Q. St Johns Wart and Tofranil. Are they similar with the same results? I thought I read somewhere that they were.
Thanks so much!

A. I am not really familiar with Tofranil, but I found this information in a quick google search. It does not address whether they work through the same metabolic pathway, but the short answer is "yes".

http://www.newhope.com/nutritionsciencenews/NSN_backs/Jun_01/stjohns.cfm

St. John's Wort Vs. Tofranil: Two recent studies have shown St. John's wort to be as effective as imipramine (Tofranil), a leading tricyclic antidepressant. This class of drugs is as effective at treating depression as SSRIs but enhances norepinephrine transmission rather than dealing with serotonin and has more side effects than SSRIs. In the first study, Michael Philipp, M.D., a psychiatry professor at the Imerem Institute for Medical Research Management and Biometrics in Nuremberg, Germany, and his colleagues gave 350 mg St. John's wort three times daily, 100 mg Tofranil (three total daily doses, one at 50 mg, two at 25 mg), or placebo to 263 people with moderate depression. When it came to improving the subjects' mental and physical well-being, the effects of St. John's wort were equivalent to Tofranil, and both were superior to placebo.4 In this eight-week study, almost half of the patients taking the drug developed side effects, chiefly dry mouth and nausea. Only about one in five patients taking St. John's wort did.

In the second study, Helmut Woelk, M.D., of the University of Giessen, Germany, and colleagues treated 324 outpatients with mild to moderate depression. They were given either 250 mg St. John's wort twice daily or 75 mg Tofranil twice daily for six weeks for depression. Both herb and drug were equally effective at reducing signs of depression by almost half. Of the 157 who took St. John's wort, 68 (43 percent) had a 50 percent decrease in depression scores; of the 167 who took Tofranil, 67 (40 percent) experienced that same 50 percent decrease. However, St. John's wort was better at relieving anxiety.5 Patients taking St. John's wort had only one-third the incidence of Tofranil's side effects, again primarily dry mouth.

4. Philipp M, et al. Hypericum extract versus imipramine or placebo in patients with moderate depression: randomized multicentre study of treatment for eight weeks. BMJ 1999 Dec 11;(8)319(7224):1534-8. 5. Woelk H. Comparison of St. John's wort and imipramine for treating depression: randomised controlled trial. BMJ 2000 Sept 2;321(7260):536-9.