St John's Wort Side Effects and Benefits                                        Feb, 2008
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

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
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.

[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;
[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.

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