Medical Health Encyclopedia

Melatonin. Women with PMS appear to have lower levels of melatonin, a powerful hormone that regulates sleep. One small study that simulated air travel reported that melatonin was helpful in reducing stress in PMS women, but controlled studies are needed to determine any real benefit.

St. John's Wort. St. John's Wort (Hypericum perforatum) is an herbal remedy that may help some patients with mild to moderate depression. It is not clear, however, how significant the benefits are. Some--but not all--studies report that it is more effective than placebo. Notably, a 2002 study reported no differences between St. John's Wort and placebo for patients with moderate depression. A 2000 study on similar patients, however, reported that it was as effective as a tricyclic.

Even if studies were consistent, this herbal substance is not regulated and there is no guarantee of quality in any brands currently available. In fact, in a 2002 St. John's Word brand comparison only three products out of eight were within 10% of the active ingredient amounts claimed on their labels.

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At this time, the following guidelines are recommended:

• People with severe depression should not take this remedy without a doctor's guidance. Even those with mild depression should not use St. John's Wort without consulting a doctor. Children and pregnant or nursing women should not take this substance.
• People should purchase brands only from well-established manufacturers until regulations have been established for this and other herbal remedies.
• Although no dose levels have been established, trials indicate that 300 milligrams taken three times a day may be effective. (Patients should check with a knowledgeable doctor.)
• It takes between two and three weeks for the drug to have an effect.
• Early studies had suggested that the herbal substance might act in the same way as chemical MAO inhibitors, but the MAO-like activity of St. John's Wort appear to be minimal. Still, some experts suggest avoiding large amounts of foods and substances that have tyramine, such as red wine, meat, and aged cheese.
• It should not be combined with other antidepressants.