St. John's Wort
(Hypericum perforatum)

This section is compiled by Frank M. Painter, D.C.
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St. John's Wort Articles

What is St. John's wort?
University of North Carolina School of Pharmacy

A nice review by students from the School of Pharmacy.

St. John's wort: Treatment for Minor Depression
National Center for Complementary and Alternative Medicine (NCCAM)
March 21, 2003 –
In a new approach to research on minor depression, the National Institutes of Health (NIH) has launched a four-year study to determine the safety and effectiveness of St. John's wort, a common herbal supplement, and citalopram, a standard antidepressant, compared to placebo.

St. John's Wort: Effective, with Caveats
Nutrition Science News (Spring 2002)

There was a lot of controversy raised regarding St. John's wort (Hypericum perforatum) last year (2001) following a study published in JAMA that discredited the herb's use in treating outpatients with major depression. Mark Blumenthal, founder and executive director of the American Botanical Council in Austin, Texas, stated that most clinical studies on St. John's wort, many of which were conducted in Europe, were targeted at cases of mild-to-moderate depression—never at major or severe depression.

St. John's Wort Vs. Drugs
Nutrition Science News (Jun 2001)

Recent clinical trials have shown that St. John's wort works as well as Prozac, Zoloft and other leading antidepressant drugs for treating mild to moderate depression. A study recently published in the April 18, 2001, Journal of the American Medical Association found the herb ineffective in treating severe depression. [1] It's important to note that St. John's wort has been indicated in the treatment of only mild to moderate depression—not severe depression—for which its efficacy has been well-demonstrated.

Natural Remedies for Depression
Nutrition Science News (February 1999)

Depression is one of the most frequent psychological problems encountered in medical practice. Some studies say 13 to 20 percent of American adults exhibit some depressive symptoms. [1] The mortality rate among those who are depressed is four times greater than those without depression—major depression accounts for 60 percent of all suicides. [2] Yet, despite this professional recognition and the fact that depression is a treatable condition, only about a third of depressed patients receive appropriate intervention. [2]

St. John's Wort Fails Potency Tests
Several of the nation's leading brands of St. John's Wort, a popular herbal remedy for depression, are not as potent as advertised on their labels, the Los Angeles Times reported Monday. In an independent test commissioned by the Times, three of 10 brands of St. John's Wort had no more than about half the potency listed on the label. One of the lowest-scoring products sampled, with about 20 percent of the labeled potency, was from Sundown Herbals, a division of Rexall, the nation's No. 1 distributor of dietary supplements.

INTERACTIONS: Specific Drugs and the diseases they treat,
which may have a negative interaction with St. John's

National Institute for Health

These are conditions, and some of their treatment drugs, which the NIH says could be compromised by St. John's Wort.


St. John's Wort Abstracts

St. John's wort (Hypericum perforatum) Monograph
Alternative Medicine Review 2004 (Sep); 9 (3): 318–325 ~ FULL TEXT

A meta-analysis published in 1996 of 23 studies involving over 1,500 individuals found significantly positive responses to St. John’s wort based on analysis of the Hamilton Depression Scale (HAMD) before and after treatment. [19] This was supported by a more recent meta-analysis covering clinical trials published through 2000. [20] In 2000, the Annals of Internal Medicine featured a two-part overview and critique of newer drug therapies for depression and dysthymia (a chronic but milder form of depression), and included St. John’s wort as a potential treatment for both conditions. [21, 22] Both reviews conclude St. John’s wort is more effective than placebo for the treatment of mild-to-moderate depression and less likely to cause side effects than commonly prescribed antidepressants. The 2000 meta-analysis of St. John’s wort clinical trials lists 16 placebo-controlled trials on persons with mild-to-moderate depression. [20]

Experience with St John's Wort (Hypericum perforatum) in Children
Under 12 Years with Symptoms of Depression and Psychovegetative Disturbances

Phytother Res 2001 (Jun); 15 (4): 367–370

The value of an extract of Hypericum perforatum (St John's wort) for children with mild to moderate depressive symptoms was investigated for the first time in a multi-centre post-marketing surveillance study. Based on the data available for analysis, the number of physicians rating effectiveness as 'good' or 'excellent' was 72% after 2 weeks, 97% after 4 weeks and 100% after 6 weeks. The ratings by parents were very similar.

Comparison of St John's wort and Imipramine for Treating Depression:
Randomised Controlled Trial

British Medical Journal 2000 (Sep 2); 321 (7260): 536–539

This Hypericum perforatum extract is therapeutically equivalent to imipramine in treating mild to moderate depression, but patients tolerate hypericum better.

Hypericum Extract Versus Imipramine or Placebo in Patients with
Moderate Depression: Randomised Multicentre Study of
Treatment for Eight Weeks

British Medical Journal 1999 (Dec 11); 319 (7224): 534–1538

At an average dose of 350 mg three times daily hypericum extract was more effective than placebo and at least as effective as 100 mg imipramine daily in the treatment of moderate depression. Treatment with hypericum extract is safe and improves quality of life.

St. John's wort (Hypericum perforatum) Monograph
Alternative Medicine Review 1999 (Jun);   4 (3):   190–192 ~ FULL TEXT

While it is not yet known definitively which constituent or constituents are responsible for Hypericum's anti-depressant effects, recent studies seem to indicate the compound hyperforin is at least in part responsible. Researchers found the concentration of this compound to significantly contribute, in a dose-dependent manner, to the anti-depressant effect of St. John's wort. [1] Another study, utilizing two behavioral assessments typically used to assess anti-depressant effects, found a positive correlation between hyperforin concentration and anti-depressant efficacy. The concentration of other constituents of several hypericum extracts were not found to be connected to their efficacy. [2]

St. John's wort (Hypericum perforatum): Clinical Effects
on Depression and Other Conditions

Alternative Medicine Review 1998 (Feb); 3 (1): 18–26 ~ FULL TEXT

Hypericum has been favorably compared to numerous antidepressant drugs, the studies having revealed equivalent results and a much more favorable incidence of side effects. Studies have also demonstrated its efficacy in treating seasonal affective disorder.

LI 160, An Extract of St. John's wort, Versus Amitriptyline in
Mildly to Moderately Depressed Outpatients:
A Controlled 6-week Clinical Trial

Pharmacopsychiatry 1997 (Sep); 30 Suppl 27: 77–80

With regard to tolerability, LI 160 was clearly superior to amitriptyline, particularly in relation to anticholinergic and Central Nervous System adverse events. Thus, 37% of the LI 160 treated patients reported adverse events, compared to 64% in the amitriptyline group. This considerable superiority in tolerability for LI 160 in relation to amitriptyline, could confer an advantage in improving compliance for antidepressant pharmacotherapy.

Effects of Hypericum Extract (LI 160) in Biochemical Models
of Antidepressant Activity

Pharmacopsychiatry 1997 (Sep); 30 Suppl 2: 102–107
Moreover, subchronic treatment of rats with hypericum extract led to a significant down-regulation of beta-receptors and to a significant up-regulation of 5-HT2-receptors in the frontal cortex. The data might suggest that hypericum extract acts via similar biochemical mechanisms to other antidepressants (e.g. tricyclics).

St John's wort for Depression: An Overview and Meta-analysis
of Randomised Clinical Trials

British Medical Journal 1996 (Aug 3); 313 (7052): 253–258

There is evidence that extracts of hypericum are more effective than placebo for the treatment of mild to moderately severe depressive disorders. Further studies comparing extracts with standard antidepressants in well defined groups of patients and comparing different extracts and doses are needed.

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