St. John`s wort

St. John's wort
(Hypericum Perforatum)
St. John's wort has been used since the Middle Ages for treatment of mental
illness or "casting out demons.” Considered a nervine in the 1800’s, it was used
for treatment of nervous conditions. It was used as far back as ancient Greece.
Hippocrates used St. John's wort for digestive disorders, worms, and scanty
urine flow. It has also been used for centuries for its wound-healing properties,
as well as its ability to treat melancholy and depression.
In most recent years, it has become one of the primary botanicals used in the
treatment of depression. It has also been used to treat a variety of mental
illnesses. Its Latin name 'hypercium' is derived from 'hyper' meaning over, and
'eikon,' meaning an apparition, which refers to its past usage in treating
demonic possession. It was also used for anxiety, and to cure bedwetting in
children, when caused by frightfulness. It has also been dubbed the 'arnica for
the nerves' among homeopaths.
Today, it is one of the best-documented and researched herbs on the market.
In Germany, it is used by prescription for depression and is covered by the
national health care plan.
Common Names
Besides St. John's wort, it is also otherwise known as goatweed, klamath weed,
binbirdelikotu, chin su tsao, tipton weed and amber.
Constituents
Glycosides, hypericin, hyperoside, quercitrin, quercetin, rutin, flavonoids,
amentoflavone, hyperforin, adhyperforin, chlorogenic acid, caffeic acid, tannins,
and pseudohypericin. There are many other unknown plant chemicals inherent
in St. John's wort as well.1-30
Scientific Research/Validation
§
Most reputable studies used an aqueous- alcohol extract standardized for
hypericin or hyperforin or both.
§
Hyperforin is proving to be promising as an active ingredient in treatment of
mild to moderate depression.17
§
Hypericin was previously considered to be the primary active ingredient,
however, recent research has reported that hyperforin is the primary active
constituent effective for treatment of depression.103
§
Three studies using a low hyperforin form of St. John's wort were found to
be effective in treatment of depression.34,66,67
§
Meta analysis of 27 trials with a total of 2,291 patients, as well as analysis
of several studies,31-40 indicated that St. John's wort was a superior to
placebos and was at least as effective as many tricyclic anti-depressants.39,4166
§
Five studies done in the last two years indicate that St. John's wort is at
least as effective in treating depression as fluoxetine and imipramine.67-71
§
It has been reported to be effective in treating seasonal affective disorder
(SAD).72-74
§
St. John's wort may reduce the uptake of serotonin, norepinephrine and
dopamine.3,4
§
It was found to be non sedating and did not affect libido.62,76-81
§
Early uncontrolled studies indicated possible use in cases of HIV and Aids.
Increased CD 4 cell counts reduced p 24 antigen levels, which reduced
incidents of swollen lymph glands and fewer infections were observed.82,83
§
However on further examination of the data and results from a later study,
the previous study appears to be based on a faulty hypothesis.12
§
Studies on insomnia and St. John's wort use found it to be significantly
more effective than placebos.37,50,84,85
§
High doses were found to be safer than standard anti-depressants in terms
of cardiac side effects.72
§
St. John's wort has been found to be more effective in treating anxiety than
placebo.37,52,57,86,87
Toxicity
§
By any real measure occurrence of side effects were very rare and mild, no
greater than those of placebos.31,87,88
§
Certain very rare instances of photosensitivity have occurred in cases of
high dosage, involving very fair skinned people.89
§
Hyper mania may occur rarely. Only anecdotal reports suggest the
possibility.90,91,96,97
Drug Interactions
§
May change the actions of Warfarin, Digoxin, Cyclosporine, Indinavir, Oral
Contraceptives and Theophylline.92-96,99
§
St. John's wort may increase the activity of selective serotonin reuptake
inhibitors, creating a mild serotonin syndrome.95,96
§
Migraine medication Imitrex and the pain medication Tramadol increase
serotonin levels and may interact with St. John's wort.38,39
§
Do not take St. John's wort if you are taking anti-depressant drugs
including MAO inhibitors or tricyclics, or:
o
Digoxin
o
Cyclosporine
o
Protease Inhibitors
o
Oral Contraceptives
o
Coumadin
o
Amitriptyline
o
Theophylline
o
Chemo therapy drugs
o
Clozapine
o
Sulfa drugs
§
St. John's wort may change how the above medications function, either
increasing or decreasing their effectiveness.
§
Sudden discontinuation of St. John's wort may dramatically increase the
blood levels of these drugs.104,105,106
§
Newly published research shows that when St. John's wort and Indinavir, a
protease inhibitor used in HIV treatment, are used together, Indinavir blood
levels are decreased, which reduces the effectiveness of Indinavir considerably,
and may lead to increased viral resistance to the drug. It is thought that St.
John's wort stimulates the cytochrome P450 pathway in the liver, which is an
indication that St. John's wort works to cleanse the liver of drugs that use the
liver to regulate blood levels of certain drugs. These may include oral
contraceptives, transplant rejection drugs, heart medications, anti-depressants
and seizure medications.
Contraindications
§
Patients with bi-polar disorder should avoid St. John's wort as it may cause
episodes.97,98
§
Photosensitivity in humans is extremely rare and only apparent when using
four times the normal dose (3600 mg per day).100,101
§
Ther is only one reported case of photosensitivity at therapeutic dose.102
§
St. John's wort has been safely tested at doses of 13 mg. per kilo of body
weight.103
§
It should be used with caution when pregnant or nursing due to mild uterine
tonic effects reported.107
Comment
A recent study has contradicted hundreds of previous studies reporting the
effectiveness of St. John's wort in treating mild to moderate depression.
Reaction has been mixed, however the majority of researchers have stated that
this one negative study does not cancel out the findings of the hundreds of
positive studies that came before.
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