Plant Part Used
Flowering buds
Introduction
This common perennial flowering plant has received attention for its potential ability to treat mild to moderate depression. (1) , (2) , (3) It has been used extensively by physicians in Europe as the agent of choice for mild or moderate depression. With approximately 18 million Americans experiencing depression in a given year from a variety of causes, St. John’s wort is attracting attention as a safe and natural alternative to current prescription therapies. However, recent studies indicate that St. John’s wort may not be a treatment option for people with major depression. (4) , (5)
Interactions and Depletions
Interactions
- Antidepressants
- reserpine
- digoxin
- theophylline
- Immunosuppressive medications
- Oral contraceptives
- Barbiturates
- Anesthesic agents
- Protease inhibitors
- Drugs metabolized by the cytochrome P-450 pathway
- Hormone replacement therapy (HRT)
- warfarin
- 5-hydroxytryptophan (5-HTP)
Dosage Info
Dosage Range
900mg (standardized extract) daily, in divided doses. (Some individuals may experience benefit with as little as 300-600mg daily.) Higher doses are used in viral infections, and should only be performed under the supervision of a doctor.
Topically: Apply oil extract as needed to affected area(s).
Liquid Extract: 1:1 in 25% ethanol – 2-4 milliliters, 3 times a day. (6)
Tincture: (1:10) in 45% ethanol – 2-4 milliliters, 3 times a day. (7)
Most Common Dosage
300mg (standardized extract), 3 times a day.
Topically: Apply oil extract as needed to affected area(s).
Liquid Extract: 1:1 in 25% ethanol – 2 milliliters, 3 times a day.
Tincture: (1:10) in 45% ethanol – 2 milliliters, 3 times a day.
Standardization
[span class=doc]Standardization represents the complete body of information and controls that serve to enhance the batch to batch consistency of a botanical product, including but not limited to the presence of a marker compound at a defined level or within a defined range.[/span]
The most current available medical and scientific literature indicates that this dietary supplement should be standardized to 0.3-0.5% hypericin and/or 3-5% hyperforin per dose.
Reported Uses
Scientists think that two compounds, hypericin and hyperforin, give St. John’s wort its ability to support moods and counteract feelings of depression. Scientists believe that these compounds may inhibit the breakdown of several neurotransmitters, including serotonin, which is partially responsible for controlling moods and emotions. (8) , (9) , (10) St. John’s wort may amplify the effects of serotonin in the brain. (11) , (12) It also contains the chemical melatonin, which has been researched for its effects on mood, anxiety and stress. (13)
While St. John’s wort is best known for its support of emotional health, it may also help the body mount a defense against viruses. Some studies have suggested that St. John’s wort at higher dosages may even help the body fight HIV. (14)
Additionally, St. John’s wort has been used topically to enhance healing of wounds and burns, while lessening the pain associated with muscle or nerve injury. (15)
Toxicities & Precautions
Introduction
[span class=alert]Be sure to tell your pharmacist, doctor, or other health care providers about any dietary supplements you are taking. There may be a potential for interactions or side effects.[/span]
General
Do not consume tyramine-containing foods, such as certain wines and cheeses among others, while using St. John’s wort. (16)
Do not use St. John’s wort supplements if you are taking prescription and/or OTC medications without the advice of your doctor or pharmacist.
Allergy
Some individuals experience an allergic reaction when taking this dietary supplement. Call your doctor or seek medical attention if you have fast or irregular breathing, skin rash, hives or itching.
Health Conditions
If you have severe or major depression, suicidal depression, or psychosis talk to your doctor before taking this dietary supplement.
Based on human data, do not use St. John’s wort if you have received an organ transplant or are currently taking medications, such as cyclosporin, that decrease immune system activity. Complications and transplant rejection have occurred with the use of this herb. (17) , (18)
Side Effects
Side effects are possible with any dietary supplement. Although rare, this dietary supplement may cause stomach and intestinal problems and fatigue. (19) Tell your doctor if these side effects become severe or do not go away.
Pregnancy/ Breast Feeding
This dietary supplement should not be used in pregnant women. (20) , (21)
This dietary supplement should not be used if you are breast-feeding an infant without first consulting a physician.
Age Limitations
To date, the medical literature has not reported any adverse effects specifically related to the use of this dietary supplement in children. Since young children may have undiagnosed allergies or medical conditions, this dietary supplement should not be used in children under 10 years of age unless recommended by a physician.
References
- View Abstract: Volz HP. Controlled Clinical Trials of Hypericum Extracts in Depressed Patients–An Overview. Pharmacopsychiatry. 1997;30(Suppl 2):72-76.
- View Abstract: Muller WE, et al. Effects of Hypericum Extract (LI 160) in Biochemical Models of Antidepressant Activity. Pharmacopsychiatry. 1997;30(Supp 2):102-07.
- View Abstract: Linde K, et al. St. John’s Wort for Depression–An Overview and Meta-analysis of Randomised Clinical Trials. BMJ. 1996;313m:253-58.
- View Abstract: Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St John’s Wort) in Major Depressive Disorder: A Randomized Controlled Trial. JAMA. Apr2002;287(14):1807-1814.
- View Abstract: Shelton RC, Keller MB, Gelenberg A, Dunner DL, Hirschfeld R, Thase ME, et al. Effectiveness of St John’s wort in major depression: a randomized controlled trial. JAMA. Apr2001;285(15):1978-86.
- PDR for Herbal Medicines, 2nd edition. Montvale, NJ: Medical Economics Company; 2000:722.
- PDR for Herbal Medicines, 2nd edition. Montvale, NJ: Medical Economics Company; 2000:722.
- Bloomfield H, et al. Can Depression Be Successfully Treated with a Safe, Inexpensive, Medically Proven Herb Available Without a Prescription? Hypericum and Depression. California: Prelude Press; 1996:110-12.
- Suzuki O, et al. Inhibition of Monoamine Oxidase by Hypericin. Planta Medica. 1984;50:272-74.
- View Abstract: Bladt S, et al. Inhibition of MAO by Fractions and Constituents of Hypericum Extract. J Geriatric Psychiatry and Neurology. 1994;7:S57-S59.
- Murray M. Natural Alternatives to Prozac. New York: William Morrow and Company, Inc; 1996:137.
- View Abstract: Muller WEG, et al. Effects of Hypericum Extract on the Expression of Serotonin Receptors. J Geriatric Psychiatry and Neurology. 1994;7:S63-S64.
- Murch SJ, et al. Melatonin in Feverfew and Other Medicinal Plants. Lancet. Nov1997;350(9091):1598-99.
- View Abstract: Dwyer JT, et al. The Use of Unconventional Remedies Among HIV-positive Men Living in California. J Assoc Nurses AIDS Care. 1995;6(1):17-28.
- View Abstract: Shipochliev T, et al. Anti-inflammatory Action of a Group of Plant Extracts. Vet Med Nauki. 1981;18(6):87-94.
- View Abstract: Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. Nov1998;158(20):2200-11.
- View Abstract: Ruschitzka F, et al. Acute Heart Transplant Rejection Due to St. John’s Wort. Lancet. Feb2000;355(9203): 548-49.
- View Abstract: Ernst E. St John’s Wort Supplements Endanger the Success of Organ Transplantation. Archives of Surgery. Mar2002;137:316-319.
- View Abstract: Ernst E. Adverse effects profile of the herbal antidepressant St. John’s wort (Hypericum perforatum L.). Eur J Clin Pharmacol. Oct 1998;54(8): 589-94.
- Grush LR, et al. St John’s Wort During Pregnancy. JAMA. 1998;280(18):1566.
- View Abstract: Ondrizek RR, et al. An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid. Fertil Steril. Mar1999;71(3):517-22.
