Johanniskrautextrakte zur antidepressiven Pharmakotherapie

Zusammenfassung

Johanniskrautextrakte enthalten eine Vielzahl von Stoffen, die einzelnen Extrakte können sich beträchtlich unterscheiden, was bei ihrer Auswahl und Beurteilung berücksichtigt werden muss. Mittlerweile liegen robuste Daten zum Wirkmechanismus vor, die sowohl einen direkten Einfluss auf die Verfügbarkeit von Neurotransmittern (v. a. Noradrenalin, Serotonin) zeigen, aber auch die β-down-Regulation an der Postsynapse. Daneben zeigten sich Effekte auf die Regulation der HPA-Achse, auf entzündliche Prozesse und auch auf die Neuroneogenese. Eine große Zahl randomisierter, kontrollierter Studien (RCT) konnte gegenüber Placebo eine bessere Wirksamkeit zeigen, gegenüber Standardantidepressiva wurde eine Gleichwirksamkeit bzw. Nichtunterlegenheit bei besserer Verträglichkeit nachgewiesen. Die meisten dieser RCTs wurde im Bereich leichter bis mittelgradiger Depressionen durchgeführt. Für einzelne Extrakte wurde auch die Langzeitwirksamkeit placebokontrolliert gezeigt. Interaktionsgesichtspunkte müssen bei Kombinationstherapien berücksichtigt werden.

Abstract

St. John's wort extracts contain a variety of substances. Individual extracts can vary considerably and this must be taken into account in their selection and evaluation. Robust data on the mechanism of action are now available, which show both direct influence on the availability of neurotransmitters (especially noradrenaline, serotonin) as well as β-down regulation at the postsynapse. In addition, effects on the regulation of the hypothalamic-pituitary-adrenal (HPA) axis, on inflammatory processes and also on neuroneogenesis were exhibited. Numerous randomized controlled trials (RCT) have shown better efficacy than placebo. Equal effectiveness or non-inferiority with better tolerability has also been demonstrated compared to standard antidepressants. Most of the RCTs were conducted in the range of mild to moderate depression. The long-term effectiveness of individual extracts has also been proven in placebo-controlled studies. Regarding combination therapies, potential interactions need to be taken into consideration.

Hypericum perforatum - St. John´s wort - depression - chemistry - pharmacology - clinical trials - efficacy - tolerability - interactions

Publication History

Article published online:
19 July 2022

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