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BET Assignment

Three Part Question

Patient = Young adults with depression

Intervention = St Johns Wort
Outcome = Improvement on bipolar depression mood swings

EXAMPLE: IS [I] an [O] in [P]

Is [St. Johns Wort] an [effective treatment to reduce the effects of bipolar depression] in [young adults with no
family or medical history related to mental illness?]

Clinical Scenario

A 17 yr old student visits his primary care physician for his annual school physical. Once the test have been
conducted, the student is informed that he has not met all the requirements to pass this physical and cannot play
for his basketball team until he passes all areas. The student goes from being calm mannered to a very saddened
depressed like state. After some time passes by the student is reassured that once he passes all aspects of the
exam he may play for the team. Once the student leaves the doctors office, the doctor couldnt help but notice the
sudden change in mood in the patient. The doctor then informs the legal guardian/parent of the student to get a
more professional psychiatric evaluation done. It is then discovered the student suffers from bipolar depression.

Search Strategy
Standard data base search with related keywords

Database: PubMed
Keywords: St Johns Wort, Bipolar depression, mood swings
Limits: human, English, young adults, age 0-22

Search Outcome
742 papers found in PubMed
URL to search:
URL to PubMed Collection
Relevant Paper(s)

Author, Study type

date and Patient group (level of Outcomes Study Weaknesses
country evidence)

Dalwood J, Adults ages 25 and Random Trials Successful results N/A Male only study. Did not help in
2013, South over. Predominantly in helping ease the focus of a wider target
Australia male symptoms audience.

Potter M, Minors under the age Patient Based The study was limited to much
2009, USA of 21 Successful results N/A young children and strictly
in helping ease focused on already established
symptoms patient/doctor history

Spinella M, Primarily older adults, Patient Based Successful results N/A No research focused on the drug
2002, USA or those that take in helping ease interaction between St johns Wort
medication regularly symptoms and that of specific targeted
Along with certain medication for younger children.
amongst other

Clinical Bottom Line

All these articles show that St Johns Wort does an aid in helping ease the affects of bipolar depression amongst
teenagers and young adults. I do believe the primary care doctor and physician should evaluate patients mental
history and any medication history to find no drug interaction between the two. So the Patient can start taking
anything that may help with little to no side effects.

Level of Evidence
Level 1 My random trail amongst young adults found that those who took dosages in controlled states with no
other mediation found improved results.


1. Potter, M, et al. Alternative Treatments in Pediatric Bipolar Disorder. Child and Adolescent Psychiatric
Clinics of North America., U.S. National Library of Medicine, Apr. 2009,
2. Dalwood, J, et al. St John's Wort - Is It Safe in Bipolar Disorder? The Australian and New Zealand
Journal of Psychiatry., U.S. National Library of Medicine, Dec. 2015,
3. Spinella, M, and L A Eaton. Hypomania Induced by Herbal and Pharmaceutical Psychotropic Medicines
Following Mild Traumatic Brain Injury. Brain Injury., U.S. National Library of Medicine, Apr. 2002,
4. /.latest_citation_text