-S14.
Stevinson C, Dixon M, Ernst E. Hypericum for fatigue -- a pilot
study. Phytomedicine 1998; 5(6): 443-447.]
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