Josey E S, Tackett R L
Department of Clinical and Administrative Sciences, College of Pharmacy, University of Georgia, Athens 30602, USA.
Int J Clin Pharmacol Ther. 1999 Mar;37(3):111-9.
The primary purpose of this article is to review the existing literature concerning the therapeutic uses, adverse effects, and possible drug interactions of St. John's wort (Hypericum perforatum) as compared to other antidepressant medications.
Reference material was obtained through database searches with time restrictions of 1985 to the present. Studies selected were those written in the English language which compared the role of St. John's wort, tricyclic antidepressants, monoamine oxidase inhibitors, and serotonin-selective reuptake inhibitors in the treatment of depression. Other studies were selected based on their evaluation of the safety and efficacy of St. John's wort as an antidepressant for a minimum of four weeks.
A review of existing literature recognized nine clinical trials that reported the efficacy of St. John's wort as compared to placebo and to other antidepressant medications. Of these nine, four controlled studies were chosen based upon their large patient populations and their consistency in brand and dosage of St. John's wort used. These four studies demonstrated that St. John's wort was as effective as other antidepressant medications and more effective than placebo, as the clinical symptoms of depression greatly decreased upon administration of H. perforatum. The side-effect profile of H. perforatum at this time appears to be superior to any current U.S.-approved antidepressant medication.
From the existing literature, St. John's wort appears to be a safe and effective alternative in the treatment of depression. Tricylic antidepressants and monoamine oxidase inhibitors can produce serious cardiac side-effects, such as tachycardia and postural hypotension, and many unwanted anticholinergic side-effects, including dry mouth and constipation. St. John's wort has proven to be free of any cardiac, as well as anticholinergic, side-effects normally seen with antidepressant medications. Based upon limited studies, St. John's wort appears to be an acceptable alternative to traditional antidepressant therapy, although trials on a larger scale are warranted in this area. Hypericum is available to the lay public as an over-the-counter preparation and may be misused if not fully understood.
本文的主要目的是回顾现有文献，比较圣约翰草（贯叶连翘）与其他抗抑郁药物在治疗用途、不良反应及可能的药物相互作用方面的情况。
通过数据库检索获取参考资料，检索时间限制为1985年至今。所选研究为用英文撰写的，比较了圣约翰草、三环类抗抑郁药、单胺氧化酶抑制剂和5-羟色胺选择性再摄取抑制剂在治疗抑郁症中的作用。其他研究则基于其对圣约翰草作为抗抑郁药至少四周的安全性和有效性的评估。
对现有文献的回顾发现了九项临床试验，这些试验报告了圣约翰草与安慰剂及其他抗抑郁药物相比的疗效。在这九项试验中，四项对照研究因其患者数量众多以及所使用的圣约翰草品牌和剂量的一致性而被选中。这四项研究表明，圣约翰草与其他抗抑郁药物一样有效，且比安慰剂更有效，因为服用贯叶连翘后抑郁的临床症状大幅减轻。此时贯叶连翘的副作用似乎优于任何目前美国批准的抗抑郁药物。
从现有文献来看，圣约翰草似乎是治疗抑郁症的一种安全有效的替代药物。三环类抗抑郁药和单胺氧化酶抑制剂会产生严重的心脏副作用，如心动过速和体位性低血压，以及许多不良的抗胆碱能副作用，包括口干和便秘。事实证明，圣约翰草没有抗抑郁药物常见的任何心脏及抗胆碱能副作用。基于有限的研究，圣约翰草似乎是传统抗抑郁治疗的一种可接受的替代药物，尽管在这一领域还需要进行更大规模的试验。贯叶连翘作为非处方药可供普通大众使用，如果没有充分了解可能会被滥用。
