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Alternative Names: Hypericum or Hypericum per foratuni. Sometimes misspelled as: St. John's Wart.
St. John's Wort is used for depression or anxiety that leads to fatigue and adrenal gland exhaustion.
St. John's Wort is a perennial herb, standing one to two feet high, bearing many bright yellow flowers. It is a shrubby plant, native to many parts of the world including Europe and the United States.
Source
Many of the active ingredients are found in tiny dark spots located on the edges of the five-petalled flowers or on the upper leaves. St. John's Wort is usually sold dried and in concentrated drops, tinctures and extracts.
While St. John's wort has been used in teas, the active ingredients are usually best extracted with a hydroalcoholic solvent. Both tinctures and liquid extracts of Hypericum are common among both modern and ancient herbalist. These hydroalcoholic extractions are deep red and quite aromatic. St. John's wort is also infused in olive oil for topical use.
Rarely are tinctures, liquid extracts or oils tested for the amount of active (or marker) ingredients. To better identify the activity of Hypericum, researchers in Europe began to standardize the powdered extracts of the plant. Hypericin, a naphthodianthrone, was chosen as the component in which to standardize the extracts of St. John's wort. While Hypericum contains two similar naphthodianthrones (hypericin and pseudohypericin), as well as many flavonoids (quercetin, quercetrin, amentoflavones, hyperin, xanthones, rutin, and more), they seem to be extracted by similar conditions. Most researchers believe that the standardization of St. John's wort extract to hypericin is a sufficient market at this time, even though other components may be primarily responsible for the medicinal activity. St. John's wort extracts can be standardized from 0.1 to 2.5% hypericin, although the 0.3% hypericin extract is the best studied and is sufficiently economical as a therapeutic agent.
Function; Reasons For Use
The extract of hypericum (hypericin) has shown a wide variety of effects including psychotropic and antidepressant. It has been theorized that depression results from decreased serotonin levels in the brain. The action of hypericin appears to be based on the its ability to inhibit monamine oxidase inhibitors; a class of enzymes involved in serotonin degradation. When researchers measured urinary metabolites of noradrenaline and dopamine following administration of St. John's Wort, they found significant increases in 3-methoxy-4-hydroxyphenylglycol (a marker commonly used to measure the effectiveness of antidepressive drugs).
Several activities and active components have been identified in extracts of Hypericum perforatum. In vitro experiments have detected MAO inhibition in extracts of Hypericum. This activity is attributed to hypericin and the xanthones, although the activity has not been shown to be strong enough to be responsible for the clinical activity of the extract. Further experiments need to be conducted to see what role, if any, MAO inhibition plays in the activities of St. John's wort extracts.
There have been many promising in vitro studies showing the inhibition of serotonin receptor expression and serotonin uptake using extracts of Hypericum. This mechanism as well needs to be tested further in order to determine how much of a role it plays in the activities of St. John's Wort extracts.
These activities, as well as a vast history of use in depressive disorders have made St. John's wort quite popular in Europe and now the United States.
There have been numerous studies comparing St. John's wort with other antidepressants. In general, St. John's wort extracts have shown to be as effective in treating mild to moderate depression without the side-effects associated with the pharmaceutical antidepressants. A dose of 300mg, three times daily (900mg total per day) of the 0.3% hypericin extract was used for most of these studies.
In one double-blind study, hypericum has been shown to be an effective treatment of seasonal affective disorder. When compared to antidepressant drugs, hypericum demonstrated comparable results without the side-effects associated with antidepressants. Well-controlled research shows that St. John's Wort alleviates symptoms of depression, particularly seasoned effective disorders (SAD).
St. John's wort is also being investigated as an antiviral agent, as many preliminary studies have shown it to be quite active in this area. I has been used as a topical arthritic wound and burns healer and an oral remedy to treat various viral conditions. Studies show that it is sedative and has anxious properties. St. John's Wort oil is said to be good for the healing of burns and deep lacerations where nerve damage is likely.
Directions
An average dose of a standardized extract containing 0.3 percent hypericin is 200 to 300mg.
While no adverse reactions have been recorded, mixing St. John's Wort extracts with other antidepressants is not advised, without the supervision of a qualified health care professional.
Expected Outcome; Side-Effects; Counter-Indicators and Warnings
The antidepressant effects of St. John's Wort may not be apparent until it is taken daily for three to four weeks.
The most common side-effects from taking St. John's Wort are mild nausea, stomach ache, lack of appetite and tiredness, although these are not common. A very small percentage of people taking high daily doses of St. John's Wort may experience increased sensitivity to sunlight.
Those taking St. John's Wort should be cautioned about eating foods that are known to interact with monoamine oxidase inhibitors (tyramine-containing foods such as cheese, beer, wine, pickles, herring, yeast, etc.).
St. John's Wort appears to work at least in part as an SRI (Serotonin Reuptake Inhibitor). Combining an SRI with an MAO inhibitor can produce a dangerous rise in blood pressure; after stopping use of MAO inhibitors, one should wait four weeks before taking any SRIs. This caution is not based on specific medical research on hypericum and MAO inhibitors, but on what is known about prescription SRIs and MAO inhibitors. Until further research is done on how and why hypericum works to alleviate the symptoms of depression, hypericum should be considered an SRI and treated accordingly.
Very rarely, with a group of antidepressants known as SSRI (Selective Serotonin Reuptake Inhibitors) such as Prozac, anserotenergic syndrome could occur -- characterized by confusion, tremors and sweating. In The Lancet (February 12, 2000) there were two reports of how one of the constituents of St. Johns Wort interfered with an intestinal drug transporter (p-glycoprotein). This caused a decrease of the availability of the cyclosporin, digoxin, dexamethasone (a cortisone drug), Propulsid, Cozar, Theoplyline, and Coumadin. Additionally, another report indicated the new AIDS drug, Indinavir, had less than an adequate blood level in patients taking St. Johns Wort.
In short, be careful if you are taking any drugs -- unfortunately, your physician may not know about these interactions.
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St John's Wort can help with the following: | | | | | Mental |  Depression | St. John’s Wort has been shown to have a 60% to 70% response rate in adult patients with mild-to-moderate depression. A 2001 study found St. John's Wort (300mg extract per day) effective in children with mild to moderate depression also. Ratings of "good" or "excellent" were found by physicians to be 72% after 2 weeks, 97% after 4 weeks and 100% after 6 weeks. The ratings by parents were 65% after 2 weeks, 93% after 4 weeks and 98% at 6 weeks. The medication was tolerated well. [Phytother. Res 2001; 15: pp.367-70]
A large trial compared St. John's wort extract with sertraline (Zoloft) and a placebo in adults with depression. The trial found that neither St. John's wort nor sertraline were more effective than placebo in treating major depression. Most successful trials with St. John's wort have focused on persons with milder forms of depression. St. John's wort should be used primarily for mild to moderate depression as well as dysthymia. [JAMA 2002;287: pp.1807-14] |
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Metabolic |
 Anorexia / Starvation Tendency |
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KEY | | May do some good | | | Likely to help |
GLOSSARY
Adrenal (Adrenal Gland, Adrenal Glands, Adrenals)
The adrenal glands sit on top of each kidney and consist of an outer cortex and an inner medulla. Of the 50 or so hormones the adrenals make, only cortisone and adrenaline are recognized by most people. Some of these hormones must be produced to preserve life, while others help resist stress. Other hormones from the adrenals control normal energy output (along with the thyroid) and govern the breakdown of stored energy into quick energy sources. The medulla produces epinephrine and norepinephrine, which are specifically designed to help the body deal with stressful situations. The adrenals control the body's potassium/sodium balance, which is vital for energy production. They also produce sex hormones in minute amounts, which is important for later years when the gonads drop or cease their production.
AIDS
Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.
Antidepressant (Antidepressants)
Literally, substances meant to oppose depressions or sadness, and generally heterocyclic types such as Elavil, MAO inhibitors like phenelzine, or lithium carbonate. This category of substances formerly included stuff like amphetamines and other stimulants. Botanical examples include Hypericum, Peganum and Oplopanax.
Antiviral
Any of a number of herbs, drugs or agents capable of destroying viruses or inhibiting their growth or multiplication until the body is capable of destroying the virus itself. Most antiviral agents are members of the antimetabolite family.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Bioflavonoid (Bioflavonoids, Flavonoid, Flavonoids)
Vitamin P. Any of a group of colored flavones (crystalline compounds) found next to the peel in many fruits. Essential for the stability and absorption of ascorbic acid.
Dopamine
A neurohormone; precursor to norepinephrine which acts as a stimulant to the nervous system. Carries signals between neurons and controls feelings of satisfaction, arousal, reward and mood.
Dysthymia
A milder but chronic form of depression.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Metabolite (Metabolites)
Any product (foodstuff, intermediate, waste product) of metabolism.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Monoamine Oxidase (MAO)
An enzyme catalyzing the removal of an amine group from a variety of substrates, including norepinephrine and dopamine. MAO inhibitors block the action of MAO, thus raising the levels of the monoamine neurotransmitters such as norepinephrine, epinephrine, dopamine, and serotonin - which have significant effects on mood and behavior. Epinephrine, norepinephrine and serotonin are normally deactivated by MAO-A while dopamine and phenylethylamine are normally metabolized by MAO-B.
Nausea
Symptoms resulting from an inclination to vomit.
Noradrenaline (Norepinephrine)
Norepinephrine. A catecholamine hormone secreted from the adrenal medulla and post-ganglionic adrenergic fibers in response to hypotension or emotional stress.
Placebo (Placebos)
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Quercetin
A highly active bioflavonoid which is absorbed most effectively in combination with bromelain.
Rutin
A bioflavonoid obtained from buckwheat leaves.
Sedative
Calming, quieting; drug that quiets nervous excitement.
Serotonin
A phenolic amine neurotransmitter (C10H12N2O) that is a powerful vasoconstrictor and is found especially in the brain, blood serum and gastric membranes of mammals. Considered essential for relaxation, sleep, and concentration.
SRI
Serotonin Reuptake Inhibitor. The result of this inhibition action is to maintain higher levels of serotonin.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Topical
Most commonly 'topical application': Administration to the skin.
Yeast
A single-cell organism that may cause infection in the mouth, vagina, gastrointestinal tract, and any or all bodily parts. Common yeast infections include candidiasis and thrush.
Last updated: Apr 13, 2008
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