HPS111 Psychology A: Fundamentals Of Human Behaviour, Deakin University, Australia
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Essay Topic: Should we be using St John's wort? If so, for whom and for what?
Question: Develop a sound, well-reasoned, and empirically supported position on the issue of whether we should be prescribing St John's wort.
Answer: Arguments on the Use of St John's Wort
St John's Wort (Hypericum perforatum) is a flowering plant with yellow, five-petaled blossoms, and is commonly found in Europe, Australia, New Zealand, Eastern Asia, and North and South America. Sunny weather and well-drained soil are thee prerequisites for these plants. It is commonly used for the treatment of ailments such as depression, and other mood disorders such as tiredness, nervousness and other problems such as sleeping troubles and poor appetite. Many claim that it is an effective drug for depression in mild or moderate cases. St John's Wort is also often used for tackling the menopause symptoms of mood swings and hot flashes.
Arguments and Discussion: Depression is a major ailment that affects all age groups, and causes a significant amount of disability and distress. Depression in older people manifests itself in a much different manner compared to that of a younger person. As documented by Frazer, Christensen and Griffiths (2005), psychotic delusions are more likely to be common among the elderly. They mention three trials that were conducted on older people with depression, and the effect that St John's Wort had was almost the same as that of regular antidepressants. However, it was also deduced that the therapy is effective only for moderate cases, and if the depression is severe, the drug works only in the short-term. However, dizziness and fatigue are some of the common side-effects that this treatment can have on the patients. St John's Wort is not recommended for children younger than 6 years of age.
St John's Wort is commonly used in the treatment of disorders such as anxiety and depression. Linde, Berner and Kriston (2008) opined that the compounds that constituted St John's Wort could have numerous pharmacological effects, which includes the anti-depressant effect as well. In many cases, isolated compounds have been used but somehow the entire extract from the plant seems to be all the more effective for serving its purpose. They have also theorised that clinical trials and studies have regarded this drug as being more effective compared to Placebo when it came to treating depression, but its use is limited to only mild to moderate cases. Major depression was observed as being unaffected by St John's Wort, and any positive impact that was elicited had been observed for a very short period of time.Furthermore, patients who received placebo treatments had as much tendency to drop out as those undergoing treatment by St John's Wort.
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Müller (2002) talks of St John's Wort as being an active agent in determining the behavioural outcomes for the patients suffering from depression. Hyperforin is the compound that dominates the anti-depressant effects of this particular medicine, and the effect of the drug on its removal was not as marked as the original, thereby consolidating the assumption that hyperforin is the element that was most effective in curbing the symptoms of depression. The effects that this compound has on the state of depression and anxiety can also be linked to the effects of that of modern anti-depressants. Attention deficit-hyperactivity disorder (ADHD) is an ailment that can show further complications if this drug is administered to such patients.
St John's Wort, although comparatively safer than most drugs, can sometimes have adverse effects on the patients due to the interaction with other drugs or during pregnancy. It is true that this herbal drug has had benefits in cases of mild depression and anxiety disorders, but other compounds such as benzodiazepine diazepam had more marked impacts on patients that had severe anxiety (Hammerness, et al., 2003). St John's Wort has also been known to show some considerable improvement for patients with obsessive-compulsive disorder. They further state that studies conducted on rats did not give any conclusive evidence as to determine the drug as being unsafe for use during pregnancy, as there was no identifiable difference in terms of the cognitive behaviour of the off-springs. Lactating mothers can pass on the hyperforin into the breast milk, but the amount is not significant enough to be of any consequence to the child.
Adverse effects with the usage of St John's Wort include skin reactions, fatigue, gastrointestinal symptoms, restlessness, dizziness, headaches, sedation and dry mouth. These adverse effects are almost the same as that inflicted by placebo, but lesser than the standard side-effects of other anti-depressants. Some of the dermatological effects are quite pronounced; rashes and skin allergies could be observed, along with sensitivity to sunlight (Hammerness, et al., 2003). Although uncommon, alopecia or hair loss has also been reported in isolated cases where high dosages of St John's Wort had been prescribed along with a combination of olanzapine. Headaches are rather common among patients, and the instances of it happening are a lot more compared to those who are undergoing a placebo treatment. Neuropathy and other drawbacks can also occur, but these are usually reversible and therefore the condition of the patients under trial generally improved with time.
Conclusion: From this analysis, it is evident that St John's Wort as a herbal drug is useful for combating the mild and moderate episodes of depression, but it is rather ineffective when it comes to dealing with the major anxiety or depression. Furthermore, the effects it has on the elderly is a little different from what is seen in younger adults. This can perhaps be attributed to the fact that depression and other mood disorders tend to manifest themselves in different ways in different people, and this is dictated greatly by the age group to which the individual belongs. Although safer than most modern and synthetic anti-depressants, St John's Wort comes with its own list of drawbacks and side-effects. For instance, it has a tendency to increase the skin's sensitivity to sunlight if the dosage is a bit high, and in many cases, headaches had also been documented. However, this herbal drug has little or no effects on pregnant and lactating women, which is a relief as this makes it safe for consumption during such situations when other anti-depressants cannot be taken. In most cases, these issues arise only when taken along with other drugs, and although the effects are markedly more as compared to placebo, they are a lot minor when compared to the regular, modern antidepressants.
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