St. John's wort is an aromatic perennial herb that produces star-shaped
golden yellow flower with five petals that secrete a red liquid
when pinched. Originally, St. John's wort was native to Europe only, but
now it can be found growing almost everywhere in the world.
This
plant has been used for over 2,000 years. Ancient Greeks believed that its
odor repelled evil spirits. Early Christians named the plant in honor of
St. John the Baptist because they believed it released its blood-red oil
on the 29th of August, the day the saint was beheaded.
Clinical
trials support the assertion that St. John's wort is effective in
maintaining normal sleep patterns and a healthy nervous system. It is also
useful in the release of stress and frustration and in the re-balancing of
moods. The efficacy of St. John's wort may be attributed to its effect on
the immune system in addition to the effect of its active compounds.
For many North Americans, it is simply amazing that a
common ground covering plant like St. John's Wort could present an
effective antidepressant option. Its very low incidence of troublesome
side effects is all the more wonderful. As a plant, many different
chemicals are present, providing a variable "pharmacy" of constituents
that work together to synergize an overall neurotransmitter rebalancing,
which is the general pharmaceutical approach to treating
depression.
In one study, St. John's Wort was effective in 81.8% of patients evaluated
for clinical mild to moderate depression, compared to 62.5% treated with
Imipramine.(19) The overall accomplishment of St John's Wort for mild to
moderate clinical depression is considered to be comparable to standard
drug therapy with a considerably reduced report of adverse side effects.
In general, it produces improvements in mood with a sense of well-being,
and clinical improvement in feelings of sadness, hopelessness,
helplessness, worthlessness, sleep initiation, and psychological anxiety,
with headaches and fatigue occurring significantly less frequently. St.
John's Wort may provide relief for those who suffer seasonal-related
depression, and might address PMS-related depression.(20)
In a
study in older volunteers, the proportion of REM sleep in the total sleep
period was within the normal range of 20%, and after several weeks of
treatment, St John's Wort at 300mg TID had no effect on sleep latency or
the amount of REM sleep.(21)
In one study, moderate use of alcohol concurrent with treatment did not
evidence an adverse interaction and the ability to drive in traffic,
concurrent with St John's Wort therapy, was not impaired.(22)
St John's Wort may increase
anxiety.(8)
St John's Wort may have the ability in the susceptible to induce serotonin
syndrome, a condition consisting of extreme anxiety, confusion, nausea,
hypertension, and tachycardia.(9)
St John's Wort may in some depressed people precipitate hypomania, mania,
or an increased cycling of mood states, particularly people with occult
bipolar disorder.(10)
Patients with uncontrolled high blood pressure, angina, or heart failure,
should discuss with their physician the potential risk of a tyramine
interaction with St John's Wort since it is thought to be a weak MAO
inhibiter. Use caution with prescription drugs that are contraindicated
with synthetic pharmaceutical MAO inhibitors, including L-dopa,
5-hydroxytryptophane, amphetamines, and over-thecounter cold and
decongestion medication containing pseudoephedrine.
Hypericin is a phototoxic constituent in St John's Wort that is known to
cause sunburn in animals grazing on St John's Wort. However, in the
standardized extract with 0.3 percent hypericin, the recommended dose of
900 mg [300 mg TID] would deliver 2.7 mg of hypericin.
In steady-state oral administration tests running 7 days, 2.7 mg per day
of hypericin did not provide evidence for a phototoxic potential in
humans.(11)
Insufficient data exists to support the use of St. John's Wort during
pregnancy or during breast feeding.(12)
Hypericin produces singlet oxygen and other excited state intermediates in
vitro that indicate it should be a very efficient phototoxic agent in the
eye lens. In a study on calf lens, hypericin did not damage lens protein
in the dark, but under light conditions produced photo-polymerization.(13)
Damage to alpha-crystallin could undermine the integrity of the lens
directly by protein denaturation.
Those who are at risk of or have cataracts should supplement their diet
with vitamins C and E, as well as lipoic acid, which are known to reduce
the risk of cataracts. Another potent natural agent for combating cataract
formation is lutein, which is specifically concentrated in the eye lens
and the macula for preventing photon induced oxidation.
The American Society of Anesthesiologists caution that St John' Wort, as
well as members of the ginseng group, can cause adverse interactions with
anesthetics and should be discontinued at least one week before surgery.
Cardiovascular collapse during anesthesia has been described in one
otherwise healthy patient who had a 6-months history of using St John's
Wort prior to surgery.(14)
Contraindications
St
John's Wort should not be used with any other antidepressant medication,
unless guided by a physician. The effect can be additive and the full
outcome is unknown.
St. John's Wort is understood to present only a
weak monoamine oxidase inhibition.(15,16) The risk of interaction with
tyramine is probably quite low. However, in at least one reported case, St
John's Wort is suspected of interacting with tyramine in an incident of
hypertensive crisis following consumption of foods containing
tyramine.(17)
At the recommended daily amount of St. John's Wort, a blanket fear of a
dietary tyramine interaction seems unwarranted. Interestingly, the long
and widespread use in Germany and Europe of St John's Wort, where tyramine
foods abound, has not given rise to a notable practical problem of
tyramine interaction.(4)
Interactions In General:
Since St John's Wort first gained
public awareness, numerous herbdrug interactions have been observed or
suspected, frequently including cytochrome P450 interactions. The reader
is referred to the Natural Medicines Comprehensive Database for
interaction details and references.(18)
Side effects with St John's Wort are low in research
literature and its extensive use in Germany has not resulted in published
reports about serious drug interactions or toxicity after
overdose.(4)
In a study with 3,250 patients, the most commonly noted side effects were
gastrointestinal symptoms (0.6%), allergic reaction (0.5%), and fatigue
(0.4%).(5)
Reports from other clinical studies include dizziness, nausea,
restlessness, and dry mouth.
Some older patients have complained of mild insomnia at 300 mg three times
a day. Dosage reductions may be appropriate in some cases.(6)
The stressful sexual dysfunctions so frequently associated with all
synthetic pharmaceutical antidepressants are much less frequently reported
with St John's Wort.(7)
1. Linde, Klaus, et al, "St John's Wort for depression-an
overview and meta-analysis of randomised clinical trials", British Medical
Journal, 313:253-258, 1996
2. Hansgen, K.D., et al, "Multicenter double blind study examining the
antidepressant effectiveness of the hypericum extract LI160", Journal of
Geriatric Psychiatry and Neurology, 7 (suppl 1):s15-18, 1994
3. Volz, H.P., et al, St John's Wort extract (LI 160) in somatoform
disorders: result of a placebo-controlled trial, Psychopharmacology
(Berl), 164:294-300, 2002
4. DeSmet, Peter A. G. M., et al, St John's Wort as an antidepressant,
British Medical Journal, 313:241-242, 1996
5. Woelk H., et al, "Benefits and risks of Hypericum extract LI-160: Drug
monitoring study with 3250 patients", Journal of Geriatric Psychiatry and
Neurology, 7 (suppl 1)):234-238, 1994
6. Harrer, G., et al, "Effectiveness and tolerance of the Hypericum
extract LI-160 compared to Maprotiline: A multicenter double-blind study",
Journal of Geriatric Psychiatry and Neurology, 7,(suppl 1):s24-s28,
1994 7. Hypericum Depression Trial Study Group, Effect of Hypericum
perforatum (St John;s Wort) in major depression disorder:a randomized
controlled trial, JAMA, 287:1807-1814, 2002
8. Beckman, S.E., et al, Consumer use of St John's Wort: A survey of
effectiveness, safety, and tolerability, Pharmacotherapy, 20:568-574,
2000
9. Parker, V., et al, Adverse reactions to St John's Wort, Can J
Psychiatry, 46:77-79, 2001
10. Nieren, A.A., et al, Mania associated with St John's Wort, Biol
Psychiatry, Dec 15; 46(12):1707-1708, 1999
11. Schempp, C.M., et al, Effect of oral administration of Hypericum
perforatum extract (St John's Wort) on skin erythemal and pigmentation
induced by UVB, UVA, visible light and solar simulated radiation,
Phytother Res, Feb; 17(2):141-146, 2003
12. Brown Donald J., "St John's Wort Clinical Monograph", Townsend Letters
for Doctors and Patients, Oct., 1997
13. Schey, K.L., et al, Photooxidation of lens alpha-crystallin by
hypericin(active ingredient in St John's Wort), Photochemistry and
Photobiology, 72(2):200-203, 2000
14. Irefin, S., Sprung, J.A., A possible cause of cardiovascular collapse
during anesthesia: long-term use of St John's Wort, J Clin Anesth,
12:498-499, 2000
15. Bladt S., Wagner H., "Inhibition of MAO by fractions and constituents
of Hypericum extract", Journal of Geriatric Psychiatry and Neurology, 7
(suppl1):s57-s59, 1994
16. Miller, L.G.,Herbal Medicinals: Selected clinical considerations
focusing on known or potential drug-herb interactions, Arch Intern Med,
158:2200-2211, 1998
17. Patel, S, et al, Hypertensive crisis associated with St John's Wort,
Am J Med, 112:507-508, 2002
18. Jellin, J.M., et al, Pharmacist's Letter/Prescriber's Letter Natural
Medicines Comprehensive Database, 6th ed., Stockton, CA: Therapeutic
Research Faculty, 2004
19. Vorbach E.-U., et al, "Effectiveness and tolerance of the Hypericum
extract LI-160 in comparison with Imipramine: Randomized double-blind
study with 135 patients", Journal of Geriatric Psychiatry and Neurology, 7
(suppl 1): s19-s23, 1994
20. Martinez, s., et al, "Hypericum in the treatment of Seasonal Affective
Disorder", Journal of Geriatric Psychiatry and Neurology, 7 (suppl
1):s29-s33, 1994
21. Schulz, H., et al, "Effects of Hypricum extract on the Sleep EEG in
older volunteers", Journal of Geriatric Psychiatry and Neurology, 7 (suppl
1): s39-s43, 1994
22. Hubner, W.-D., et al, "Hypericum treatment of Mild Depression with
Somatic Symptoms", Journal of Geriatric Psychiatry and Neurology, 7 (suppl
1): s12-s14, 1994
Botanical Latin Name: Hypericum perforatum Plant Part: Aerial parts
These statements have not been evaluated by the Food and Drug Administration (FDA). Products are intended to support general well being and are not intended to treat, diagnose, mitigate, prevent, or cure any condition or disease. If conditions persist, please seek advice from your medical doctor.
