St. John’s Wort
Biological Name: Hypericum Perforatum
Other Names: Johnswort, Amber, Touch-and-heal, Goat weed, Hardhay, Klamath Weed, Rosin Rose, Hypericum, Tipton weed, St. John’s Wort
Parts Used: Tops and flowers
St. John’s Wort has a complex and diverse chemical make-up. Hypericin and pseudohypericin are believed to have antidepressive and antiviral properties. Other constituents, such as xanthones and flavonoids, may also contribute to the medicinal actions of St. John’s Wort. The following are the active constituents:
• Essential oil, containing caryophyllene, methyl-2-octane, n-nonane, n-octanal, n-decanal, a- and b-pinene, and traces of limonene and myrcene
• Hypericins, prenylated phloroglucin derivatives; hypericin, pseudohypericin and hyperforin
• Miscellaneous; flavonoids, () and (-) – epicatechin.
Hypericum extract contains numerous active compounds that together create the antidepressant and antianxiety effects. Hypericum is the first known substance to enhance three key neurotransmitters- serotonin, norepinephrine, and dopamine. Preliminary research suggests that St. John’s Wort also lowers levels of the stress hormone cortisol and enhances the activity of gamma-aminobutyric acid (GABA), a naturally occurring tranquilizer in the brain. It is a very mild, clinically insignificant monoamine oxidase (MAO) inhibitor.
The mechanism by which St. John’s Wort acts as an antidepressant is not fully understood. Early research indicated that this herb mildly inhibits the enzyme monoamine oxidase (MAO). MAO is responsible for the breakdown of two brain chemicals – serotonin and norepinephrine. By inhibiting MAO and increasing norepinephrine, St. John’s Wort may exert a mild antidepressive action. The antidepressant or mood elevating effects of St. John’s Wort were originally thought to be due solely to hypericin, but hypericin does not act alone. St. John’s Wort relies on the complex interplay of many constituents such as xanthones and flavonoids for its antidepressant actions. St. John’s Wort may also block the receptors that bind serotonin.
Ancient Greeks believed that the fragrance of St. John’s Wort would cause the evil spirits to fly away. The plant was given magical powers. In ancient Greece, the herb was used to treat many ailments, including sciatica and poisonous reptile bites. In Europe it was used for the topical treatment of wounds and burns. It is also a folk remedy for kidney and lung ailments as well as depression.
• Inflammation of the skin
• Blunt Injuries
• Wounds and Burns
• Recurrent Ear infection
• Being tested for AIDS
Antispasmodic, astringent, expectorant, nervine, vulnerary, anti-inflammatory, anti-microbial.
Hypericum was recommended by Hippocrates for “nervous unrest.” It has a 2400-year history of folk use for anxiety; sleep disturbances, and worry. Modern medical research has shown that Hypericum can be as effective as prescription antidepressants for mild to moderate depression. However, unlike prescription antidepressants, Hypericum’s side effects are few and mild. The standardized extract of St. John’s Wort (containing 0.14 percent hypericin) has significant support in the treatment of mild to moderate depression. The official German Commission E monograph for St. John’s Wort lists psychovegetative disturbances, depressive states, fear, and nervous disturbances as clinical indications for the extract. Clinical studies have shown significant improvement in symptoms of anxiety, apathy, hypersomnia, and insomnia, anorexia, psychomotor retardation, depression feelings of worthlessness. Clinical double blind studies indicated that St. John’s Wort extract (0.3% hypericin) at a dosage of 300 milligrams three times daily is as effective in relieving symptoms of depression as standard antidepressants but is much better tolerated with fewer side effects.
Hypericum is now the number one antidepressant, natural or synthetic, prescribed by German physicians. In Germany, Hypericum accounts for over 50 percent of the antidepressant market, while Prozac is down to 2 percent.
In addition to Hypericum’s mood-elevating properties, Germany’s Commission E has approved this herb for the treatment of anxiety and sleep disorders. In two clinical studies, Hypericum demonstrated anti-anxiety effects comparable to those of Valium (diazepam). Yet Hypericum is not addictive and does not impair cognitive functions.
Taken internally, St. Johns Wort has a sedative and pain reducing effect, which gives it a place in the treatment of neuralgia, anxiety, tension and similar problems. It is especially regarded as an herb to use where there are menopausal changes triggering irritability and anxiety. In addition to neuralgic pain, it will ease fibrositis, sciatica and rheumatic pain.
Externally it is a valuable healing and anti-inflammatory remedy. As a lotion it will speed the healing of wounds and bruises, varicose veins and mild burns. The oil is especially useful for the healing of sunburn.
The calming properties of St. John’s Wort have been useful in treating bedwetting, insomnia, and other nervous conditions, as well as some form of melancholy. An oil extract of the herb can be taken for stomach ache, colic, intestinal problems, and as an expectorant for the congestion in the lungs. A tea made from the flowers is good for anemia, headache, insomnia, jaundice, chest congestion, and catarrh. A tea made from the herb has been used for uterine cramping and menstrual difficulties. The oil extract also make a good external application for burns, wounds, sores, bruises, and other skin problems.
St. John’s Wort is also being tested as an AIDS drug. There are evidence of its antiviral actions. Anecdotal reports have claimed hypericin is beneficial for persons with HIV virus. There are also reports that hypericin extract works synergistically with AZT against HIV. Further clinical research is in progress in this area.
Clinical Trials and Proof of Efficacy:
Dr. Klaus Linde and colleagues analyzed the data from 1008 patients. The results showed that Hypericum extracts were indeed more effective than placebo in the treatment of mild to moderately severe depression. In addition, six comparison studies found that Hypericum was as effective as synthetic antidepressants but with fewer side effects. These studies reported that 10.8 percent of the patients had side effects with Hypericum (gastrointestinal irritation, dizziness, dry mouth, and a few mild allergic reactions), while 35.9 percent reported side effects from prescription antidepressants. Less than 5 percent of people stop taking Hypericum because of side effects.
In a major study by Drs. Woelk et al., 3250 patients were treated with 300 mg Hypericum extract three times daily by 633 physicians. Eight typical complaints heard in general practice were recorded: depression, gastrointestinal symptoms, restlessness, difficulty initiating sleep, difficulty falling asleep, headaches, cardiac symptoms, and sweating. About 80 percent of the patients felt improved after four weeks, as measured by medical and patient evaluations. Side effects were seen in only 2.4 percent of subjects.
In a 1997 randomized, double- blind study by Dr. Vorbach and colleagues published in Pharmacopsychiatry, 209 patients with severe, recurrent depression (but with no psychotic or delusional symptoms) were treated for six weeks with 600 mg of Hypericum extract (standardized to 0.3-percent hypericin) three times a day. This high-dose treatment ( 1800 mg daily of Hypericum is double the usual dqsage) proved equal to treatment with a full dose of Tofranil (imipramine) (50 mg three times daily), but even at this higher dosage Hypericum showed considerably less side effects. Caution: Do not take such high doses of St. John’s Wort daily without intensive medical supervision.
It is an erect perennial herb that grows up to 32 inches tall and has a somewhat woody base. Commonly found in dry, gravelly soils, fields and sunny places in many parts of the world, including eastern North America and the Pacific coast. A woody branched root produces many round stems which put out runners from the base. The opposite, oblong to linear leaves are covered with transparent oil glands that look like holes. Flat topped cymes of yellow flowers, whose petals are dotted with black along the margins, appear from June to September. The fruit is a three celled capsule containing small, dark brown seeds. The whole plant has turpentine-like odor.
The best preparation to use appears to be the St. John’s Wort extract standardized to contain 0.3% hypericin. The recommended dosage of this extract as an antidepressant is 300 mg three times per day. Each dose should be taken with meals.
Many people take 500 mg per day of herbal extract, tablets or capsules of St. John’s Wort standardized to contain 0.2% hypericin. Higher intakes of St. John’s Wort extract, such as 900 mg per day, may be used in some instances. St. John’s Wort should be taken close to meals. Assess the effectiveness of the herb after 4 to 6 weeks of starting the herbal treatment.
Infusion: pour a cup of boiling water onto l-2 teaspoonfuls of the dried herb and leave to infuse for l0-l5 minutes. This should be drunk three times a day.
Tincture: take l-4ml of the tincture three times a day.
National Institutes of Health is studying the dosage requirements of St. John’s Wort and its effectiveness.
Hypericum should not be combined with a MAO inhibitor antidepressant such as Nardil (phenelzine) or Parnate (tranylcypromine). This combination can produce a dangerous rise in blood pressure or hypertensive crisis, along with severe anxiety, fever, muscle tension, and confusion. After stopping a MAO inhibitor, one should wait at least four weeks before taking other antidepressants, including Hypericum.
There are some recent reports that suggest that St. John’s Wort may interfere with medications given during organ transplant (such as kidney and liver.) Do not take this herb if you have undergone or plan to undergo a transplant operation.
Avoid foods and medications that are known to interact negatively with MAO-inhibiting drugs. Tyramine containing foods ( red wine, cheese, beer, yeast, and pickled herring) and drugs such as L-dopa and 5-hydoxytryptophan should be avoided. St. John’s Wort should not be used at the same time as prescription antidepressants. Do not use St. John’s Wort during pregnancy or lactation.
St. John’s Wort makes the skin more light sensitive. Persons with fair skin should avoid exposure to strong sunlight and other sources of ultraviolet light, such as tanning beds. These individuals may suffer a dermatitis, severe burning, and possibly blistering of the skin. The severity of these effects will depend on the amount of the plant consumed and the length of exposure to sunlight. Some experts suggest that all individuals avoid sunlight when using hypericin, especially when taking large quantities.
Saint John’s Wort has a good safety record over centuries of folk medicine. In contrast to synthetic antidepressants, there have been no reports of Hypericum-related deaths. Drug monitoring studies on over 7000 patients and twenty-seven double-blind research studies confirm its safety. The extensive use of Hypericum by millions of people has not resulted in reports of serious side effects.