ST. JOHN'S WORT
St. John's wart (Hypericum perforatum) has been used as a medicinal herb since ancient times. The word "hypericum" is derived from the Greek words, "hyper" and "eikon," which translates to "above" and "icon," an allusion to the herb's ancient use for protection against evil spirits. "St. John's wart" derives from the fact that the flower of the plant blooms around St. John's Day (June 24). Also, when the buds and flowers are squeezed, they exude a red pigment which was associated with the blood of St. John the Baptist.1 St. John's wart is native to Europe, North Africa, West Asia and the Mores, but it has been naturalized in many other parts of the world as well, including North America and Australia. In the United States, the plant is particularly prevalent in northern California and southern Oregon, but it also grows in the wild throughout the Middle and Eastern regions of the country. St. John's wart is an erect, many-stemmed perennial with regular flowers that are yellow with black dots along the margins and which bloom from June until September.
While St. John's wart was used in pre-Christian religious practices as protection from apparitions, its medicinal benefits have been cited by herbalists for at least four hundred years. In the United States, the earliest recorded mention of St. John's wart may have been by Griffith (1847), who stated that the herb can be taken as an oil or ointment for ulcers, tumors and as a diuretic.2 Generally,
St. John's wart has been used for ailments such as nervous disorders, depression, neuralgia, kidney problems and wounds and burns.3 The aerial part of the plant is used for medicinal purposes, and the dried herb con sists mostly of the leaves, unopened buds and flowers. Care should be taken to use only the middle to the top portion of the plant, since harvesting the lower leaves will significantly lower constituent concentrations.4 Harvesting generally occurs from June to September, depending upon local climate and elevation.
There are four ways to prepare St. John's wart as a medicinal herb: infusions, tinctures, oil macerates and standardized extracts. The most common preparation is standardized extract at a daily dosage of 300 mg of 0.3 per cent hypericin. Beside hypericin, which is one of many dianthrone derivatives in the herb, there are a number of other compounds with biological activity These include flavonoids, xanthones, phloroglucinol derivatives essential oil components and carotenoids.
The number of compounds in St. John's wart's may help to explain the diversity of its medicinal uses. As an anti-viral medicine studies have shown that two of the herb's constituents, hypericin and pseudohypericin, inhibit a range of viruses, including herpes simplex types 1 and 2 and para-influenza 3 virus.5 Although St. John's wart has shown potential promise for treatment of HlV infetion in in vitro studies, there has been no clinical evidence of its efficacy in humans to date. St. John's wart also is used as a treatment for wounds. The anti-microbial activity is attributed to the essential oil components, phloraglucinals and flavonoids. Recently, St. John's wart has been used in herbal formulations for weight loss. If St. John's wart affects the serotonin levels in the brain as same researchers believe, it is plausible that the herb may impact the body's desire for food. However; no research has effectively examined the potential uses of St. John's wart for weight loss.
Clearly St. John's wart's most prevalent medicinal use is as an antidepressant. Studies, mostly conducted in Germany, have found that St. John's wart reduces feelings of depression, anxiety, apathy and worthlessness. Researchers are not totally sure how St. John's wort chemically acts on the brain as a treatment for depression, but they believe that components of the herb that may impact depression include hypericin, xanthones and flavonoids. St. John's wart appears to be most effective for mild to moderate depression rather than for severe depression.
The only known potential side effect of St. John's wart is that it may cause phototoxicity in fair-skinned people, and it therefore may be prudent far these people not to expose themselves to strong sunlight when taking the herb. At the same time, however there have been no reported cases of phototoxicity in humans despite its wide use in Europe. In a study of 3,250 people using St. John's wart, only 2.4 percent experienced side effects of any kind. To date, no studies have examined the long-term effects of using the herb.
Due to St. John's wart's growing popularity, researchers in the United Studies have began taking interest in the botanical. For instance, the National Institutes of Health (NIH) recently launched the first U.S. clinical trial of St. John's wart. Previous studies on St. John's wart include:
An oft-cited review of 23 clinical trials in the British Medical Journal found that St. John's wart is more effective than placebo in treating mild to moderate depression. The authors also concluded that St. John's wart appears to be comparably effective to many pharmaceutical antidepressants while pro-
ducing less side effects.6
· The October 1994 issue of the Journal of Geriatric Psychiatry and Neurology is devoted to St. John's wart and contains more than a dozen articles on the herb, including effectiveness, potential side effects, pharmacology and pharmaceutical quality of extracts.7
· A clinical trial in the United States published in Fitoterapia examined the antiviral properties of St. John's wart.8
· A study in Pharm. Acta. Helv. of comparative analyses of hypericin and amentaflavane in St. John's wart extracts revealed a possible correlation between the amentoflavane concentration and the
inhibition of flumazenil binding. For hypericin, no correlation was observed. This finding indicates that amentoflavone may have a role in the antidepressant effects of St. John's wart.9
·Researchers reporting in Phytochemistry isolated four new xanthones from the roots of a species of St. John's wart. Some of these xanthones exhibited antifungal activity against Candida albicans.10
· A study published in Arzneimittelforschung found that St. John's wart extract caused a 50 percent inhibition of serotonin uptake by rat synaptasomes. The researchers concluded that the antidepressant activity of the extract is due to an inhibition of serotonin uptake by postay naptic receptors.11
References:
1 Upton R, et al. St. John's Wort (Hypericum Perforatum): Quality Control, Analytical and
Therapeutic Monograph. Santa Cruz, CA: American Herbal Pharmacopeja, 1997. p. 4.
2 Hobbs, C. "St John's Wart: Hypericum Perforatum." HerbalGram. 18/19:24-33 (1989).
3 Pati K, Degidio A. Vitamin and Herbal Digest: Vitamins, Herbs & Supplements..
Burlingame, CA: New Editions Publishing, 1996. p. 343.
4 Upton, R. p. 8.
5 Upton, R. p. 22-23.
6 Linde K, et al. "St Johns Wart for Depression-an Overview and Meta-Analysis of Randomized Clinical Trials. British Medical Journal. 313(7052):253-258 (1996).
7 Journal of Geriatric Psychiatry and Neurology. Michael Jenike, Ed. 7(S1):entire issue (1994).
8 Bombardelli W, Morazzoni P. "Hypericum Perforatum." Fitoterapia. 66:43-68(1995).
9 Baureitbel K, et al. "Inhibition of Bencodiazepine Binding In Vitro by Amentofiavone, a Constituent of Various Species of Hypericum." Pharm. Acta. Helv. 72(3):153-147 (1997).
10 Rath G, et al. "Xanthones from Hypericum Roeperanum.' Phytochemisty 43(2):513-520 (1996).
11 Perovic 5, Muller W. "Pharmacological Profile of Hypericum Extract. Effect on Serotonin
Uptake by Postsynaptic Receptors." Arzneimittelforschung. 45(11):1145-1148 (1995).