Hypericum Perforatum (St. John's Wort)
Other Common Names: Binbirdelikotu, Common St Johnswort,
Hiperico, Hypericum, Klamath Weed, Perforate St John's-wort, Klamath
Weed, Hypericum perforatum
Range: Britain; and throughout Europe and Asia; USA.
Habitat: Open woods, hedgebanks and grassland, in dry sunny places, usually on calcareous soils.
There are many ancient superstitions regarding this herb. Its name
Hyperieum is derived from the Greek and means 'over an apparition,' a
reference to the belief that the herb was so obnoxious to evil spirits
that a whiff of it would cause them to fly.
There is considerable public interest in the United States in claims
that extracts of the herb St. John's wort may be an effective treatment
for depression. In Europe - where the herb is now widely prescribed - a
number of studies have been conducted that support the treatment
efficacy of certain St. John's wort extracts. In the United States, St.
John's wort is not a prescription medication, but is sold in health
food stores and pharmacies as an herbal tea or nutritional supplement,
which the U.S. Food & Drug Administration (FDA) does not regulate.
St. John's wort has a long history of herbal use. It fell out of
favor in the nineteenth century but recent research has brought it back
to prominence as an extremely valuable remedy for nervous problems. An
overview of 23 clinical studies in Europe, published in the British
Medical Journal (Vol. 313, August 3, 1996), found that the herb might
be useful in cases of mild to moderate depression. The studies, which
included 1,757 outpatients, reported that St. John's wort was superior
to placebo and appeared to produce fewer side effects than standard
antidepressants.
Depression, at least in its milder forms, is a condition that seems
to afflict many Americans. In this country, the disease is the fourth
most likely reason for one to consult a family physician and costs our
economy more than chronic respiratory illness, diabetes, arthritis, or
hypertension. The treatment and rehabilitation expenses in the United
States exceed $12 billion annually.
More than a dozen prescription drugs are routinely used to treat
America's depression. All of them are synthetic, and they all produce
more or less unpleasant side effects ranging from skin rashes to
overtly violent behavior. Meanwhile, in Germany the most popular
prescription drug of any type, natural or synthetic, for the treatment
of depression is a concentrated extract of the flowers and leaves of
St. John's wort, often simply called hypericum. More than 200,000
prescriptions per month are filled for a single brand (Jarsin) there
compared to about 30,000 per month for fluoxetine (Prozac). This figure
does not include sales of other hypericum products, whether prescribed
or self-selected. Actually, 80-90% of the sales in Germany are
prescriptions, which allows their cost to be reimbursed by the health
insurance system.
The plant contains many biologically active compounds including
rutin, pectin, choline, sitosterol, hypericin and pseudohypericin.
These last two compounds have been shown to have potent anti-retroviral
activity without serious side effects and they are being researched in
the treatment of AIDS.
The herb's multiple constituents apparently function in several
different ways. Initially, St. John's wort was thought to act as a
monoamine oxidase (MAO) inhibitor. This effect has now been shown to be
insignificant. Some evidence supports its effect as a selective
serotonin reuptake inhibitor (SSRI).
Although St. John's wort is marketed as a drug in Germany and has
been approved there by the German equivalent of our Food and Drug
Administration for the treatment of depression, anxiety, and nervous
unrest, it is sold in the United States only as a dietary supplement.
The most effective preparations are capsules containing an extract of
the herb standardized on the basis of 0.3% hypericin. Dosage is 300-900
mg daily. Improvement of mild to moderate depression should result
after 2 to 6 weeks of treatment
The flowers and leaves are analgesic, antiseptic, antispasmodic,
aromatic, astringent, cholagogue, digestive, diuretic, expectorant,
nervine, resolvent, sedative, stimulant, vermifuge and vulnerary. The
herb is used in treating a wide range of disorders, including pulmonary
complaints, bladder problems, diarrhoea and nervous depression. It is
also very effectual in treating overnight incontinence of urine in
children. Externally, it is used in fomentations to dispel herd
tumours, caked breasts and bruising. The flowering shoots are harvested
in early summer and dried for later use. Use the plant with caution and
do not prescribe it for patients with chronic depression. The plant was
used to procure an abortion by some native North Americans, so it is
best not used by pregnant women. See also the notes on toxicity.
A tea or tincture of the fresh flowers is a popular treatment for
external ulcers, burns, wounds (especially those with severed nerve
tissue), sores, bruises and cramps. An infusion of the flowers in olive
oil is applied externally to wounds, sores, ulcers, swellings and
rheumatism. It is also valued in the treatment of sunburn and as a
cosmetic preparation to the skin.
A homeopathic remedy is made from the fresh whole flowering plant.
It is used in the treatment of injuries, bites, stings etc and is said
to be the first remedy to consider when nerve-rich areas such as the
spine, eyes, fingers etc are injured
Known Hazards: Skin contact with the sap, or ingestion of the
plant, can cause photosensitivity in some people. The European studies
reported that some patients have complained of mild problems with dry
mouth, dizziness, gastrointestinal symptoms, increased sensitivity to
sunlight, fatigue, and/or confusion.
Many "natural" substances can have harmful effects, especially if
taken in large quantities or with other medications. Even too much
vitamin A, for example, can be damaging. St. John's wort, like certain
other herbal treatments, is now known to adversely interact with or
change blood levels of particular prescription drugs, such as indinavir
and cyclosporine, as discussed below.
Further, NIH findings on indinavir that were reported in the Lancet
article, as well as other information in the medical literature,
suggest that St. John's wort may be an inducer of the metabolic pathway
cytochrome P450. Consequently, the combined use of St. John's wort and
other drugs metabolized via this route could result in harmful effects.
These may include oral contraceptives; medications to treat heart
disease, depression, seizures, and certain cancers; and those to
prevent organ transplant rejection.
The Food and Drug Administration
would like to inform you about results from a study conducted by The
National Institutes of Health (NIH) that showed a significant drug
interaction between St John's wort (hypericum perforatum), an herbal
product sold as a dietary supplement, and indinavir, a protease
inhibitor used to treat HIV infection. In this study, concomitant
administration of St. John's wort and indinavir substantially decreased
indinavir plasma concentrations, potentially due to induction of the
cytochrome P450 metabolic pathway. For additional information on this
study please refer to the February 12, 2000 Lancet publication
(Piscitelli, et al).
Given the research to date, it is evident that "natural" does not
always mean "safe." Alternative medical treatments require more
research, and people are well advised to seek competent medical
supervision before trying them. The National Institute of Mental Health
(NIMH) also urges individuals who are already taking St. John's wort
with any of the above types of medications to contact their doctors
immediately for medical direction. Health care providers are strongly
advised to alert patients to these potential drug interactions, until
additional research is done.
Another caution against using St. John's wort for the treatment of
depression is that the herb is not a proven therapy for the disorder.
If major depression is not adequately treated, it can become
debilitating and, in some cases, lead to suicide. Proven treatments
most commonly used are prescription antidepressants, specific
psychotherapies (such as cognitive-behavioral therapy and interpersonal
therapy), or a combination of both. Also, because other medical
conditions, such as thyroid disorders, can mimic depression, anyone
with symptoms of depression should receive a thorough medical
examination before beginning any treatment, in order to rule out other
possible causes.
Other Common Names: Binbirdelikotu, Common St Johnswort,
Hiperico, Hypericum, Klamath Weed, Perforate St John's-wort, Klamath
Weed, Hypericum perforatum
Range: Britain; and throughout Europe and Asia; USA.
Habitat: Open woods, hedgebanks and grassland, in dry sunny places, usually on calcareous soils.
There are many ancient superstitions regarding this herb. Its name
Hyperieum is derived from the Greek and means 'over an apparition,' a
reference to the belief that the herb was so obnoxious to evil spirits
that a whiff of it would cause them to fly.
There is considerable public interest in the United States in claims
that extracts of the herb St. John's wort may be an effective treatment
for depression. In Europe - where the herb is now widely prescribed - a
number of studies have been conducted that support the treatment
efficacy of certain St. John's wort extracts. In the United States, St.
John's wort is not a prescription medication, but is sold in health
food stores and pharmacies as an herbal tea or nutritional supplement,
which the U.S. Food & Drug Administration (FDA) does not regulate.
St. John's wort has a long history of herbal use. It fell out of
favor in the nineteenth century but recent research has brought it back
to prominence as an extremely valuable remedy for nervous problems. An
overview of 23 clinical studies in Europe, published in the British
Medical Journal (Vol. 313, August 3, 1996), found that the herb might
be useful in cases of mild to moderate depression. The studies, which
included 1,757 outpatients, reported that St. John's wort was superior
to placebo and appeared to produce fewer side effects than standard
antidepressants.
Depression, at least in its milder forms, is a condition that seems
to afflict many Americans. In this country, the disease is the fourth
most likely reason for one to consult a family physician and costs our
economy more than chronic respiratory illness, diabetes, arthritis, or
hypertension. The treatment and rehabilitation expenses in the United
States exceed $12 billion annually.
More than a dozen prescription drugs are routinely used to treat
America's depression. All of them are synthetic, and they all produce
more or less unpleasant side effects ranging from skin rashes to
overtly violent behavior. Meanwhile, in Germany the most popular
prescription drug of any type, natural or synthetic, for the treatment
of depression is a concentrated extract of the flowers and leaves of
St. John's wort, often simply called hypericum. More than 200,000
prescriptions per month are filled for a single brand (Jarsin) there
compared to about 30,000 per month for fluoxetine (Prozac). This figure
does not include sales of other hypericum products, whether prescribed
or self-selected. Actually, 80-90% of the sales in Germany are
prescriptions, which allows their cost to be reimbursed by the health
insurance system.
The plant contains many biologically active compounds including
rutin, pectin, choline, sitosterol, hypericin and pseudohypericin.
These last two compounds have been shown to have potent anti-retroviral
activity without serious side effects and they are being researched in
the treatment of AIDS.
The herb's multiple constituents apparently function in several
different ways. Initially, St. John's wort was thought to act as a
monoamine oxidase (MAO) inhibitor. This effect has now been shown to be
insignificant. Some evidence supports its effect as a selective
serotonin reuptake inhibitor (SSRI).
Although St. John's wort is marketed as a drug in Germany and has
been approved there by the German equivalent of our Food and Drug
Administration for the treatment of depression, anxiety, and nervous
unrest, it is sold in the United States only as a dietary supplement.
The most effective preparations are capsules containing an extract of
the herb standardized on the basis of 0.3% hypericin. Dosage is 300-900
mg daily. Improvement of mild to moderate depression should result
after 2 to 6 weeks of treatment
The flowers and leaves are analgesic, antiseptic, antispasmodic,
aromatic, astringent, cholagogue, digestive, diuretic, expectorant,
nervine, resolvent, sedative, stimulant, vermifuge and vulnerary. The
herb is used in treating a wide range of disorders, including pulmonary
complaints, bladder problems, diarrhoea and nervous depression. It is
also very effectual in treating overnight incontinence of urine in
children. Externally, it is used in fomentations to dispel herd
tumours, caked breasts and bruising. The flowering shoots are harvested
in early summer and dried for later use. Use the plant with caution and
do not prescribe it for patients with chronic depression. The plant was
used to procure an abortion by some native North Americans, so it is
best not used by pregnant women. See also the notes on toxicity.
A tea or tincture of the fresh flowers is a popular treatment for
external ulcers, burns, wounds (especially those with severed nerve
tissue), sores, bruises and cramps. An infusion of the flowers in olive
oil is applied externally to wounds, sores, ulcers, swellings and
rheumatism. It is also valued in the treatment of sunburn and as a
cosmetic preparation to the skin.
A homeopathic remedy is made from the fresh whole flowering plant.
It is used in the treatment of injuries, bites, stings etc and is said
to be the first remedy to consider when nerve-rich areas such as the
spine, eyes, fingers etc are injured
Known Hazards: Skin contact with the sap, or ingestion of the
plant, can cause photosensitivity in some people. The European studies
reported that some patients have complained of mild problems with dry
mouth, dizziness, gastrointestinal symptoms, increased sensitivity to
sunlight, fatigue, and/or confusion.
Many "natural" substances can have harmful effects, especially if
taken in large quantities or with other medications. Even too much
vitamin A, for example, can be damaging. St. John's wort, like certain
other herbal treatments, is now known to adversely interact with or
change blood levels of particular prescription drugs, such as indinavir
and cyclosporine, as discussed below.
Further, NIH findings on indinavir that were reported in the Lancet
article, as well as other information in the medical literature,
suggest that St. John's wort may be an inducer of the metabolic pathway
cytochrome P450. Consequently, the combined use of St. John's wort and
other drugs metabolized via this route could result in harmful effects.
These may include oral contraceptives; medications to treat heart
disease, depression, seizures, and certain cancers; and those to
prevent organ transplant rejection.
The Food and Drug Administration
would like to inform you about results from a study conducted by The
National Institutes of Health (NIH) that showed a significant drug
interaction between St John's wort (hypericum perforatum), an herbal
product sold as a dietary supplement, and indinavir, a protease
inhibitor used to treat HIV infection. In this study, concomitant
administration of St. John's wort and indinavir substantially decreased
indinavir plasma concentrations, potentially due to induction of the
cytochrome P450 metabolic pathway. For additional information on this
study please refer to the February 12, 2000 Lancet publication
(Piscitelli, et al).
Given the research to date, it is evident that "natural" does not
always mean "safe." Alternative medical treatments require more
research, and people are well advised to seek competent medical
supervision before trying them. The National Institute of Mental Health
(NIMH) also urges individuals who are already taking St. John's wort
with any of the above types of medications to contact their doctors
immediately for medical direction. Health care providers are strongly
advised to alert patients to these potential drug interactions, until
additional research is done.
Another caution against using St. John's wort for the treatment of
depression is that the herb is not a proven therapy for the disorder.
If major depression is not adequately treated, it can become
debilitating and, in some cases, lead to suicide. Proven treatments
most commonly used are prescription antidepressants, specific
psychotherapies (such as cognitive-behavioral therapy and interpersonal
therapy), or a combination of both. Also, because other medical
conditions, such as thyroid disorders, can mimic depression, anyone
with symptoms of depression should receive a thorough medical
examination before beginning any treatment, in order to rule out other
possible causes.
- Tyler,
V.E. 1999. Herbs affecting the central nervous system. p. 442?449. In:
J. Janick (ed.), Perspectives on new crops and new uses. ASHS Press,
Alexandria, VA.
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