An Investigation of the people understandings between the effects of St John’s Wort and Prozac® in relation to Depression
Nandar Maung Maung Aye
AYENMP1503
Tutor: Allison Davies
Word Count:
Background:
Emanuel et al (2001) state that major depression will be the second most important cause of disability worldwide by the year 2020. A number of people suffered from depression have improved by approximately half a million in three years in England, according to the NHS data (BBC News, 2012). The number of antidepressants dispensed yearly in England has been increased by 25million between 1998 and 2012. The use of antidepressants has accelerated pointedly in England since the financial crash in 2008 with 12.5million more pills prescribed in 2012 than in 2007. Growths in unemployment were directly related with majorities of antidepressants prescribed and that poor housing areas have a tendency to realise considerably greater antidepressant use.
According to the study of NHS prescriptions on dispensing tablets in the United Kingdom, the use of antidepressants in women, white people and people over age 65 is more popular than in men and people from ethnic sections. There is a variation in antidepressant rates between regions, ethnicities and age groups. On the other hand, over-prescribing of antidepressants can have the adverse effect on patient health and characterises an inefficient use of health care resources. Therefore, it is important to control prescribing of these important drugs and also need to be careful with possible side effects of these antidepressant drugs (Qualitywatch.org.uk, 2014).
According to Emanuel et al (2001), conventional antidepressants will be beneficial in approximately 65%-75% of patients with major depression. However, there has been a rise in the use of alternative treatments for depression because of cultural traditions, lack of governmental regulation, availability, adverse effects of pharmaceutical products and drug interactions. Among the alternative treatments, there has been an attention in alternative medicines especially St John’s wort which is available over the counter.
There is a safety recall of some batches of St John’s wort tablets in the UK which were found to be contaminated with toxin named pyrrolizidine alkaloid during harvesting (BBC News, 2016). Therefore, more scientifically controlled studies are required to consider the clinical efficacy of these products compared to conventional drugs (Emanuel et al, 2001). With the recent relation to the problem of St John’s wort, the research aims to find the people understandings between the use of St John’s wort and Prozac® in relation to depression.
Literature review:
According to Schrader (2000), German physicians treated 240 patients with mild to moderate depression for six weeks in a double-blind study at seven medical clinics. A total of 126 patients received a standardized extract of St. John's wort (250 mg twice daily) and 114 received 20 mg/day fluoxetine (Prozac). The scores ranged from 16 to 24 at the beginning of the study by using the Hamilton Depression Scale (a standard clinical measure of depression). Scores decreased to 12.2 in the Prozac group and 11.54 in the St. John's wort group at the end of the study. St. John's wort was slightly more effective than Prozac, and also one-third of the patients responded to the herb than to the drug. 34 people (29.8 percent) taking Prozac reported some side effects, such as gastrointestinal problems, vomiting, dizziness, and erectile dysfunction, whereas only six (4.7 percent) of the patients taking St. John's wort reported side effects with GI distress.
Another study was performed in the United States by using double blind treatment for 12 weeks. One hundred thirty five patients with major depressive disorders were treated with LI-160 St John’s wort extract (900 mg/d) and fluoxetine (20 mg/d). The 17-item Hamilton Rating scale for Depression (HAMD-17) and analysis of covariance were used to compare the results of these two groups. Analysis of covariance gave lower mean HAMD-17 scores at end point in the St John’s wort group compared with the fluoxetine group. There was also a trend toward higher rates of remission in the St John’s wort group (38%) compared with the fluoxetine group (30%). Generally, St John’s wort was considerably more effective than fluoxetine (Fava et al, 2005).
Research Aim
The research aim of this study is to investigate how people understand the effectiveness between St John’s wort and Prozac® in relation to depression.
Research Question
To determine what influences people choice of medication between St John’s wort and Prozac®?
Research objectives
1) To explore the people’s understandings of homeopathic treatment as opposed to prescription medication
2) To understand the effectiveness of St John’s wort and Prozac®
3) To evaluate the factors which influence the choices of St John’s wort and Prozac® in depression
References:
BBC News, (2012). Depression up 'by half a million' – BBC News. [Online] Available at: http://www.bbc.co.uk/news/health-19967037 [Accessed: 02-03-2016].
BBC News, (2016). Safety recall of St John's Wort tablets – BBC News. [Online] Available at: http://www.bbc.co.uk/news/health-35523020 [Accessed: 02-03- 2016].
Emanuel, A.M., Moore, T.R. and Ghazvini, P. (2001), "Considerations for the Use of Alternative Therapies in the Treatment of Depression", Journal of Pharmacy Practice, vol. 14, no. 6, pp. 551-559. [Online] Available at: http://jpp.sagepub.com/content/14/6/551 [Accessed: 02-03-2016]
Fava, M., Alpert, J., Nierenberg, A.A., Mischoulon, D., Otto, M.W., Zajecka, J., Murck, H. & Rosenbaum, J.F. 2005, "A double-blind, randomized trial of St John's wort, fluoxetine, and placebo in major depressive disorder", Journal of Clinical Psychopharmacology, vol. 25, no. 5, pp. 441-447. [Online] Avalilable at: http://ud7ed2gm9k.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A+Double-blind%2C+Randomized+Trial+of+St+John%27s+Wort%2C+Fluoxetine%2C+and+Placebo+in+Major+Depressive+Disorder&rft.jtitle=Journal+of+Clinical+Psychopharmacology&rft.au=Fava%2C+Maurizio&rft.au=Alpert%2C+Jonathan&rft.au=Nierenberg%2C+Andrew+A&rft.au=Mischoulon%2C+David&rft.date=2005-10-01&rft.issn=0271-0749&rft.eissn=1533-712X&rft.volume=25&rft.issue=5&rft.spage=441&rft.epage=447&rft_id=info:doi/10.1097%2F01.jcp.0000178416.60426.29&rft.externalDBID=n%2Fa&rft.externalDocID=10_1097_01_jcp_0000178416_60426_29¶mdict=en-UK [Accessed: 02-03-2016]
Qualitywatch.org.uk, (2014). News: Antidepressant prescribing | QualityWatch. [Online] Available at: http://www.qualitywatch.org.uk/news/englands-use-antidepressants-rising-fasT [Accessed: 02-03-2016].
Schrader, E., 2000. Equivalence of St John's wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mildmoderate depression. International clinical psychopharmacology, 15(2), pp.61-68.[Online] Available at:http://journals.lww.com/intclinpsychopharm/Abstract/2000/15020/Equivalence_of_St_John_s_wort_extract__Ze_117__and.1.aspx [Accessed: 02-03-2016]