St Johns Wort Introduction
St Johns Wort Latin Name: Hypericum perforatum St Johns Wort Commonly referenced as: Common Goatweed or Klamath Weed
Ancient European, North African, and Asian civilizations have used St. Johns Wort for centuries, both ornamentally and as a potent medicinal herb. Some cultures in these lands even believed that this shrub-like perennial plant held magical properties. Americans, being intrigued by its medicinal and purposed magical properties, imported St. Johns Wort in the late 17th century. From its inception in Northern America, St. Johns Wort has continued to gain popularity as an alternative treatment option for a host of physical and psychological conditions.
St. Johns Wort’s key medicinal ingredients are hypericin, pseudohypericin, and hyperforin. These pigments are found in both the leaves and flowers of the plant. Supplemental St. Johns Wort is available in dried and powdered forms, with the majority of products being standardized to contain a 0.3% hypericin content. Hypericin was once thought to be the chief component regarding the herb’s therapeutic effects, but recent studies indicate that hyperforin may produce the most effective mood-enhancing effects. [1] This is of great importance due to the ever-increasing popularity of St. Johns Wort supplements for various psychological conditions.
Therapeutically, St. Johns Wort primary use continues to be in the areas of emotional stability, primarily its ability to counteract feelings of depression by increasing the release of the brain chemical serotonin. Nutritional scientists now recommend an extract to contain standardized 0.3% hypericin and 3.0% hyperforin. St Johns Wort has not only been used for depression. It has been employed for treating specific forms of anxiety, addiction, immunity, and healing.
St Johns Wort Sources
St. Johns Wort is available in numerous delivery forms including capsules, tablets, tinctures, teas, and oil-based skin lotions. As mentioned, chopped, powdered, and dry forms of the herb are also available for nutritional supplementation.
St Johns Uses
St. Johns Wort has proved itself as an effective tool in the reduction of depressive symptoms in persons suffering from mild to moderate depression. [2] Studies have praised its potency, suggesting that its therapeutic properties may even produce effects equal, or greater to, the traditionally prescribed tricyclic anti-depressants and SSRIs, or selective serotonin reuptake inhibitors. [3-4] St. Johns Wort may also be an effective tool in combating a specific form of depression linked to the changes in the duration of night and day named SAD, or seasonal affective disorder. [5] This type of depression is often referred to as the “wintertime blues” and is characterized by symptoms ranging from chronic fatigue to anxiety. St. Johns Wort has also been proven to promote sound sleeping patterns and may be useful for insomnia caused by moderate depression. [6]
Women may be at greatest risk for developing depression. They often experience depression as a primary symptom of Premenstrual Syndrome (PMS). European women have been using St. Johns Wort, with varying success, in the treatment of symptoms related to the depression caused by this hormonal change. [7] European patients suffering from fibromyalgia have also used St. Johns Wort as a means to ease depressive symptoms and to improve individual tolerance(s) to muscle pain resulting from the condition. Because of this, St. Johns Wort has increasingly taken the place of conventional antidepressants in fibromyalgia sufferers.
In stark contrast to emotional health, St. Johns Wort has been shown to exhibit antibacterial and antiviral properties. St. Johns Wort has demonstrated positive effects when used to fight certain resilient strains of bacteria that harness the potential to cause bodily harm. [8] Topical applications have proved even more potent than oral dosages when used for prevention of infection on burns, cuts, and different skin irritations. [9] Studies suggest that St. Johns Wort may be also a legitimate inhibitory supplement, possibly protecting persons from such immunosuppressive viruses as influenza and Epstein-Barr. However, more research is needed to support these preliminary claims of “boosting” immunity.
St. Johns Wort may also assist in the reduction of pain and inflammation. [10] By reducing the amount of inflammation, St. Johns Wort may expedite healing if applied directly to the traumatized area(s) of skin. St. Johns Wort has been a primary ingredient in many synergistic formulas for the treatment of inflammation caused by wounds, minor burns, ear infections, and even viral encephalitis. [11] Creams and ointments of St. Johns Wort may also lessen the burning and itching of hemorrhoids, while helping to alleviate the swelling of the inflamed tissue.
Studies are currently being conducted to further determine St. Johns Wort efficiency and its possible interactions with commonly prescribed medications. Alcoholism, general anxiety, and panic attacks are among the most prioritized of all conditions presently being research.
St Johns Wort Dosages
The majority of scientific research into St. Johns Wort has been conducted upon adults. However, studies done in children, less than 12 years of age, for the treatment of mild to moderate depression have shown great promise. [12] Preliminary indications suggest that St. Johns Wort is a safe and effective alternative treatment for specific psychological disorders in the pediatric population.
The dosage spectrum for St. Johns Wort is particularly broad. There are no established recommended dosages for this herb and its administration is determined by the ailment and an individual’s tolerance to St. Johns Wort-containing supplements. St. Johns Wort often takes up to four weeks before it circulates in sufficient amounts, absorbable by the body. This remains the recommended intake period for St. Johns Wort. Average dosages may range from as little as 300 milligrams per day, to an estimated intake of 900 milligrams per day.
Examples for the dietary supplementation of St. Johns Wort:
| Condition being treated | Adults and Teenagers (milligrams per day) |
|---|---|
| ADHD | 450 mg, twice per day |
| Anxiety and Panic | 300 mg, three X per day |
| Chronic Fatigue Syndrome | 300 mg, three X per day |
| Chronic Pain | 300 mg, three X per day |
| Mild to Moderate Depression | 600 mg in morning, 300mg in the evening |
| Fibromyalgia | 300 mg, three X per day |
| Hemorrhoids | Application of Oil/Ointment, three X per day, or as needed |
| High Cholesterol | 450 mg, twice per day |
| Irritable Bowel Syndrome | 300 mg, three X per day |
| Memory Loss | 300 mg, three X per day |
| Menopause | 300 mg, three X per day |
| Migraine | 450 mg, twice per day |
| Perimenopause | 300 mg, three X per day |
| PMS | 300 mg, three X per day |
| Stress | 300 mg, three X per day |
| Tobacco Dependence | 450 mg, twice per day |
| Weight Loss | 450 mg, twice per day |
[13]
St Johns Wort Side Effects and Interactions
St Johns Wort Side Effects
Side effects resulting from the supplementation of St. Johns Wort are extremely rare. Adverse reactions may include dry mouth, fatigue, dizziness, upset stomach, and constipation. Some individuals may also develop photo dermatitis, or extreme skin sensitivity to sunlight. [14] Persons exposed to sunlight for extended periods of time, and who are fair skinned, may be at an elevated risk for the development of this condition.
St Johns Wort Possible Drug Interactions
St. Johns Wort is notorious for its interactions with prescription medications. [15, 16] Due to the probability of these interactions, St. Johns Wort is not recommended if you are taking:
- Antidepressants (or other medications for mood disorder)
- Digoxin
- Immunosuppressive medications
- Protease inhibitors
- Loperamide
- Oral contraceptives
- Reserpine
- Theophylline
- Warfarin
Cyclosporine, an immunosuppressive medication, may yield the highest interaction rate of any medication listed above. There have been documented cases of cyclosporin blood levels dropping in individuals receiving a major organ transplant, even causing the rejection of transplanted organs. [17]
The Food and Drug Administration (FDA) has also issued a public health advisory for possible interactions between supplemental St. Johns Wort and Indinavir, a protease inhibitor. [18] These classes of medications are often used in the standardized treatment of HIV and AID patients. The FDA continually recommends that St. Johns Wort not be used with either antiretroviral or immunosuppressive medications.
References
1. Laakmann, G.; Schule, C.; Baghai, T., and Kieser, M. St Johns Wort in mild to moderate depression: the relevance of hyperforin for the clinical efficacy. Pharmacopsychiatry. 1998 Jun; 31 Suppl 1:54-9.
2. Linde, K. and Mulrow, C.D. St. John’s wort for depression. Cochrane Database Syst Rev. 2000; (2): CD000448.
3. Phillipp M, Kohnen R, Hiller KO. Hypericum extract versus impramine or placebo in patients with moderate depression: randomised multicentre study of treatment for eight weeks. BMJ. 1999:319(7224):1534-1538.
4. Brenner R, Azbel V, Madhusoodanan S, Pawlowska M. Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: a double-blind, randomized pilot study. Clin Ther. 2000;22(4):411-419.
5. Martinez B, Kasper S, Ruhrmann S, Moller HJ. Hypericum in the treatment of seasonal affective disorders. J Geriatr Psychiatry Neurol. 1994;7(Suppl 1):S29–33.
6. Friede, M.; Henneicke von Zepelin, H. H., and Freudenstein, J. Differential therapy of mild to moderate depressive episodes (ICD-10 F 32.0; F 32.1) with St. John’s wort. Pharacopsychiatry. 2001 Jul; 34 Suppl 1:S38-S41.
7. Stevinson C, Ernst E. A pilot study of Hypericum perforatum for the treatment of premenstrual syndrome. British Journal of Obstetrics and Gynaecology. 2000;107:870-876.
8. Schempp CM, Pelz K, Wittmer A, Schopf E, Simon JC. Antibacterial activity of hyperforin from St. John’s wort, against multireistant Staphylococcus aureus and gram-positive bacteria. Lancet. [Research Letters]1999;353:2129.
9. Schempp, C. M.; Winghofer, B.; Ludtke, R.; Simon-Haarhaus, B.; Schopf, E., and Simon, J. C. Topical application of St John’s wort (Hypericum perforatum L.) and of its metabolite hyperforin inhibits the allostimulatory capacity of epidermal cells. Br J Dermatol. 2000 May; 142(5):979-84.
10. Shipochliev T, et al. Anti-inflammatory Action of a Group of Plant Extracts. Vet Med Nauki. 1981; 18(6):87-94.
11. Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med. 2001;155:796-799.
12. Hubner W-D, Kirste T. Experience with St. Johns wort (Hypericum perforatum) in children under 12 years with symptoms of depression and psychovegetative disturbances. Phytother Res. 2001; 15:367-370.
13. “St Johns Wort.” WholeHealthMD.com. WholeHealthMD.com Corporation. 19 Apr. 2005.
http://www.wholehealthmd.com/refshelf/substances_view/1,1525,824,00.html
14. Brockmoller J, et al. Hypericin and Pseudohypericin: Pharmokinetics and Effects of Photosensitivity in Humans. Pharmacopsychiatry. 1990; 30(Suppl 2):94-101.
15. Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200–2211.
16. Biffignandi PM, Bilia AR. The growing knowledge of St. John’s wort (Hypericum perforatum L) drug interactions and their clinical significance. Curr Ther Res. 2000; 61(70):389-394.
17. Ruschitzka F, Meier PJ, Turina M, et al. Acute heart transplant rejection due to Saint John’s Wort [letter]. Lancet. 2000,355.
18. Food and Drug Administration. Risk of Drug Interactions with St John’s Wort and Indinavir and Other Drugs. Rockville, Md: National Press Office; February 10, 2000. Public Health Advisory.
