072383.doc

HERBCLIP
FILE: • St. John’s wort (Hypericum perforatum)
•Depression
St. John’s Wort Review
Chavez M.L. and P.I. Chavez. Saint John’s Wort. Hospital Pharmacy, 1997, Vol. 32, pp. 1621-1632. St. John’s Wort (Hypericum perforatum L.) is a shrubby, aggressive, perennial weed that belongs to the family Hypericaceae. It blooms between June and September and the harvesting period is from July to August. The plant must be dried immediately after harvesting to avoid degradation of the active chemical principles, which are complex, numerous and diverse. The amount of the constituents present in the herbal preparation is directly related to the plant’s harvesting period, drying process and storage. The above ground plant parts contain up to 16% tannins, which may be responsible for the plant’s wound-healing effects and up to 0.5% hypericin and pseudohypericin, reported to have antidepressant and antiviral activities. Other of the plant’s constituents include flavonoids, essential oils and summary and the enclosedarticle as an educational service. By providing thisarticle, ABC does not St. John’s wort extract is prepared by treating the plant with mixtures of ethanol and water and then standardizing for the hypericin and hypericin-like accurate and correct, nordoes distribution of the constituents. An oil preparation of St. John’s wort is typically prepared by extracting the flower with olive oil. The oil preparation contains no hypericin. It any endorsement of theinformation contained or is most often used externally for wounds and hemorrhoids. It is also used in ABC does not authorizethe copying or use of the St. John’s wort has been used since Greek and Roman times as a “nerve tonic” for mood and temperament. Other folkloric uses include treatment of Reproduction of thesummaries is allowed on bronchial inflammation, burns, cancer, gastritis, hypothyroidism, insect bites and stings, insomnia, kidney disorders and scabies. It is currently best known colleagues, employeesand/or customers. Other as being “nature’s Prozac” and is widely used in Europe for the treatment of uses and distributionrequire prior approval.
mild to moderate depression. In Germany, where it is licensed for the treatment of depression, anxiety and insomnia, sales out-number all other antidepressants combined and it outsells Prozac by more than seven to one. The herb has been studied extensively for its antidepressant effects, including 25 controlled double-blind studies, with response rates of 50% to 80%. A 1996 meta-analysis of clinical trails using St. John’s wort found hypericum extract to be more effective than placebo and equally effective as standard antidepressant medications. It has been suggested that hypericin inhibits monamine oxidase (MAO) and that it acts as a serotonin reuptake inhibitor, similar to Meridian, a recently approved diet drug. Still, the exact mechanisms of how St. John’s wort works are not fully understood. (The MAO activity has not been established in vivo.) Hypericin and pseudohypericin have been shown to inactivate a broad range of viruses and retroviruses in the laboratory, including herpes and influenza viruses. Current research interest focuses on the use of hypericin for the treatment of AIDS. A Phase I/II clinical trial in Thailand found that hypericin administered once a day for 28 days to 12 HIV -infected patients at a dose of 0.05 mg/kg, resulted in ten of the 12 patients exhibiting reduced viral load. Despite its widespread use, there is some confusion over how to dose hypericum. The current recommendation is that the dose be based on the total plant extract and not just the hypericin content. The European Scientific Cooperative on Phytomedicine (ESCOP) recommends a daily dose of 0.2 milligram to 1 milligram total hypericin for treatment of depression. (This is the equivalent to the dose recommended by the German Commission E.) Most clinical trails used standardized extracts with 0.3% hypericin; the normal dose in the trials was 300 milligrams of St. John’s wort extract three times a day. Hypericin appears to be safe; the incidence of adverse reactions reported in clinical trials ranges from none to 25%, with the most commonly reported being emotional vulnerability, fatigue, severe itching and weight gain. However, it does have the potential to cause photosensitivity in fair-skinned persons who use it for a long period of time. Though some references indicate that there are no reports of phototoxicity in humans, it is a well documented phenomenon in animals that consume large amounts of the plant. Though the herb is safe, there are a few contraindications. According to the authors, it should not be used in combination with narcotics, amphetamines, over-the-counter cold and flu medications or tyramine-containing foods such as wine, aged cheese, overripe bananas, avocados, chicken liver, peanuts, alcoholic beverages. (The contraindication for tyramine-containing foods is based on the presumption of MAO activity—although neither Commission E nor ESCOP have confirmed this.) Because there is insufficient information on the safety of using St. John’s wort during pregnancy, it is not recommended for pregnant women. The authors also expressed concern over self-treatment of depression and recommend that patients see a qualified health professional before deciding to use St. John’s wort. Moreover, because of the herb’s possible mechanism of action similar to a currently used diet drug, it has been promoted, usually in combination with ephedra, as an herbal alternative to prescription weight-loss drugs. However, the authors warn that these combination products could cause significant adverse effects and recommend against them, noting that there are no clinical trials supporting the use of St. John’s wort as a weight-loss supplement. Densie Webb, Ph.D. Bin #145

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