| St John's Wort Side Effects and Benefits zhion@zhion.com Feb, 2008 |
Introduction
St.-John's wort owes its name to the fact that it flowers at the time of the
summer solstice on or around St. John's day on 24 June. Having been
administered as a remedy by the Roman military doctor Proscurides as
early as the 1st century AD, it was mainly used for magic potions during
the Middle Ages. It was used to protect humans and animals against
witches, demons and evil diseases.
Today, herbalists suggest St. JohnÂ’s wort for depression and anxiety
disorders. In numerous clinical double-blind trials against placebo and
other antidepressants, researchers found that the whole extract of St.-
John's wort is beneficial in treating mild and moderate depression. [2]
However, we still do not well-understand the composition of St. John's
wort and how it might work.
What is St. John's wort?
St. John's wort (Hypericum perforatum in Latin) is a long-living plant with
yellow flowers. It contains many chemical compounds. Some are believed
to be the active ingredients that produce the herb's effects, including the
compounds hypericin and hyperforin.
How these compounds actually work in the body is not yet known, but
several theories have been suggested. Preliminary studies suggest that
St. John's wort might work by preventing nerve cells in the brain from
reabsorbing the chemical messenger serotonin, or by reducing levels of a
protein involved in the body's immune system functioning.
For what medicinal purposes has St. John's wort been used?
St. John's wort has been used for centuries to treat mental disorders as
well as nerve pain. In ancient times, doctors and herbalists (specialists in
herbs) wrote about its use as a sedative and treatment for malaria as
well as a balm for wounds, burns, and insect bites. Today, St. John's wort
is used by some people to treat mild to moderate depression, anxiety, or
sleep disorders.
What is depression?
Information on depression is available from the National Institute of
Mental Health. Here is a brief overview.
Depression is a medical condition that affects nearly 19 million Americans
each year. A person's mood, thoughts, physical health, and behavior all
may be affected. Symptoms commonly include:
· Ongoing sad mood
· Loss of interest or pleasure in activities that the person once enjoyed
· Significant change in appetite or weight
· Oversleeping or difficulty sleeping
· Agitation or unusual slowness
· Loss of energy
· Feelings of worthlessness or guilt
· Difficulty "thinking," such as concentrating or making decisions
· Recurrent thoughts of death or suicide
Depressive illness comes in different forms. The three major forms are
described below. Each can vary from person to person in terms of
symptoms experienced and the severity of depression.
· In major depression, people experience a sad mood or loss of interest
or pleasure in activities for at least 2 weeks. In addition, they have at
least four other symptoms of depression. Major depression can be mild,
moderate, or severe. If it is not treated, it can last for 6 months or more.
· In minor depression, people experience the same symptoms as major
depression, but they are fewer in number and are less disabling.
Symptoms last at least 6 months but less than 2 years continuously.
· In dysthymia, a milder, but more chronic form of depression, people
experience a depressed mood for at least 2 years (1 year for children)
accompanied by at least two other symptoms of depression.
· In bipolar disorder, also called manic depression, a person has periods
of depressive symptoms that alternate with periods of mania. Symptoms
of mania include an abnormally high level of excitement and energy,
racing thoughts, and behavior that is impulsive and inappropriate.
Some people still hold outdated beliefs about depression--for example,
that the emotional symptoms caused by depression are "not real" and
that a person can merely "will" himself out of it. Depression is a real
medical condition. It can be treated effectively with conventional medicine,
including by antidepressant drugs and certain types of psychotherapy
(talk therapy)
.
Why is St. John's wort used as an alternative therapy for depression?
Some patients who take antidepressant drugs do not experience relief
from their depression. Other patients have reported unpleasant side
effects from their prescription medication, such as a dry mouth, nausea,
headache, or effects on sexual function or sleep.
Sometimes people turn to herbal preparations like St. John's wort
because they believe "natural" products are better for them than
prescription medications, or that natural products are always safe.
However, these statements is not completely true.
Finally, cost can be a reason. St. John's wort costs less than many
antidepressant medications, and it is sold without a prescription (over the
counter).
How widely is St. John's wort used for treating depression?
In Europe, St. John's wort is widely prescribed for depression. In the
United States, St. John's wort is not a prescription medication, but there
is considerable public interest in it. St. John's wort remains among the top-
selling herbal products in the United States.
How is St. John's wort sold?
St. John's wort products are sold in the following forms:
· Capsules
· Teas--the dried herb is added to boiling water and steeped for a period
of time.
· Extracts--specific types of chemicals are removed from the herb, leaving
the desired chemicals in a concentrated form.
Does St. John's wort work as a treatment for depression?
In 1998 a standardized hypericum extract has been approved in Austria
and Germany for treatment of mild and moderate depression. The efficacy
has been already recognized since 1984 from the German Health
Authorities based on traditional knowledge.
Controlled clinical trials on St. JohnÂ’s wort effectiveness or health
benefits on depression have been conducted in the last few years. In the
past ten years several controlled clinical trials have been conducted
compared with placebo as well as synthetic antidepressants. St. JohnÂ’s
wort appeared to produce fewer side effects than some standard
antidepressants These studies have shown that the effective dosage is
within a range of 600-900 mg extract. [1]
Recent pharmacological studies revealed that St. JohnÂ’s wort extracts
have a similar mechanism of action like the selective serotonin reuptake
inhibitors (SSRI), however, very likely to a smaller extent. [1]
Other studies conducted recently have found little or no benefit from the
use of St. John's wort for certain types of depression. For example, the
results of a study funded by Pfizer Inc., a pharmaceutical company, found
that St. John's wort, when compared with placebo, was not effective for
treating major depression. [3]
How does St. John wort benefit patient suffered from depression?
In a study of rats, St-John's wort treatment showed significant down-
regulation of beta receptor density and a significant increase in 5HT2
receptors. The extract also exhibited antidepressant activity in animal
pharmacological models of depression. St-John's wort exerts marked
inhibitory effects on synaptosomal uptake of serotonin and noradrenaline.
More studies are needed to clarify how St JohnÂ’s wort works on
depression. [4]
What are the side effects of St. John's wort?
The side effects of St. JohnÂ’s work are substantially fewer than with
synthetic antidepressants and range within 3%. The most important risk
is photosensitization, which is however without clinical relevance in the
recommended dosages. [1] Other common side effects include dry mouth,
dizziness, diarrhea, nausea, increased sensitivity to sunlight, and fatigue.
Research from NIH has shown that St. John's wort interacts with some
drugs--including certain drugs used to control HIV infection (such as
indinavir). Other research shows that St. John's wort can interact with
chemotherapeutic, or anticancer, drugs (such as irinotecan). The herb
may also interact with drugs that help prevent the body from rejecting
transplanted organs (such as cyclosporine). Using St. John's wort may
limit these drugs' effectiveness.
In addition, if depression is not adequately treated, it can become severe
and, in some cases, may be associated with suicide. Consult a health care
practitioner before taking any supplements or medicines.
What are some other possible problems with using St. John's wort?
Herbal products such as St. John's wort are classified as dietary
supplements by the U.S. Food and Drug Administration (FDA), a regulatory
agency of the Federal Government. The FDA's requirements for testing
and obtaining approval to sell dietary supplements are less strict than its
requirements for drugs.
The strength and quality of herbal products are often unpredictable.
Products can differ in content not only from brand to brand, but from
batch to batch. Information on labels may be misleading or inaccurate.
What are the dosages?
Please, check the recommended dose from the product label before
taking St. JohnÂ’s wort, the dose varies from product to product. The
standard dosage of St. John's wort is 300 mg 3 times a day of an extract
standardized to contain 0.3% hypericin. However, a few new products on
the market are standardized to hyperforin content (usually 2 to 3%)
instead of hypericin. These are taken at the same dosage. Some people
take 500 mg twice a day, or 600 mg in the morning and 300 mg in the
evening. Consult with your doctor before taking any supplements.
If the herb bothers your stomach, take it with food. Most manufacturers
state that the full effect of St. JohnÂ’s wort needs take 4 weeks to
develop.
REFERENCE
[1] Kasper S and Schulz V, St. Johns wort extract as plant antidepressant,
Schweiz Rundsch Med Prax. 2000 Dec 21;89(51-52):2169-77.
[2] Poldinger W History of St. Johns wort Schweiz Rundsch Med Prax.
2000 Dec 14;89(50):2102-9.
[3] Shelton RC, Keller MB, Gelenberg AJ, et al. Effectiveness of St. John's
wort in major depression. Journal of the American Medical Association.
2001; 285:1978-86.
[4] Muller WE et al, Mechanism of action of St. Johns wort extract Schweiz
Rundsch Med Prax. 2000 Dec 14;89(50):2111-21
Selected Sources
American Herbal Pharmacopoeia and Therapeutic Compendium. St. John's
wort (Hypericum perforatum) Monograph. Herbalgram: The Journal of the
American Botanical Council and the Herb Research Foundation. 1997;s
(40):1-16.
American Psychiatric Association. Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (DSM-IV), Washington, DC: American
Psychiatric Association, 1994.
National Institute of Mental Health. Fact Sheets on Depression--"The
Invisible Disease: Depression," "Depression Research at the National
Institute of Mental Health," and "The Numbers Count: Mental Disorders in
America,"
Hypericum Depression Trial Study Group. "Effect of Hypericum perforatum
(St. John's wort) in major depressive disorder: A Randomized, Controlled
Trial". Journal of the American Medical Association. 2002; 287:1807-14.
Shelton RC, Keller MB, Gelenberg AJ, et al. Effectiveness of St. John's wort
in major depression. Journal of the American Medical Association. 2001;
285:1978-86.
Linde K, et al. St. John's wort for depression--An Overview and Meta-
analysis of Randomized Clinical Trials. British Medical Journal. 1996; 313:
253-8.
Piscitelli SC, et al. Indinavir concentrations and St. John's wort. The
Lancet. 2000; 355:547-8.
Mathijssen RHJ, et al. Effects of St. JohnÂ’s wort on irinotecan metabolism.
Journal of the National Cancer Institute. 2002; 94:1247-9.
THIS ARTICLE IS FOR YOUR REFERENCE ONLY. CONSULT YOUR DOCTOR FOR ANY
MEDICAL QUESTION. PUBLISHER DOES NOT GUARRANTEE THE ACCURACY OF
THIS ARTICLE. ALL RIGHT RESERVED @ 2005. DO NOT COPY NOR TRANSFER THE
CONTENT TO OTHER WEBSITES OR OTHER FORMS OF PUBLICATIONS.
St.-John's wort owes its name to the fact that it flowers at the time of the
summer solstice on or around St. John's day on 24 June. Having been
administered as a remedy by the Roman military doctor Proscurides as
early as the 1st century AD, it was mainly used for magic potions during
the Middle Ages. It was used to protect humans and animals against
witches, demons and evil diseases.
Today, herbalists suggest St. JohnÂ’s wort for depression and anxiety
disorders. In numerous clinical double-blind trials against placebo and
other antidepressants, researchers found that the whole extract of St.-
John's wort is beneficial in treating mild and moderate depression. [2]
However, we still do not well-understand the composition of St. John's
wort and how it might work.
What is St. John's wort?
St. John's wort (Hypericum perforatum in Latin) is a long-living plant with
yellow flowers. It contains many chemical compounds. Some are believed
to be the active ingredients that produce the herb's effects, including the
compounds hypericin and hyperforin.
How these compounds actually work in the body is not yet known, but
several theories have been suggested. Preliminary studies suggest that
St. John's wort might work by preventing nerve cells in the brain from
reabsorbing the chemical messenger serotonin, or by reducing levels of a
protein involved in the body's immune system functioning.
For what medicinal purposes has St. John's wort been used?
St. John's wort has been used for centuries to treat mental disorders as
well as nerve pain. In ancient times, doctors and herbalists (specialists in
herbs) wrote about its use as a sedative and treatment for malaria as
well as a balm for wounds, burns, and insect bites. Today, St. John's wort
is used by some people to treat mild to moderate depression, anxiety, or
sleep disorders.
What is depression?
Information on depression is available from the National Institute of
Mental Health. Here is a brief overview.
Depression is a medical condition that affects nearly 19 million Americans
each year. A person's mood, thoughts, physical health, and behavior all
may be affected. Symptoms commonly include:
· Ongoing sad mood
· Loss of interest or pleasure in activities that the person once enjoyed
· Significant change in appetite or weight
· Oversleeping or difficulty sleeping
· Agitation or unusual slowness
· Loss of energy
· Feelings of worthlessness or guilt
· Difficulty "thinking," such as concentrating or making decisions
· Recurrent thoughts of death or suicide
Depressive illness comes in different forms. The three major forms are
described below. Each can vary from person to person in terms of
symptoms experienced and the severity of depression.
· In major depression, people experience a sad mood or loss of interest
or pleasure in activities for at least 2 weeks. In addition, they have at
least four other symptoms of depression. Major depression can be mild,
moderate, or severe. If it is not treated, it can last for 6 months or more.
· In minor depression, people experience the same symptoms as major
depression, but they are fewer in number and are less disabling.
Symptoms last at least 6 months but less than 2 years continuously.
· In dysthymia, a milder, but more chronic form of depression, people
experience a depressed mood for at least 2 years (1 year for children)
accompanied by at least two other symptoms of depression.
· In bipolar disorder, also called manic depression, a person has periods
of depressive symptoms that alternate with periods of mania. Symptoms
of mania include an abnormally high level of excitement and energy,
racing thoughts, and behavior that is impulsive and inappropriate.
Some people still hold outdated beliefs about depression--for example,
that the emotional symptoms caused by depression are "not real" and
that a person can merely "will" himself out of it. Depression is a real
medical condition. It can be treated effectively with conventional medicine,
including by antidepressant drugs and certain types of psychotherapy
(talk therapy)
.
Why is St. John's wort used as an alternative therapy for depression?
Some patients who take antidepressant drugs do not experience relief
from their depression. Other patients have reported unpleasant side
effects from their prescription medication, such as a dry mouth, nausea,
headache, or effects on sexual function or sleep.
Sometimes people turn to herbal preparations like St. John's wort
because they believe "natural" products are better for them than
prescription medications, or that natural products are always safe.
However, these statements is not completely true.
Finally, cost can be a reason. St. John's wort costs less than many
antidepressant medications, and it is sold without a prescription (over the
counter).
How widely is St. John's wort used for treating depression?
In Europe, St. John's wort is widely prescribed for depression. In the
United States, St. John's wort is not a prescription medication, but there
is considerable public interest in it. St. John's wort remains among the top-
selling herbal products in the United States.
How is St. John's wort sold?
St. John's wort products are sold in the following forms:
· Capsules
· Teas--the dried herb is added to boiling water and steeped for a period
of time.
· Extracts--specific types of chemicals are removed from the herb, leaving
the desired chemicals in a concentrated form.
Does St. John's wort work as a treatment for depression?
In 1998 a standardized hypericum extract has been approved in Austria
and Germany for treatment of mild and moderate depression. The efficacy
has been already recognized since 1984 from the German Health
Authorities based on traditional knowledge.
Controlled clinical trials on St. JohnÂ’s wort effectiveness or health
benefits on depression have been conducted in the last few years. In the
past ten years several controlled clinical trials have been conducted
compared with placebo as well as synthetic antidepressants. St. JohnÂ’s
wort appeared to produce fewer side effects than some standard
antidepressants These studies have shown that the effective dosage is
within a range of 600-900 mg extract. [1]
Recent pharmacological studies revealed that St. JohnÂ’s wort extracts
have a similar mechanism of action like the selective serotonin reuptake
inhibitors (SSRI), however, very likely to a smaller extent. [1]
Other studies conducted recently have found little or no benefit from the
use of St. John's wort for certain types of depression. For example, the
results of a study funded by Pfizer Inc., a pharmaceutical company, found
that St. John's wort, when compared with placebo, was not effective for
treating major depression. [3]
How does St. John wort benefit patient suffered from depression?
In a study of rats, St-John's wort treatment showed significant down-
regulation of beta receptor density and a significant increase in 5HT2
receptors. The extract also exhibited antidepressant activity in animal
pharmacological models of depression. St-John's wort exerts marked
inhibitory effects on synaptosomal uptake of serotonin and noradrenaline.
More studies are needed to clarify how St JohnÂ’s wort works on
depression. [4]
What are the side effects of St. John's wort?
The side effects of St. JohnÂ’s work are substantially fewer than with
synthetic antidepressants and range within 3%. The most important risk
is photosensitization, which is however without clinical relevance in the
recommended dosages. [1] Other common side effects include dry mouth,
dizziness, diarrhea, nausea, increased sensitivity to sunlight, and fatigue.
Research from NIH has shown that St. John's wort interacts with some
drugs--including certain drugs used to control HIV infection (such as
indinavir). Other research shows that St. John's wort can interact with
chemotherapeutic, or anticancer, drugs (such as irinotecan). The herb
may also interact with drugs that help prevent the body from rejecting
transplanted organs (such as cyclosporine). Using St. John's wort may
limit these drugs' effectiveness.
In addition, if depression is not adequately treated, it can become severe
and, in some cases, may be associated with suicide. Consult a health care
practitioner before taking any supplements or medicines.
What are some other possible problems with using St. John's wort?
Herbal products such as St. John's wort are classified as dietary
supplements by the U.S. Food and Drug Administration (FDA), a regulatory
agency of the Federal Government. The FDA's requirements for testing
and obtaining approval to sell dietary supplements are less strict than its
requirements for drugs.
The strength and quality of herbal products are often unpredictable.
Products can differ in content not only from brand to brand, but from
batch to batch. Information on labels may be misleading or inaccurate.
What are the dosages?
Please, check the recommended dose from the product label before
taking St. JohnÂ’s wort, the dose varies from product to product. The
standard dosage of St. John's wort is 300 mg 3 times a day of an extract
standardized to contain 0.3% hypericin. However, a few new products on
the market are standardized to hyperforin content (usually 2 to 3%)
instead of hypericin. These are taken at the same dosage. Some people
take 500 mg twice a day, or 600 mg in the morning and 300 mg in the
evening. Consult with your doctor before taking any supplements.
If the herb bothers your stomach, take it with food. Most manufacturers
state that the full effect of St. JohnÂ’s wort needs take 4 weeks to
develop.
REFERENCE
[1] Kasper S and Schulz V, St. Johns wort extract as plant antidepressant,
Schweiz Rundsch Med Prax. 2000 Dec 21;89(51-52):2169-77.
[2] Poldinger W History of St. Johns wort Schweiz Rundsch Med Prax.
2000 Dec 14;89(50):2102-9.
[3] Shelton RC, Keller MB, Gelenberg AJ, et al. Effectiveness of St. John's
wort in major depression. Journal of the American Medical Association.
2001; 285:1978-86.
[4] Muller WE et al, Mechanism of action of St. Johns wort extract Schweiz
Rundsch Med Prax. 2000 Dec 14;89(50):2111-21
Selected Sources
American Herbal Pharmacopoeia and Therapeutic Compendium. St. John's
wort (Hypericum perforatum) Monograph. Herbalgram: The Journal of the
American Botanical Council and the Herb Research Foundation. 1997;s
(40):1-16.
American Psychiatric Association. Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (DSM-IV), Washington, DC: American
Psychiatric Association, 1994.
National Institute of Mental Health. Fact Sheets on Depression--"The
Invisible Disease: Depression," "Depression Research at the National
Institute of Mental Health," and "The Numbers Count: Mental Disorders in
America,"
Hypericum Depression Trial Study Group. "Effect of Hypericum perforatum
(St. John's wort) in major depressive disorder: A Randomized, Controlled
Trial". Journal of the American Medical Association. 2002; 287:1807-14.
Shelton RC, Keller MB, Gelenberg AJ, et al. Effectiveness of St. John's wort
in major depression. Journal of the American Medical Association. 2001;
285:1978-86.
Linde K, et al. St. John's wort for depression--An Overview and Meta-
analysis of Randomized Clinical Trials. British Medical Journal. 1996; 313:
253-8.
Piscitelli SC, et al. Indinavir concentrations and St. John's wort. The
Lancet. 2000; 355:547-8.
Mathijssen RHJ, et al. Effects of St. JohnÂ’s wort on irinotecan metabolism.
Journal of the National Cancer Institute. 2002; 94:1247-9.
THIS ARTICLE IS FOR YOUR REFERENCE ONLY. CONSULT YOUR DOCTOR FOR ANY
MEDICAL QUESTION. PUBLISHER DOES NOT GUARRANTEE THE ACCURACY OF
THIS ARTICLE. ALL RIGHT RESERVED @ 2005. DO NOT COPY NOR TRANSFER THE
CONTENT TO OTHER WEBSITES OR OTHER FORMS OF PUBLICATIONS.
