St. John’s Wort (hypericum) is used for depression or anxiety that leads to fatigue and adrenal gland exhaustion. It 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.
St John’s wort has been used for so-called ‘nervous disorders’ for a couple of thousand years. It is sold over the counter, usually in tablet form, and is also supplied by complementary practitioners such as naturopaths and herbalists.
The balance of evidence suggests that if St John’s wort is taken at a sufficiently high dose, it is as effective as pharmaceutical antidepressants for mild, and possibly moderate, depression. However, it is unlikely to benefit people with more severe depression. The dosage of St. John’s Wort that has been used in most studies is a 900mg daily dose taken in 300mg increments TID. The typical preparation is a 0.3% extract of hypericin). Results may not be seen for at least four to six weeks. Discontinue use after six weeks if you’ve noticed no results because it’s probably not effective for you.
The benefit of St John’s wort is that it has fewer side effects than prescription antidepressants (though it can cause drowsiness, headaches or a photosensitivity to sunlight in some individuals). Like the pharmaceuticals, it can cause serotonin syndrome, and it has recently been discovered that St John’s wort can interfere with other medicines, including anti-HIV drugs, immunosuppressants, warfarin, and potentially others, including the oral contraceptive pill. For this reason it is important to talk to a GP before taking St John’s wort, and anyone seeing a herbalist or naturopath should also tell them what other medicines they are taking.
In 2003, laboratory testing of 54 commercial St John¹s wort products from Canada and the United States found only two products with a total hypericin content within 10% of the amount stated on the label. On average, most products tested contained half of the labeled amount of hypericin.
Caution:
Fourteen days of supplementation with a St. John’s wort extract (300mg TID) induced cytochrome P450 3A4 (CYP 3A4) enzyme activity in a crossover study of 12 healthy adults. The investigators concluded that St. John’s wort may diminish the clinical effectiveness or increase dosing requirements for all CYP 3A4 substrate drugs, which represent at least 50% of all marketed medications.
St John's Wort (Hypericum perforatum) can help with the following
Upcoming Surgical Procedure
St. John’s wort may intensify the effects of anesthetic medications and interfere with the metabolism of some drugs used before and after surgery.
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 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 in mild to moderate depression as well as dysthymia. [JAMA 2002;287: pp.1807-14]
Rarely, with high doses, there may be temporary withdrawal symptoms when St. John’s Wort is stopped suddenly. [Ann Pharmacother 2003;37(1): p.151]
A combination product called Amoryn contains St. John’s Wort, 5HTP, and small amounts of B6, B12 and folic acid.
Anorexia / Starvation Tendency
Used for depression or anxiety that leads to fatigue and adrenal gland exhaustion.
Hepatitis
Interview with Dr. Bihari in Honest Medicine.
Q: You’re also using it for Hepatitis C?
Dr. Bihari: Yes, I am. With Hepatitis C, it’s hard for me to identify how much it does, because I’m using it with purified extract of St. John’s Wart, the plant, in which an ingredient called hypericon has been extracted from the St. John’s Wart and added back in about twenty-two fold. So, since hypericon in the test tube is extremely effective against hepatitis C and hepatitis B, I had a company make this concentrated form up to use in treating people with those two kinds of hepatitis. And the combination of that with LDN looks very promising. It looks to me like the hypericon, the concentrated St. John’s Wart, looks to be the more important of the two ingredients. I think the naltrexone is helpful with any chronic infection, but the more dramatic element here is the hypericon. In the test tube, it really suppresses these two viruses. In people it seems to suppress hepatitis B and Hepatitis C growth and markedly improve liver function.
Eczema
A St. John’s wort extract cream (1.5% hyperforin) was applied to one side of the body twice daily for 4 weeks in a well-controlled study of 21 patients with mild to moderate atopic dermatitis. The treated side experienced reduced eczematous lesions. St. John’s wort cream did not reduce skin colonization by Staphylococcus aureus. [Hautarzt 2003;54(3): pp.248-53 (German)]
Key
| May do some good |
| Likely to help |
| May have adverse consequences |
Glossary
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
SRI
Serotonin Reuptake Inhibitor. The result of this inhibition action is to maintain higher levels of serotonin.
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.
MAO
Abbreviation for a breakdown enzyme monoamine oxidase. A MAO inhibitor blocks the action of monoamine oxidase, 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.
Over-The-Counter
A drug or medication that can legally be bought without a doctor's prescription being required.
Naturopathy
Medical practice using herbs and other various methods to produce a healthy body state by stimulating innate defenses without the use of drugs.
Milligram
(mg): 1/1,000 of a gram by weight.
TID
Three times a day.
Enzymes
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.