Clinical studies on St. John's wort extract support its use in mild to moderate depression and depressive episodes. The effectiveness of St. John's wort plant is superior to placebo and comparable with synthetic antidepressant drugs. The rate of side effects is lower and their severity is milder.
Benefits of St. John's wort
plant
Depression -- St. John's wort plant is helpful in the therapy of
mild to moderate depression with fewer side effects than conventional pharmaceutical
antidepressants. The effect of St. John's wort may be noticed the first day, but often it
takes a few days or weeks for the full benefits of St. John's wort to occur. Some studies
indicate that St. John's wort may be as good an antidepressant as some of the SSRIs such
as Prozac and Zoloft. A 6 week double blind study using a combination of St.
John'w wort, valenian, and passionflower was found the combination to be
effective in treating mild depression. The dosage used was 360 mg for St. John's
wort, 160 mg for valerian, and 190 for passionflower taken once daily.
PMS -- St. John's wort plant has been found to be partially helpful in treating PMS.
St. John's wort plant has also
been studied for its antiviral, antidepressant, anti-inflammatory, and cytotoxic
properties.
St. John's Wort plant extract, 300
mg, 180 Capsules - Natural FactorsS
cientific research shows hat St. John's Wort may
lighten mood and support a positive emotional balance. Remember that a sensible
program of diet and exercise can enhance the benefits of this standardized
herbal product. St. John's Wort (Hypericum perforatum) is standardized to
contain 0.3% hypericin and 3% hyperiforin.
St. John's Wort Extract, 300 mg - Natural Factors
Scientific research shows hat St. John's wort may
lighten mood and support a positive emotional balance. Remember that a sensible
program of diet and exercise can enhance the benefits of this standardized
herbal product. St. John's wort (Hypericum perforatum) is standardized to
contain 0.3% hypericin and 3% hyperiforin.
Hyperforin Rich
Mood Support
St. John's Wort Active ingredients
St. John’s wort plant has hypericin and other dianthrones, flavonoids, xanthones,
and hyperforin. New research suggests that St. John’s wort extracts may exert their
antidepressant actions by inhibiting the reuptake of the neurotransmitters serotonin,
norepinephrine, and dopamine. Long-term administration of St. John's wort modifies levels
of neurotransmitters in brain regions involved in the pathophysiology of depression.
Side effects of St. John's Wort
plant
The most common side effect of St. John's wort is insomnia,
which is likely to be worse on higher doses.
Headaches and irritability or anxiety have also been reported.
St. John's Wort and long term use
There is always a concern when taking a particular herb for
prolonged periods. Thus far, it does not seem that St. John's wort has any significant
side effects (particularly compared to standard pharmaceutical antidepressants). However, I
often recommend taking breaks from a supplement every few weeks. It also depends on
dosage. If a person is only taking one pill a day, they can continue taking this much
longer that someone taking three pills a day.
One study indicates St. John's wort
does not influence heart rate variability.
St. John's Wort Caution
Reduce exposure to sunlight when you take
St. John's wort. One
study has indicated that in the presence of light, hypericin (a component of St. John's
wort) can induce changes in lens protein that could lead to the formation of cataracts.
Appropriate precautions should be taken to protect the eye from intense sunlight while
taking St. John's wort. St. John's wort should also be avoided by those who are
prone to macular degeneration and are exposed to sunlight.
St. John’s wort may
interfere with oral contraceptives. St John's wort is an inducer of
cytochrome P450 (CYP) 3A enzymes and may reduce the efficacy of oral
contraceptives.
St. John's wort interacts
with many medicines, including antidepressants, so caution is advised when combining this
herb with other medicines. Combining St. John's wort with SSRIs or other
pharmaceutical antidepressants should only be done under medical supervision
since their effects are additive and it is possible that the combination could
cause serotonin syndrome.
St. John's wort may increase metabolism of
certain drugs such as indinavir used in treating HIV. The mechanism is likely due to st.
john's wort inducing the production of cytochrome P450 3A, an enzyme that breaks down
certain drugs, but the specifics of this interaction are not yet clear. St. John's wort
may also interefere with the metabolism of Camptosar, a medicine used to treat some kinds
of cancer.
Certain formulations of
St. John's wort seem to reduce levels of digoxin, a drug that helps the heart to
pump in people who have heart failure. If the digoxin level falls too low, the
drug may not provide a beneficial effect. St. John's formulations rich in
chemicals called hypericin and hyperforin seemed to reduce blood-stream levels
of digoxin. There were no interactions, however, when volunteers took
"traditionally used" St. John's wort preparations. The hypericin- and hyperforin-rich
formulations produce their effect by turning on enzymes that break down digoxin.
Phototoxicity in human retinal pigment epithelial
cells promoted by hypericin, a component of St. John's wort.
Photochem Photobiol. 2007 May-Jun;83(3):706-13. Wielgus AR, Chignell
CF, Miller DS, Van Houten B, Meyer J, Hu DN, Roberts JE. Laboratory of
Pharmacology and Chemistry, National Institute of Environmental Health Sciences,
Research Triangle Park, NC, USA.
St. John's wort contains hypericin, which absorbs light in the UV and visible
ranges. In vivo studies have determined that hypericin is phototoxic to skin and
our previous in vitro studies with lens tissues have determined that it is
potentially phototoxic to the human lens. To determine if hypericin might also
be phototoxic to the human retina, we exposed human retinal pigment epithelial (hRPE)
cells to 10(-7) to 10(-5) M hypericin. Fluorescence emission detected from the
cells (lambda(ex) = 488 nm; lambda(em) = 505 nm) confirmed hypericin uptake by
human RPE. Neither hypericin exposure alone nor visible light exposure alone
reduced cell viability. However when irradiated with 0.7 J cm(-2) of visible
light (lambda > 400 nm) there was loss of cell viability as measured by MTS and
lactate dehydrogenase assays. The presence of hypericin in irradiated hRPE cells
significantly changed the redox equilibrium of glutathione and a decrease in the
activity of glutathione reductase. Increased lipid peroxidation as measured by
the thiobarbituric acid reactive substances assay correlated to hypericin
concentration in hRPE cells and visible light radiation. Thus, ingested St.
John's wort is potentially phototoxic to the retina and could contribute to
retinal or early macular degeneration.
St. John's Wort for depression -- Who's right?
"Major new study
finds proprietary St. John's Wort extract at least as
effective as popular prescription anti-depressant." Another headline from 2 years ago "JAMA study fails to support the efficacy of
St. John's Wort in moderately severe major depression." Well, one of these
results has to be wrong... right?
In the latest report, according to a randomized, double-blind clinical
study published in the prestigious British Medical Journal, a
St. John's Wort extract was at least as effective in
treating depression and better tolerated by patients than the widely
prescribed anti-depressant paroxetine, known by the product name Paxil (a
SSRI similar to Prozac).
In the study, 251 patients with moderate to severe forms of depression
were divided into two groups: one receiving 900 mg/day of WS(R) 5570 (a
proprietary form of St. John's Wort), and
the other 20 mg/day of paroxetine, for six weeks. The results: St. John's
Wort produced as good an improvement with fewer side effects.
In order to know with a greater sense of
certainty the effectiveness of a particular herb or medicine, several
studies over a period of time have to be evaluated. At this point, the
majority of studies testing St. John's wort have found that this herb has
mood lifting effects. The dose required varies, ranging from 300 mg to 900
mg a day. Another good mood lifter is SAM-e.
German researchers at the Centre for Complementary Medicine in Munich in Germany, reviewed studies involving a total of 5,500 patients with depression that compared treatment with extracts of St. John's wort with placebo treatment or standard antidepressant medications. Overall, patients on St. John's wort had results that were superior to placebos and as effective as standard antidepressants, with fewer adverse effects."
St. John's Wort Research Update
Is St. John’s Wort an Anti-inflammatory Herb? -- For many
centuries St. John’s Wort has been used in Europe to treat a variety of
conditions including infections and depression. Compounds within this herb, one
being hypericum, have very strong biological activity, including the ability to
reduce inflammation and fight against bacterial infections. In a study conducted
at Ege University, in Izmir, Turkey, scientists investigated the in vitro
effects of three Hypericum species, on human white blood cell myeloperoxidase (MPO)
activity. MPO is a major component of the antimicrobial system of white blood
cells. MPO helps the conversion of hydrogen peroxide and chloride to
hypochlorous acid. Hypochlorous acid is a strong oxidant produced by white blood
cells that contributes to inflammatory tissue damage. The researchers found that
hypericum in St. John’s wort reduces the oxidative activity of white blood
cells, thus potentially reducing damage from oxidation.
Comments: It appears that St. John’s wort has
many roles to play in the human body. For now, the most common use for St.
John’s wort is as an antidepressant. Even though studies have used 300 mg three
times a day, I find that most people notice some uplifting in mood even with 300
mg once a day in the morning. High doses could cause insomnia.
An open-label pilot study of St. John's wort in juvenile
depression.
Findling RL.
Department of Psychiatry, Case Western Reserve University/University Hospitals
of Cleveland, USA.
J Am Acad Child Adolesc Psychiatry. 2003 Aug;42(8):908-14.
This pilot study examined the effectiveness, safety, tolerability,
and pharmacodynamics of Hypericum perforatum (St. John's wort) in the treatment
of youths diagnosed with major depressive disorder. METHOD: Youths 6 to 16 years
of age meeting DSM-IV criteria for major depressive disorder with depressive
symptoms of at least moderate severity were eligible to enroll between January
1999 and January 2001 in this 8-week, prospective, open-label, outpatient study.
Outcome measures included the Children's Depression Rating Scale-Revised (CDRS-R)
and the Clinical Global Impressions (CGI) scale. A priori criteria for response
consisted of a CDRS-R score of </=28 and a CGI severity score </=2. Patients
were initially prescribed 150 mg St. John's wort three times daily. If at the
end of week 4 the patient did not meet a priori response criteria, the dose was
increased to 300 mg three times daily. RESULTS: Thirty-three youths with a mean
(SD) age of 10.5 (2.9) years were enrolled. After 4 weeks of St. John's wort
therapy, 22 youths had their dose increased to 900 mg/day. Twenty-five of the
patients met response criteria after 8 weeks of treatment. Overall, St. John's
wort was well tolerated. CONCLUSION: St. John's wort may be an effective
treatment for youths diagnosed with major depressive disorder. Placebo
controlled trials seem indicated.
St. John's wort questions
Q. Can a person take St. John's wort
supplement in the morning and 5-HTP supplement in the evening?
A. Yes, if the dosages of both supplements are kept low. and you have no
major medical problems.
Q. I am currently on a SSRI medication, Prozac to be
exact, and I am considering adding St. John's wort. Is there a potential problem
combining a SSRI drug with this herbal supplement?
A. There may be depending on the dosages of the prescription
medicine and the dosage of the St. John's wort. Much of the herb drug
interactions is dependent on dosage. Unexpected reactions can occur when drugs
and potent herbs are combined. St. John's wort has potent effects. For this
reason, it may be a good idea not to take the antidepressant medication the same
day as a St. John's wort supplement.
Q. i am taken St. john wort can i take passion Rx with
st. john wort plant or how should i take them.
A. We suggest not taking them same day. Passion Rx is potent and
can increase alertness and energy. In the long run, Passion Rx is only used
about two days a week and St. John's wort can be taken on the off days. Please
have approval by your doctor.
Do you know of any reports/research into acute anxiety
as a side effect of St John's wort plant? I had a long period (about 6 months)
of very acute and debilitating anxiety at the start of the year and had been
taking St John's wort supplement for the first time (and nothing else). I had
had one previous episode, which was much shorter (5 days) about 3 years before
which came on as I started taking fluoxetine, which the GP thought might have
exacerbated low level anxiety (indeed I'd also be interested to know more about
adverse reactions to fluoxetine in this context). I also have a slightly
enlarged thyroid (tho thyroid function tests were OK when tested) and suprar
ventricular tachycardia, and I don't seem to tolerate coffee very well either.
A. High dosages of St. John's wort could aggravate anxiety in some
users. Some people may find St. John's wort plant helpful for depression even if
used in low dosages or every other day.
Q. My son is autistic and has problems sleeping. We
took him to the doctor and inquired about herbal remedies. The doctor
recommended St. John's wort. We started one capsule a day. At first he seemed to
be improving, getting more sleep and more focused (he is 13 years old). Then
last Sunday he started to "trip out". He was constantly moving. We called the
doctor and he said to stop the St. John's wort. It is now Thursday and he has
been very unfocused all week. The teachers say that he is not doing anything at
school. Can this amount of St. John's wort cause permanent damage?
A. It is unlikely that St. John's wort causes permanent damage, but
the effects from certain herbs can last several days. The effects of St. John's
wort tend to accumulate over time and the dosage would either need to be reduced
or the frequency of use would need to be reduced.
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