Anti-depressant effects of hypericum have been confirmed in several clinical studies that have compared this compound to placebo as well as to standard anti-depressants … One of the most important features is that side-effects occur rarely. This benign side-effect profile may make hypericum a particularly attractive choice for treating mild-to-moderate depression in our elderly patients.
Michael Jenike, MD, editor,
Journal of Geriatric Psychiatry and Neurology, 1994
One result of the success of modern medicine in conquering the diseases of childhood and middle life is the ageing of our population and the progressive increase in those of us who can be regarded as elderly, regardless of how we define that term. Depression is very common among the elderly and major depression has been estimated to affect approximately one in seven individuals over age 65 in community settings, and as many as one in four individuals in nursing homes. An index of the severity of this problem is the fact that the highest suicide rates occur among our elderly citizens. The elderly have many reasons to be depressed, including physical ailments, isolation from family, the loss of friends, and financial difficulties, to name just a few. This leads to the common misconception even among healthcare workers that depression may be a natural and justifiable response to an elderly person’s life circumstances. Regardless of how adverse a person’s life circumstances may be, wherever depression is encountered, including among the elderly, it is certainly worth treating. This will often result in a markedly improved quality of life even though it will not necessarily change the realistic basis for a person’s sorrows.
Because St John’s Wort has only recently come to the attention of clinicians, doctors have very little experience with its use in older patients with depression. Yet, as Michael Jenike points out in the editorial quoted above, St John’s Wort would seem like a very reasonable anti-depressant for those elderly patients who are depressed. As our population ages, medications that are suited to older people will surely become increasingly important and, considering the widespread prevalence of depression in the elderly, it is a particular blessing that Nature’s own apothecary appears to have yielded so excellent a remedy for this group of people in the form of St John’s Wort.
Perhaps the person with the most experience in treating elderly patients with St John’s Wort is Dr Hans-Peter Volz, Chief of the Department of Psychiatry in Jena, Germany. He estimates that he has treated approximately 70 depressed patients over age 65 with St John’s Wort in dosages of up to 900 mg per day. He is comfortable with recommending it as a first-line treatment in mildly depressed elderly patients, though he is still inclined to use conventional anti-depressants for those who are moderately or severely depressed. He acknowledges, however, that his practice of not using St John’s Wort as a first-line treatment in more seriously depressed cases is not based on any direct experience of its ineffectiveness for such people, but rather on the absence of sufficient controlled study data on St John’s Wort in severely affected individuals.
Volz reports excellent anti-depressant effects in the elderly people he has treated with St John’s Wort, with very few side-effects. In addition, he has noted no adverse interactions between St John’s Wort and the many drugs that elderly people often need to take for ailments accumulated over a lifetime. He emphasizes the need to wait six to eight weeks before passing judgement as to whether the herbal remedy is working or not. Here are two cases from Professor Volz’s clinical files.
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