Aug. 17, 2000 -- A little obsessive and compulsive behavior may be a good thing. It helps us make sure the iron is really off before we leave the house, or brush our teeth after every meal. But for those with diagnosed obsessive-compulsive disorder, life can become a nightmare of intrusive thoughts and ritualistic and repetitive actions.
Treating patients with obsessive-compulsive disorder is not easy. Many feel that the best therapy is a type of talking therapy called cognitive behavior therapy. Sometimes, if patients don't respond or respond only partially, antidepressants -- usually selective serotonin reuptake inhibitors (SSRIs), like Prozac -- are prescribed.
St. John's wort, or Hypericum perforatum, an herbal medication, has antidepressant activity. It also appears to work pretty much the same way as the SSRI antidepressants. So researchers decided to give it a try in patients with obsessive-compulsive disorder.
And guess what? It worked, at least as well as SSRIs, according to a report in the August issue of the Journal of Clinical Psychiatry. Almost half of the people in a small trial group claimed to have significant improvement in their symptoms after taking one of the active ingredients of St. John's wort for three months.
"It appears that people responded favorably, but ... it's still too early to use it with any degree of certainty," cautions study author Kenneth A. Kobak, PhD. "I wouldn't go out and assume it is an effective treatment at this point, and I wouldn't use it in place of standard treatments that are out there that have been thoroughly tested," However, he writes that he and his colleague on the study are sufficiently encouraged by the findings to conduct a larger and better-designed trial of St. John's wort for obsessive-compulsive treatment.
Kobak, who is with the Dean Foundation for Health Research and Education in Middleton, Wis., and co-investigator Leslie Taylor, MD, treated a group of 12 obsessive-compulsive patients with hypericin, which is the active ingredient in St. John's wort. Behavior was monitored weekly by both the patients and their physicians.
Obsessive-compulsive symptoms improved notably within a week after treatment began and continued to improve throughout the trial. About 40% of the patients were found to be "much improved" or "very much improved" by both the clinicians and the patients themselves. About half indicated that their symptoms were "minimally improved," and only one patient was found to be unchanged.
The treatment was well tolerated. Three patients reported diarrhea and two reported restless sleep. One patient left the trial early because of a rash. Interestingly, "this treatment appears less effective for people who fail to respond to ... SSRIs," Kobak tells WebMD.
"It's neat that some other things other than standard medications are popping up that might be helpful," says Michael Jenike, MD, of Harvard Medical School, noting that about one-third of patients do not respond well to currently available medications.
In his experience, Jenike has had patients with obsessive-compulsive disorder who have used St. John's wort. "I haven't seen any dramatic successes, but most of the people I use it for are sicker patients who have failed other drugs. In their study, the ones that had already failed other drugs do not do very well." Jenike is also the director of the scientific advisory board of the Obsessive-Compulsive Foundation, which supported this study.
He adds: "People may ask, 'Why not use [St. John's wort], since it probably has fewer side effects, [and] is safer and less difficult to take than SSRIs?' My answer is that this report is really the only evidence that we have that St. John's wort might do anything [for obsessive-compulsive disorder]. The other drugs have been carefully studied, so they would still be the [drugs to choose]. But if this shows [in larger studies] it works as well as the other drugs, people might eventually pick St. John's wort over the SSRIs."
Patients sometimes take herbal compounds in addition to prescribed medications, and often without their physicians' knowledge, says Kobak. He urges patients to proceed with caution, because issues such as standardization of medications, contraindications, and drug interactions have not yet been well examined for many herbal medicines. He adds that there is also little information about any interactions between St. John's wort and other medications. "At a minimum," Kobak tells WebMD, "always let your physician know you are taking any herbal compounds."