Herbal medicinal products in the treatment of depression

Abstract

For dry hydroalcoholic extracts of St. John's wort herb, Hyperici herba (Hypericum perforatum, Hypericaceae), it was demonstrated in clinical trials that in the treatment of mild to moderate (but not severe) major depression, they are more effective than placebo, and as effective as some standard antidepressants. These extracts represent complex mixtures of structurally diverse constituents with various mechanisms of action. The quantity of active components can vary among different extracts. The Committee on Herbal Medicinal Products of the European Medicines Agency (EMA/HMPC) published monograph on St. John's wort herb, Hyperici herba, according to which these extracts are the components of herbal medicinal products with well-established medicinal use of the active substance, intended for the treatment of mild to moderate depressive episodes and for the short term treatment of symptoms in mild depressive disorders. These herbal drugs are characterized by good tolerability. Compared to synthetic antidepressants, they cause less undesirable effects. However, they exhibit interactions with the large number of drugs, due to the induction of the isoenzymes of cytochrome P450 system (CYP, primarily CYP3A4) and P-glycoprotein, as well as the potentiation of serotonergic effects. Because of mentioned interactions, for these herbal drugs appropriate contraindications, special warnings and precautions for use were established.

Za suve vodenoalkoholne ekstrakte herbe kantariona, Hyperici herba (Hypericum perforatum, Hypericaceae), u kliničkim studijama je pokazano da su u slučaju blage i umerene (ali ne i teške) velike depresije značajno efikasniji od placeba, i da je njihova efikasnost uporediva sa nekim sintetskim antidepresivima. Ovi ekstrakti predstavljaju složene smeše hemijski različitih sastojaka koji deluju različitim mehanizmima. Količina aktivnih sastojaka među različitim ekstraktima može da varira. Komitet za biljne lekovite proizvode Evropske agencije za lekove (EMA/HMPC) izdao je monografiju za herbu kantariona, Hyperici herba, prema kojoj se na bazi ovih ekstrakata izrađuju biljni lekovi sa dobro dokumentovanom upotrebom aktivne supstance (eng. well-established medicinal use), namenjeni za terapiju blagih do umerenih depresivnih epizoda i kratkotrajnu terapiju blagih depresivnih poremećaja. Ove biljne lekove karakteriše dobra podnošljivost. U odnosu na sintetske antidepresive izazivaju manje neželjenih dejstava. Međutim, biljni lekovi na bazi suvih vodenoalkoholnih ekstrakata herbe kantariona ispoljavaju interakcije sa velikim brojem lekova zahvaljujući indukciji izoenzima sistema citohrom P450 (CYP, prvenstveno CYP3A4) i P-glikoproteina, kao i potenciranju serotoninskih efekata. Zbog navedenih interakcija ustanovljene su odgovarajuće kontraindikacije i posebna upozorenja i mere opreza vezane za primenu ovih biljnih lekova.