Economic evaluation of St. John's wort (Hypericum perforatum) for the treatment of mild to moderate depression.

School of Population Health, University of Queensland, Herston Road Herston, QLD 4006, Australia. Electronic address: .
Journal of Affective Disorders (Impact Factor: 3.76). 01/2013; DOI: 10.1016/j.jad.2012.11.064
Source: PubMed

ABSTRACT BACKGROUND: The burden of rising health care expenditures has created a demand for information regarding the clinical and economic outcomes associated with Complementary and Alternative Medicines. Clinical controlled trials have found St. John's wort to be as effective as antidepressants in the treatment of mild to moderate depression. The objective of this study was to develop a model to assess the cost-effectiveness of St. John's wort based on this evidence. METHODS: A Markov model was constructed to estimate health and economic impacts of St. John's wort versus antidepressants. Outcomes were treatment costs, quality-adjusted life years (QALYs) and Net Monetary Benefits (NMB). Probabilistic analyses were conducted on key model parameters. RESULTS: The average NMB across 5000 simulations identified St. John's wort as the strategy with the highest net benefit. The total cost savings for SJW were $359.66 and $202.56 per individual for venlafaxine and sertraline respectively, with a gain of 0.08 to 0.12 QALYs over the 72 weeks of the model. LIMITATIONS: A lack of direct comparative clinical trial data comparing SJW to venlafaxine and limited data with sertraline as a comparator was a major limitation. CONCLUSIONS: In this model, St. John's wort was shown to be a cost-effective alternative to generic antidepressants. Patients are more likely to receive treatment for a duration consistent with professional guidelines for treatment of major depression due to reduced incidence of adverse effects, improving outcomes. This represents an important option in the treatment of Major Depressive Disorder.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Regeneration of transgenic shoots was achieved from Hypericum perforatum L. hairy roots on hormone-free MS/B5 medium for a period of 4 weeks under a photoperiod of 16-h light. A control experiment was set up with root segments obtained from in vitro grown seedlings. Investigations have been made to study the production of phenolic compounds in non transgenic and transgenic shoot cultures. Six groups of phenolic compounds such as phenolic acids, flavonols, flavan-3-ols, naphtodianthrones, phloroglucinols, and xanthones were recorded in the transgenic shoots. Chlorogenic acid was found as the most representative phenolic acid in shoot extracts. With regard to the class of quercetin derivatives in transformed shoots, quercetin 6-C-glucoside usually dominated among the glycosides followed by quercitrin and hyperoside. The analysis of flavan-3-ols in transgenic shoots resulted in the identification of epicatechin and proanthocyanidin dimers. One of the main achievements in this study was considerably enhanced hypericin and pseudohypericin production in transgenic shoots. The concentration of identified naphtodianthrones was about 12-fold higher in transformed shoots compared to control. Chromatographic analysis of phloroglucinols in transgenic shoots resulted in the identification of hyperforin, while its homolog adhyperforin was detected in traces. A twofold higher content of hyperforin was observed in transgenic shoots compared to control. Although mangiferin was found as the main representative xanthone in shoot extracts, several other xanthones identified as c-mangostin isomers, trihydroxy-1-methoxy-C-prenyl xanthone, garcinone E, and banaxathone E were de novo synthesized in transformed shoots. Therefore, H. perforatum transgenic shoots could be considered as a source for rapid and increased production of naphtodianthrones and other specific phenolic compounds.
    Acta Physiologiae Plantarum 07/2014; 36(10). DOI:10.1007/s11738-014-1627-4 · 1.52 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The population of older immigrants in the United States is growing and they bring their health beliefs and practices with them. Older immigrants from the former Soviet Union use a variety of complementary and alternative medicine (CAM) remedies which includes in part: 1) foods to which medicinal properties are attributed, 2) herbs, 3) external treatments, and 4) pharmaceuticals manufactured in the former Soviet Union and available over-the-counter. These remedies vary in their efficacy and are often used in combination with or in lieu of prescribed allopathic (Western) medications. Health beliefs regarding medicine in the United States has led older Slavic immigrant to distrust their US health care providers and system. Nurses are in a key position to inquire and work with older Slavic immigrants to safely use their CAM and provide more information about prescribed allopathic medications and the harmful effects of combining remedies without consultation.
    Geriatric nursing (New York, N.Y.) 03/2014; 35(2 Suppl):S45-8. DOI:10.1016/j.gerinurse.2014.02.019 · 0.92 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Anxiety and depression are pathologies that affect human beings in many aspects of life, including social life, productivity and health. Cannabidiol (CBD) is a constituent non-psychotomimetic of Cannabis sativa with great psychiatric potential, including uses as an antidepressant-like and anxiolytic-like compound. The aim of this work is to review the animal study articles using CBD as an anxiolytic-like and antidepressant-like compound. Articles were identified using the major electronic databases, including the ISI Web of Knowledge, Scielo, PubMed and PsycINFO, combining the terms “cannabidiol”, “antidepressant-like” and “anxiolytic-like”. As languages for this search, we used Portuguese and English. Animal study articles were primarily included. Studies involving animal models, performing a variety of experiments on the above-mentioned disorders, such as the forced swimming test (FST), elevated plus maze (EPM) and Vogel conflict test (VCT), suggest that CBD exhibited an anti-anxiety and anti-depressant effects in animal models discussed. Experiments with CBD demonstrated non-activation of neuro-receptors CB1 and CB2. Most of the studies demonstrated a good interaction between CBD and the 5-HT1A neuro-receptor, except by on that it was not clear.
    CNS & neurological disorders drug targets 08/2014; 13(6):953-60.. DOI:10.2174/1871527313666140612114838 · 3.57 Impact Factor


Available from
May 28, 2014