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St. John's Wort
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St. John's wort (Hypericum
perforatum), a common shrub-like perennial,
bears bright yellow flowers that contain
numerous therapeutic substances when dried.
Europeans have used the herb for centuries
to calm jangled nerves and heal wounds,
among other ills. And so it's not surprising
that North Americans have recently embraced
its use as a treatment for depression and
conditions associated with it. Not only is
St. John's wort effective and relatively
free of side effects, it also costs under
$20 for a month's supply, about 75% less
than the most popular antidepressant drugs.
In Germany, where doctors routinely
prescribe herbal remedies, St. John's wort
is the most common form of
antidepressant--more widely used than the
drugs Prozac or Zoloft because it has far
fewer side effects.
Although St. John's wort has
been the focus of a number of well-regarded
studies, researchers still don't know
exactly how the herb works. A pigment called
hypericin has long been identified as a key
medicinal ingredient, although other
compounds are now similarly believed to
contribute to the herb's therapeutic
effects. In general, St. John's wort appears
to boost levels of the brain chemical
serotonin, which affects the emotions. The
National Institutes of Health (NIH), in
Washington D.C., are currently conducting
multiple studies on the efficacy of St.
John’s Wort for many psychological
conditions. Because of its widespread use
among the public, the NIH is also in the
process of conducting research to determine
St. John’s Wort effects on other commonly
prescribed drugs.
A number of other uses for
St. John's wort have been proposed as well,
many of them related to the herb's
antidepressive actions. The herb is even
being investigated as a treatment for
alcoholism, panic attacks, and general
anxiety.
Specifically, St. John's
wort may help to:
Relieve mild to moderate
depression.
Careful analysis of 27 different studies of
St. John's wort including 2291 study
participants concluded that the herb works
better than a placebo in the treatment of
mild to moderate depression (1). And because
it helps promote sound sleep, St. John's
wort is particularly beneficial for those
who suffer fatigue, low energy, or insomnia
as a result of depression (2). The herb may
also aid in treating depressive elements of
chronic fatigue syndrome and seasonal
affective disorder (also known as SAD or
"wintertime blues"), a type of depression
linked to the shortage of daylight in the
fall and winter(3).
Control certain PMS and
fibromylagia symptoms.
Many women experience depression as their
primary symptom of PMS (premenstrual
syndrome). In such cases, St. John's wort
may be worth a try. Take the herb regularly
for this purpose, but be patient; it may
take one or two menstrual cycles for the
active ingredients to reach therapeutic
levels in your system and lessen emotional
upset. European women have been turning to
this herbal PMS cure for years. In the case
of fibromylagia, St. John's wort may not
only ease depression but also improve
tolerance to the widespread muscle pain
associated with this chronic condition. In
fact it's used in much the same way that
conventional antidepressants are prescribed
for fibromyalgia.
Ease anxiety, stress, and
chronic pain. The
depression and tension often associated with
these conditions may lessen with St. John's
wort.
Ward off infections.
St. John's wort has been shown to have
antibacterial and antiviral properties. It's
particularly effective when applied
topically (in the form of an ointment) for
the treatment of burns, cuts, scrapes, and
minor skin irritations(4,5). Some
preliminary laboratory studies indicate that
St. John's wort might also be useful against
herpes simplex, influenza, and the
Epstein-Barr virus (the cause of
mononucleosis). Clinical trials are still
needed to confirm these findings, however.
Relieve hemorrhoids.
St. John's wort cream or ointment can soothe
the pain of hemorrhoids. Burning and itching
may lessen as well. The ointment may even
help to shrink the inflamed and swollen
tissue.
tincture tablet softgel ointment cream
capsule
Special tip:
Although most clinical
studies have been done using an extract
standardized for hypericin, there seems to
be some doubt as to what aspect of the herb
is truly responsible for its clinical
efficacy. Research findings indicate that a
substance called hyperforin may even have
more potent mood-enhancing properties than
hypericin (6). For this reason, when
treating depression, look for an extract
standardized to contain 0.3% hypericin and
hyperforin (3.0%).
For depression, PMS, and
the majority of other ailments mentioned:
Take 900 mg a day--either a 300 mg pill
three times a day or a 450 mg pill twice a
day. To avoid missing doses, you can also
simplify the regimen by taking two 300 mg
capsules in the morning and one in the
evening (or vice versa). If using a
tincture, follow the instructions on the
bottle for dosage equivalence.
For fibromyalgia: Take 450 mg
twice a day.
For skin infections and
hemorrhoids: Apply St. John's wort ointment
three or four times a day. Use an ointment
when treating hemorrhoids, applying it
several times a day and, when possible,
directly after bowel movements. Be sure to
check out our Dosage Recommendations
Chart for St. John's Wort, which lists
therapeutic dosages for specific ailments at
a glance.
St. John's wort takes some time to build up in the
blood, so allow at least four weeks to see
if it works for you. It can be used long
term as needed.
Take St. John's wort with
meals to reduce the risk of stomach
irritation.
No foods are off limits for
those taking St. John's wort, not even aged
cheese and red wine, which are not
recommended for those on MAO inhibitors.
To prevent the risk of
adverse reactions to the herb, avoid making
your own preparations of the plant. Stick to
standardized supplements you can buy over
the counter.
Although rare, serious adverse reactions have been
reported from the combination of a
conventional antidepressant, such as Prozac
and Zoloft, with St. John's wort. Don't
start taking St. John's wort without
consulting your doctor.
Certain medications, such as
tetracycline and fluoroquinolone
antibiotics, can increase the skin's
sensitivity to the sun, so avoid taking St.
John's wort, which can also have this
effect, at the same time. Consult your
doctor for more information.
Because St. John's wort and
oral contraceptives are broken down and used
by the body in the same way, the
effectiveness of the oral contraceptives may
be compromised. Consult your doctor (7,8).
A study conducted by The
National Institutes of Health (NIH) showed a
significant interaction between St. John's
wort and indinavir, a protease inhibitor
drug used to treat HIV infection (9). It
showed that taking St. John's wort at the
same time as indinavir greatly reduced the
effectiveness of indinavir. St. John's wort
may also affect other protease
inhibitors--such as saquinavir--in a similar
manner. Caution is advised.
Because the herb's exact
mechanism of action is still unclear, it's
probably not wise to combine it with MAO
inhibitors, medications prescribed for
depression and Parkinson's disease.
Side effects are uncommon but can include fatigue, dry
mouth, dizziness, constipation, and upset
stomach.
Some people experience
increased sun sensitivity when taking St.
John's wort, especially if they are exposed
to the sun for long periods of time (10).
Skin reactions in AIDS patients taking high
doses of St. John's wort were so severe in
one trial that many stopped participating.
So while sun sensitivity is not a problem
for most people at commonly recommended
doses, be sure to contact your doctor if you
develop an unexpected sunburn or rash after
being in the sun(11,12).
If you are taking prescription drugs check with your
physician before beginning treatment with
St. John’s wort. Studies are now underway
to determine the effects of possible
interactions between many commonly
prescribed prescription medications and St.
John’s wort (13,14,15,16).
Never stop taking
prescription antidepressants (or even lower
the dosage) without checking with your
doctor first.
Serious allergic reactions to
any food, herb or medication are always
possible. Fortunately, such allergies to St.
John's wort are extremely rare. However, if
you do develop hives or wheezing after
taking the herb, get immediate medical help.
Though no adverse effects
have been reported in pregnant or lactating
women using the herb, there have been few
studies on this group, so caution is
advised.
Discuss all herbal
supplements you take with your physician
prior to an operation. St. John’s wort may
increase the metabolism of many drugs
commonly prescribed in the post-operative
period (17,18).
Preliminary studies show that
St. John’s wort may have a negative effect
on irinotecan as a treatment for cancer. You
should fully discuss any herbal supplements
you take with your physician prior to
undergoing treatment (19).
References
1. Linde, K. and Mulrow, C.
D. St John's wort for depression. Cochrane
Database Syst Rev. 2000; (2):CD000448.
2. 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.
Pharmacopsychiatry. 2001 Jul; 34 Suppl
1:S38-41.
3. Kasper, S. Treatment of seasonal
affective disorder (SAD) with hypericum
extract. Pharmacopsychiatry. 1997 Sep; 30
Suppl 2:89-93.
4. Schempp, C. M.; Hezel,S., and Simon, J.
C. [Topical treatment of atopic dermatitis
with Hypericum cream. A randomised,
placebo-controlled, double-blind half-side
comparison study].Hautarzt. 2003 Mar;
54(3):248-53.
5. 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.
6. Laakmann, G.; Schule,C.; Baghai, T., and
Kieser, M. St. John's wort in mild to
moderate depression: the relevance of
hyperforin for the clinical efficacy.
Pharmacopsychiatry. 1998 Jun; 31 Suppl
1:54-9.
7. Henderson, L., Yue, Q. Y.; Bergquist, C.,
Gerden, B., and Arlett, P. St John's wort
(Hypericum perforatum): drug interactions
and clinical outcomes. Br J Clin Pharmacol.
2002 Oct; 54(4):349-56.
8. Pfrunder, A.; Schiesser, M.; Gerber, S.,
Haschke, M.; Bitzer, J., and Drewe, J.
Interaction of St John's wort with low-dose
oral contraceptive therapy: a randomized
controlled trial. Br J Clin Pharmacol. 2003
Dec; 56(6):683-90.
9. Hennessy, M.; Kelleher, D.; Spiers, J.
P.; Barry, M.; Kavanagh, P.; Back, D.;
Mulcahy, F., and Feely, J. St Johns wort
increases expression of P-glycoprotein:
implications for drug interactions. Br J
Clin Pharmacol. 2002 Jan; 53(1):75-82.
10. Schempp, C. M.; Ludtke, R.; Winghofer,
B., and Simon, J. C. Effect of topical
application of Hypericum perforatum extract
(St. John's wort) on skin sensitivity to
solar simulated radiation. Photodermatol
Photoimmunol Photomed. 2000 Jun;
16(3):125-8.
11. Schempp, C. M., Muller, K., Winghofer,
B., Schulte-Monting, J., and Simon, J. C.
Single-dose and steady-state administration
of Hypericum perforatum extract (St John's
Wort) does not influence skin sensitivity to
UV radiation, visible light, and
solar-simulated radiation. Arch Dermatol.
2001 Apr; 137(4):512-3.
12. Schempp, C. M., Winghofer, B., Muller,
K., Schulte-Monting, J., Mannel, M., Schopf,
E., and Simon, J. C. Effect of oral
administration ofHypericum perforatum
extract (St. John's Wort) on skin erythema
and pigmentation induced by UVB, UVA,
visible light and solar simulated radiation.
Phytother Res. 2003 Feb; 17(2):141-6.
13. Brazier, N. C. and Levine, M. A.
Drug-herb interaction among commonly used
conventional medicines: a compendium for
health care professionals. Am J Ther. 2003
May-2003 Jun 30; 10(3):163-9.
14. Markowitz, J. S. and DeVane, C. L. The
emerging recognition of herb-drug
interactions with a focus on St. John's wort
(Hypericum perforatum). Psychopharmacol
Bull. 2001 Winter; 35(1):53-64.
15. Ernst, E. The risk-benefit profile of
commonly used herbal therapies: Ginkgo, St.
John's Wort, Ginseng, Echinacea, Saw
Palmetto, and Kava. Ann Intern Med. 2002 Jan
1; 136(1):42-53.
16. Wang, L. S., Zhou, G., Zhu, B., Wu, J.,
Wang, J.G., Abd El-Aty, A. M., Li, T., Liu,
J., Yang, T. L., Wang, D., Zhong, X. Y., and
Zhou, H. H. St John's wort induces both
cytochrome P450 3A4-catalyzed sulfoxidation
and 2C19-dependent hydroxylation of
omeprazole. Clin Pharmacol Ther. 2004 Mar;
75(3):191-7.
17. Ang-Lee, M. K.; Moss, J., and Yuan, C.
S. Herbal medicines and perioperative care.
JAMA. 2001 Jul 11; 286(2):208-16. 18.
Kistorp, T. K. and Laursen, S. B. [Herbal
medicines--evidence and drug interactions in
clinical practice]. Ugeskr Laeger. 2002 Sep
2; 164(36):4161-5.
19. Mathijssen, R. H.; Verweij, J.; de
Bruijn, P.; Loos, W. J., and Sparreboom, A.
Effects of St. John's wort on irinotecan
metabolism. J Natl Cancer Inst. 2002 Aug 21;
94(16):1247-9.
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Ailments
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Dosage
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ADHD |
450 mg twice a
day with food, if depression is
also present.
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Anxiety and Panic |
300 mg 3 times a
day or 450 mg twice a day
|
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Chronic Fatigue
Syndrome |
450 mg twice a
day or 300 mg 3 times a day
|
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Chronic Pain |
300 mg 3 times a
day or 450 mg twice a day
|
|
Depression |
300 mg 3 times a
day (or 450 mg twice a day or
600 mg in the morning and 300 mg
in the evening)
|
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Fibromyalgia |
450 mg twice a
day or 300 mg 3 times a day with
food
|
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Hemorrhoids |
Apply oil or
ointment 2 or 3 times a day, as
needed.
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High Cholesterol |
450 mg twice a
day for anxiety
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Irritable Bowel
Syndrome |
450 mg twice a
day or 300 mg 3 times a day
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Memory
Loss/Impairment |
300 mg 3 times a
day or 450 mg twice a day
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Menopause |
450 mg twice a
day or 300 mg 3 times a day
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Migraine |
300 mg 3 times a
day (or 450 mg twice a day or
600 mg in the morning and 300 mg
in the evening)
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|
Perimenopause |
450 mg twice a
day or 300 mg 3 times a day
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|
PMS |
300 mg 3 times a
day (or 450 mg twice a day)
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Stress |
300 mg 3 times a
day or 450 mg twice a day
|
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Tobacco Dependence |
300 mg 3 times a
day (or 450 mg twice a day).
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Weight Loss |
450 mg twice a
day
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