St. Johns Wort as a Treatment for Childhood Depression

St. Johns Wort as a Treatment for Childhood Depression Depression Treatment Medication Print St. Johns Wort as a Treatment for Childhood Depression By Lauren DiMaria linkedin Lauren DiMaria is a member of the Society of Clinical Research Associates and childhood psychology expert. Learn about our editorial policy Lauren DiMaria Medically reviewed by Medically reviewed by Aron Janssen, MD on November 19, 2019 linkedin Aron Janssen, MD is board certified in child, adolescent, and adult psychiatry and is the vice chair of child and adolescent psychiatry Northwestern University.   Learn about our Medical Review Board Aron Janssen, MD Updated on February 03, 2020 Depression Overview Types Symptoms Causes & Risk Factors Diagnosis Treatment Coping ADA & Your Rights Depression in Kids esemelwe / Getty Images In This Article Table of Contents Expand Overview What the Research Says Use in Children vs. Adults Interactions Adverse Effects Talking to Your Pediatrician View All If your child has been diagnosed with depression or has signs or symptoms of childhood depression, you may be wondering if natural remedies for depression, such as St. Johns wort, are appropriate. Heres what you need to know about the effectiveness and safety of St. Johns wort for treating childhood depression. What Is St. Johns Wort? St. Johns wort is an over-the-counter natural herb also known as Hypericum perforatum, Klamath weed, hypericum, and goatweed. The flowering plant can be used for many purposes and is available in a variety of forms. The extract can be used alone or in combination with other herbs as a nutritional supplement in a capsule, tablet, liquid, or topical product. The flowering tops of the St. Johns wort plant is often used in teas. People have reported using the herb to treat a wide variety of symptoms and disorders including depression, nerve pain, sleep problems, and anxiety. St. Johns wort was also investigated as a potential treatment for attention deficit hyperactivity disorder (ADHD) in children, however, the research found it to be ineffective.?? What Is St. Johns Wort? What the Research Says About Use in Children The National Center for Complementary and Alternative Medicine states that the research on St. Johns wort has provided inconsistent results and therefore it doesnt consider it to be an effective treatment for depression.?? However, there have been studies that appear to demonstrate St. Johns worts potential effectiveness for treating depressive symptoms in adults, both when compared to a placebo and prescription depression medications such as Zoloft (sertraline).?? When used appropriately, St. Johns wort may be comparable to serotonin reuptake inhibitors (such as Prozac, Zoloft, Celexa, Zoloft, and others) in effectiveness and safety for treating depression in adults. However, the use of St. Johns wort for depression in children has not been well-studied. There have not been many studies specifically assessing the use of St. Johns wort in the treatment of childhood depression. A study from 2003 included boys between the ages of 6 and 16 found that of the 33 youths in the study, 25 met response criteria (based on responses to a depression rating scale) after taking St. Johns wort for 8 weeks and didnt have any major side effects from taking the herb. This data is promising, but doesnt compare St. Johns wort with placebo.?? Another study in 2005 found that some adolescents with mild depression might benefit from using St. Johns wort. However, the study did not look specifically at improvement of depressive systems as an outcome variable. In both studies, the researchers noted the need for additional research to support the findings, particularly with placebo-controlled trials. Use in Children vs. Adults Studies that look at how a medication works for adults cant always be used to show how it would work in children. There are many factors that determine how a medication or supplement might affect a child, and its not necessarily as simple as giving them a lower dose of a drug because they are smaller than an adult. One example of this phenomenon is the use of prescription antidepressant medications in children. A potential danger of antidepressant use in people under the age of 25 is an increase in suicidal thoughts or behavior. While the side effect is uncommon, it was significant enough that the FDA put a black box warning on all prescription antidepressants. Its unclear if natural and herbal supplements could carry the same risk. But if St. Johns wort can alter neurotransmitters in a way thats similar to how antidepressant medications work, the question would be of valid concern for researchers, medical professionals, alternative medicine practitioners, and anyone considering using it. Its important to remember that a diagnosis of depression alone is associated with a higher risk of suicide, regardless of treatment. If someone you love is depressed, make sure you know the warning signs of suicide. What to Do If Your Child Has Suicidal Thoughts Medication Interactions St. Johns wort has the potential to interact with many commonly used medications. The FDA issued a public health advisory about these possible interactions and maintains an updated database of drug-herb interactions. Due to its effect on enzymes in the liver, St. Johns wort has the potential to either decrease the levels (and effectiveness) of medications, or increase levels which raises the risk of toxicity. While many of these reactions are minor, dangerous and life-threatening reactions can occur if St. Johns wort is combined with certain drugs. Medications that may interact with St. Johns wort include: Antidepressants (Combining St. Johns wort with serotonin reuptake inhibitors may result in serotonin syndrome.)Cough and cold preparationsOral contraceptives (i.e., birth control pills)Seizure medicationsDrugs used to treat cancerBlood thinners such as Coumadin (warfarin)Heart disease medication such as digoxinMedications used to reduce the risk of organ transplant rejectionAntibioticsHIV drugs such as Crixivan (indinavir) and Viramune (nevirapine)Other herbal and nutritional supplements If you are considering using St. Johns wort for your child, its important to talk to your pediatrician or child psychiatrist about any medications, herbal supplements, over-the-counter drugs, or vitamins that your child is taking. St. Johns Wort and Antidepressants Adverse Effects Its sometimes thought that herbal medications are safer or that they dont have side effects because they are natural, but this is simply not true. Herbal preparations can increase the risk of adverse effects just as prescription drugs can. The fact that St. Johns wort is plant-based makes some people feel that these products are safer than traditional drugs, but its important to keep in mind that many prescription medications, including some blood thinners and strong chemotherapy agents, are also plant-based. Common side effects of St. Johns wort include sensitivity to sunlight, dry mouth, dizziness, stomach upset, fatigue, headache, and anxiety. Parents should weigh the risks and benefits of any herbal products much the same way as they would a prescription drug. This can be difficult as herbal products are not regulated to the same degree in the United States. Talking With Your Pediatrician If your child is depressed and you would like to try complementary treatments, discuss the possibility with your childs pediatrician or psychiatrist. Your childs doctor can discuss the risks and benefits of St. Johns wort with you and help determine the best treatment options for your childs specific circumstances. With a few exceptions, most general practitioners may be unfamiliar with both the potential benefits and risks of St. Johns wort and may only prescribe it infrequently. If you are unsure if your childs symptoms are part of a depressive disorder, ask your pediatrician about having an evaluation. Its best to have your child seen by a psychiatrist or other mental health professional before trying any natural remedies for depression. If you have started using St. Johns wort or any herbal supplement with your child, you must tell your childs doctor due to the potential for serious interactions with other medications that may be prescribed. Importance of Addressing Childhood Depression Depression is not uncommon in children and can be serious. St. Johns wort may or may not be an appropriate treatment, but you have already taken a major and important step by considering the presence of depressive symptoms in your child. Childhood depression can be difficult to diagnose, as warning signs of depression in young children arent always recognized. From extreme shyness to irritability  and anger, many parents assume they facing a behavioral issue rather than depression. If you believe your child may have depression, talk to your pediatrician. They can help you learn more about using medications to treat depression in children, and how the process may be different than the approach used in adults. Ultimately, the most comprehensive treatment for childhood depression will involve more than finding the right drug or supplement. Building a network of support is an important step for the well being of your entire family. Your childs doctor can refer you to others, such as mental health specialists and social workers, who you can work with to create a plan for your child at home and school, as well as provide support for your family. What Parents Should Know About Childhood Depression