St. John's Wort

Hypericum Perforatum

St. John's Wort has been used throughout Europe for a number of symptoms of nervous tension: insomnia, cramps (e.g. menstrual), intestinal colic, irritable bowel, bed wetting and anxiety. St. John's Wort extracts have shown a wide variety of effects in experimental and clinical studies. Some of the activities demonstrated include psychotropic, antidepressant, antiviral, and antibiotic effects as well as increased healing of wounds and burns.

ANTI-DEPRESSANT - St. John's Wort is commonly used as a mild to moderate antidepressant. This action appears to be based on the ability of hypericin and other components to inhibit monoamine oxidase (MAO) types A and B. As a result of this inhibition, the level within the brain of certain nerve impulse transmitters increases - helping maintain normal mood and emotional stability. While it was previously thought the antidepressant actions of St. John's wort were due to hypericin and the inhibition of the enzyme monoamine oxidase, current research has challenged this belief, focusing on other constituents, such as hyperforin, and flavonoids.
A meta-analysis was performed on three double-blind, randomised multi-centre trials, involving 544 out-patients suffering from mild to moderate depression. After 6 weeks of treatment with St. John's Wort, the results indicated that Hypericum extract accelerated the recovery from depression by influencing all investigated signs and symptoms of the disease. The effect was found to be similar to the profile of selective serotonin reuptake inhibitors (SSRIs).

Seasonal Affective Disorder (SAD)
Atypical depression, neurasthenia and fibromyalgia seem to form a spectrum of disorders, who share a common biological basis, i.e. a reduced activity of the hypothalamus-pituitary-adrenocortical(HPA)-system. Treatment with hypericum seems to disinhibit the HPA-system in healthy subjects and patients with a depression. Clinical studies with patients with depression with atypical features like the seasonal affective disorder (SAD) and with patients with a depressive syndrome accompanied by somatic complaints or fatigue, support this view.
ANTI STRESS / ANXIETY - St. John's wort has a traditional use as a restorative treatment for the nervous system; spinal injuries, neuralgia, sciatica, muscular rheumatism, mild psychological disorders, excitability and nervousness.
WOUND HEALING - Oral administration of hypericum tincture has demonstrated improved healing effects. This would appear to be due to the facilitation of the collagen maturation phase of wound healing, enhanced new skin growth, and an influence on epithelial cell proliferation and migration.
MENOPAUSE - St. John's Wort has a specific application for the various nervous system related symptoms of the menopause, through its restorative and convalescent effects.
ANTI-VIRAL / ANTI- BACTERIAL - studies have shown that St. John's Wort exhibits strong antiviral activity against herpes simplex virus type 1 and 2 as well as influenza types A and B, vesicular stomatitis virus, Epstein Barr virus, cytomegalovirus, and even HIV. St. John's Wort extracts demonstrate broad spectrum antimicrobial activity against such organisms as staph. aureus, strep. mutans, proteus vulgaris, E.coli, and pseudo. aeruginosa.

Dosage

Up to 300mg (standardised to 0.3% hypericin) three times daily have been used in depression studies. No restriction on duration of use although at least 4 weeks of treatment is required to assess the anti-depressant effect. Organic Tincture - 15-30 drops 2-3 times daily.

Potential applications

Mild to moderate depression. Viral conditions such as herpes virus 1 and 2. Menopausal conditions and other states involving tension / anxiety e.g. SAD and chronic fatigue syndrome. Injuries and trauma. Nicotine and alcohol withdrawal. Hypericin has produced potent anti-tumour activity in-vitro against several tumour cells, although no toxic effects were noted on normal cells. St. Johns Wort has been shown to increase nocturnal melatonin secretion after using 500mg / day for 3 weeks. Topical application - St. John's Wort has long been used as a wound healing substance. Preparations have been used in burns, as a sunscreen, and in the treatment of muscular pain. The topical application of hypericum has shown significant inhibition of Staphylococcus aureus in cases of Atopic Dermatitis (an eczema like condition) over 4 weeks of application. In Greece the herb is used externally for the treatment of shingles.

Known contraindications

St. John's Wort should not be used during pregnancy or lactation without seeking physician guidance. People with a history of manic-depressive illness (bipolar disorder) or a less severe condition known as hypomania, should avoid use of St. John's Wort as it may trigger a manic episode. Hypericum is not advisable in cases of known photosensitivity. Patients should reduce artificial UVA irradiation while taking hypericum, but normal doses of hypericum should represent no concern with regard to photosensitivity.

Interactions

Caution should always be exercised in patients receiving orthodox medication. Patients should be monitored for any symptoms suggestive of serotonin syndrome (such as confusion, fever, shivering, sweating, diarrhoea and muscle spasms. This effect has been shown by the use of both SSRI and MAO inhibitors in combination. Hypericum has been shown to increase activity of the P450 enzymes in the liver and so increase drug clearance. Many drugs and also several common foods and drinks can influence this enzyme system. Those on medication, including the contraceptive pill, should consult their physician for advice.

Use in conjunction with

Depression - Flax seed oil, 'High six' B complex, multi-phytonutrient complex, rhodiola rosea / schisandra
Diet and lifestyle - regular aerobic exercise, stress management, adequate sleep, antioxidant rich diet, low saturated / hydrogenated fats, high protein (fish/vegetarian), regular meals, keep hydrated (1.5 litres water). Thyroid check. Therapeutic fast may be advisable (seek guidance).

Note

Paracelsus named St. John's Wort "arnica of the nerves" because of its empirical use in nervous diseases.

REFERENCES

Simon Mills & Kerry Bone. Principles and Practice of Phytotherapy. Modern Herbal Medicine. 2000.
PDR for Herbal Medicines. Second Edition. 2000
Melvyn R. Werbach & Michael T. Murray. Botanical Influences on Illness. A source book of clinical research. 1994
Kasper S, Dienel A. Cluster analysis of symptoms during antidepressant treatment with Hypericum extract in mildly to moderately depressed out-patients. A meta-analysis of data from three randomized, placebo-controlled trials. Department of General Psychiatry, University of Vienna, Wien, Austria. Psychopharmacology (Berl). 2002 Nov;164(3):301-8. Epub 2002 Sep
Murck H. Atypical depression and related illnesses--neurobiological principles for their treatment with Hypericum extract. Wien Med Wochenschr. 2002;152(15-16):398-403.
Schempp CM, Windeck T, Hezel S, Simon JC. Topical treatment of atopic dermatitis with St. John's wort cream--a randomized, placebo controlled, double blind half-side comparison. Phytomedicine. 2003;10 Suppl 4:31-7.
Bilia AR, Gallori S, Vincieri FF. St. John's wort and depression: efficacy, safety and tolerability-an update. Life Sci. 2002 May 17;70(26):3077-96.

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