St. John's Wort

Botanical Name: Hypericum perforatum

Common Name: St. John's Wort

Even Athletes Get The Blues

No matter who you are, you may possibly suffer from mild to moderate depression. If so, relief may be just a plant away. St. John’s Wort is the common name for Hypericum perforatum, the most popular natural remedy for mild to moderate depression, and one of the best-selling botanical products of all time. Native to Europe and Asia, St. John’s Wort is profuse through the United States. St. John’s Wort products are made from the whole fresh or dried plant or its components (such as flowers, leaves).

An impressive body of science on St. John’s Wort shows clearly that the plant does indeed work as an anti-depressant. But as an inexpensive and safe competitor against multi-billion dollar drugs for the same purpose, St. John’s Wort has been attacked by the media in one article after another.

Historically St. John’s Wort has been used to treat enuresis (involuntary discharge of urine), nervous tension, anxiety, PMS, shingles, sciatica, and fibrositis. From as early as the 400’s B.C., the distinguished ancient herbalists, including Hippocrates, Galen, Pliny, Dioscorides and Theophrastus, all employed St. John’s Wort. In the 1400’s Swiss herbalist Paracelsus employed the plant to treat psychiatric disorders. Eclectic physicians in the 19^th century prescribed St. John’s Wort for depression and hysteria.

Today St. John’s Wort is listed in the national pharmacopoeias of France, Poland, Czechoslovakia, Russia and Romania. It is widely available in pharmacies worldwide.

Since 1979 approximately 30 human clinical trials have shown that St. John’s Wort is effective in treating mild to moderate depression. St. John’s Wort is generally tolerated better than prescription antidepressants, and proves safer overall.

How It Works

The antidepressive effects of St. John’s Wort are not thoroughly understood. However, the extract appears to inhibit monoamine oxidase (MAO), and interact with GABA. Both are brain-active chemicals whose activity is complex, and both influence mood. The extract demonstrates anti-depressant CNS activity and appears to modify the activity of both serotonin and dopamine, two important neurotransmitters which affect mood.

Germany’s Commission E approves the use of St. John’s Wort: for “psychovegetative disturbances,” depressive moods, anxiety and nervous unrest. ESCOP (European Scientific Cooperative On Phytotherapy) approves the use of St. John’s Wort for mild to moderate depressive states, restlessness, anxiety and irritability,

Potential Risks

There are some safety issues and concerns associated with this herb. St. John’s Wort may cause photosensitivity (sensitivity to light, particularly sunlight), especially in fair-skinned individuals. Additionally, evidence suggests that St. John’s Wort may interact with serotonin reuptake inhibitors, antihistamines, oral contraceptives, some anti-retrovirals, antiepileptics, AIDS drugs, immunosuppressive drugs, calcium channel blockers, cyclosporine, chemotherapy, some antibiotics, and select antifungals. St. John’s Wort may also put transplant patients at risk. If you are on one of these drugs, you should seek the advice of a physician before taking St. John’s Wort.

Usage Tips

The daily dosage of St. John’s Wort employed in clinical studies for mild to moderate depression is equivalent to between 0.5 – 3.0 milligrams of hypericin. Use this range as a guide for use. Follow directions on product labels.

Recommended St. John's Wort Product

References:

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9. Moerman, D., Native American Ethnobotany. 1^st ed., (Portland, Oregon Timber Press 1998) 272-273

10. American herbal Pharmacopoeia and Therapeutic Compendium. St John’s Wort Hypericum perforatum Quality Control, Analytical and Therapeutic Monograph. Santa Cruz, CA 1997

11. European Scientific Cooperative on Phytotherapy. ESCOP Monographs on the Medicinal Uses of Plant Drugs. 1^st ed., (Exeter, U.K.: ESCOP 1997). Fascicule 1.

12. Evans, W.C., Trease and Evans’ Pharmacognosy, 13^th ed., (Philadelphia, Bailliere Tindall, 1989) 417

13. Blumenthal M, Busse W, Goldberg A, Gruenwald J, Hall T, Riggins CW, Rister RS (eds.). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. S. Klein, R.S. Rister (trans.). 1st ed., (Austin, TX: American Botanical Council. 1998).

14. Roby, C., Kantor, E., Anderson, G., “St. John’s Wort impact on CYP3A4 activity” (poster presentation) . Boca raton (FL): 39^th annual meeting of the New Clinical Drug Evaluation Unit Program; 1999 June 1-4.

15. Roby, C., Kantor, E., Anderson, G., et al. St John’s Wort: Effect on CYP3A4 activity. Clin Pharmacol Ther. 2000;67:451-457.

16. Piscitelli, S., Burstein, A., Chaitt, D., Alfaro, R., Falloon, J., Indinavir concentrations and St. John’s Wort. The Lancet, 2000; Vol 355, 547-548.

17. Ernst E. “ St John's Wort supplements endanger the success of organ transplantation.” Arch Surg 2002 Mar 137:3 316-9

18. Whiskey E, Werneke U, Taylor D “A systematic review and meta-analysis of Hypericum perforatum in depression: a comprehensive clinical review.” Int Clin Psychopharmacol 2001 Sep 16:5 239-52

19. Friede M, Henneicke von Zepelin HH, Freudenstein “Differential therapy of mild to moderate depressive episodes (ICD-10 F 32.0; F 32.1) with St. John's wort.” JPharmacopsychiatry 2001 Jul 34 Suppl 1: S38-41

20. Volz HP, Laux P “Potential treatment for subthreshold and mild depression: a comparison of St. John's wort extracts and fluoxetine.” Compr Psychiatry 2000 Mar-Apr 41:2 Suppl 1 133-7

21. Gaster B, Holroyd J “St John's wort for depression: a systematic review.” Arch Intern Med 2000 Jan 24 160:2 152-6

22. Stevinson, C., Ernst, E., “A pilot study of Hypericum perforatum for the treatment of premenstrual syndrome.” British Journal of Obstetrics and Gynaecology. 2000;107(7):870-876.

23. Davidson JRT et al. “Effect of Hypericum perforatum (St. John’s Wort) in major depressive disorder: A randomized controlled trial.” JAMA. 2002;287:1807-1814.

Recommended St. John's Wort