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St. John's Wort
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What is St. John's Wort?
The leaf and flower of the plant St. John's Wort has been used medicinally for centuries to treat a variety of conditions. In the US, it has traditionally been used to support the body in fighting low mood. Other historical uses include nervous conditions, including anxiety, sleep disorders, inflammation and bacterial infections.
Why Is Our St. John's Wort Better?
Our St. John's Wort Extract is standardized to 0.3% hypericin to ensure consistent quality, AND we use the whole leaf and flower of St. John's Wort. Most products available use something inert such as alfalfa leaf as the capsule filler because it is inexpensive; OUR product uses whole St. John's Wort flower and leaf in addition to the standardized hypericin extract. We do this because there may be a dozen different compounds in St. John's Wort acting synergistically (as current research indicates), so we will not have eliminated 11 of them, just because research indicates that hypericin may be the main compound producing the desired result. Our St. John's Wort is all-natural, using 100% Vegetarian capsules; no artificial fillers or chemicals are added, no gelatin, pork or bovine.
Who Should Consider St. John's Wort?
In Europe and especially Germany, St. John's Wort is prescribed twice as often as standard antidepressants for depression. Other historical uses include:
- Nervous conditions, including anxiety, depression, and traditionally for many other psychiatric ailments
- Wound management
- Kidney conditions
- Sleep disorders
- Inflammation
- Bacterial infection
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If You Plan To Take St. John's Wort
Please read through ALL of this information and pay particular attention to the drug interactions warning below.
St. John's Wort - What's in a name?
The name of this important herb gives us some indication as to its position of reverence among traditional, native and folk healers through time and across geographical regions: St John of God is the patron Saint of nurses, "wort" is simply Old English for "plant", rendering "nurses plant" or "herb for nurses", given through the beneficence of Saint John of God. But the etymology extends beyond this simple rendition. According to The Textbook of Natural Medicine16, there was a belief during medieval times that if one slept with a bit of the plant under his pillow on St. John's Eve, St. John would appear in a dream and bless the sleeper, granting protection from death for the upcoming year. Further, the scientific name, Hypericum perforatum, has special meaning. Derived from the Greek, it means "over an apparition", referring to its power to ward off evil spirits.16
The St. John's Wort available on the market varies greatly in formulation and quality. If you decide St. John's Wort is right for you, you will be happy to know that we have found, a product that is standardized to 0.3% hypericin, supplemented with whole leaf, and we offer it at a greatly discounted price.
Drug Interactions
The medical journal, The Lancet, has published a study that showed that a drug interaction has been found with St. John's Wort.5 The interaction is that of an inhibitory effect on a protease inhibitor called indinavir, which is used in the treatment of HIV. The Lancet also published, in the same issue, a study that showed that St. John's Wort may also stimulate the rejection of transplanted hearts.5 From this new information, scientists postulate that it is likely that St. John's Wort works along a metabolic pathway (particularly one involving the liver). THEREFORE, it may render such drugs as birth control less effective. If you are currently taking a drug that works along a metabolic pathway (your doctor will know), St. John's Wort may not be for you. Consult a physician.
Depression
Depression can be a serious illness with many potentially serious consequences, and its treatment should always be prescribed and supervised by a qualified physician. The following is for informational purposes only, and should not be construed as, nor is it a substitute for, professional medical advice.
Depression Is a Common Manifestation of Stress
If you're depressed, you are not alone. Depression afflicts nearly 17% of all Americans in the U.S. for the length of their lives. Furthermore, depression is nothing to be embarrassed of or shy about; quite to the contrary: those afflicted tend to be more gifted and higher achieving than their non-depressed peers. Indeed, stress (i.e., the stress commonly associated with achieving people) is a consistent cofactor in depressed people. It is in relieving this stress that St. John's Wort and nearly every prescribed pharmaceutical anti-depressant achieves its anti-depressant qualities. It is important to note that stress is the same no matter how it manifests itself; it is because of this that anxiolytic drugs and herbs are able to relieve so many disorders - ranging from depression to gastric upset to use as weight control agents.
A Note On Environmental and Genetic Causes
Depressed patients' environmental stresses play a major role in their disease. Most of these influences are better addressed with a licensed psychologist, however a few obvious factors bear note. Low light levels, poor sleep habits, and poor diet can, in combination or singly, provide the necessary factors for inducing depression. A good first line of treatment that you don't need a prescription for is as follows: increased exposure to bright light (the brighter the better), good sleep habits (depressed people's sleep schedules tend to rotate clockwise; staying up later and sleeping in longer - don't fall into this pattern! You should also be sleeping in a dark room and waking up under bright lights), and a balanced diet - by "balanced" is meant 40-30-30; the 40-30-30 method balances good and bad prostaglandins, chemicals normally produced by the body, but which are highly influenced by the foods we eat and which have significant bearing on one's state of well-being.
It is suspected that depressed people's increased sensitivity to stress may also carry a hereditary component. Whether this is the case or not, is beyond the scope of this discussion, and not relevant to treatment anyway; one certainly hopes that investigation into genetic inheritance would yield results for future generations. For the remainder, we will concern ourselves with what to do if you are depressed and leave how it happened to the researchers.
Three Types Of Anti-Depressant Agents
- Tricyclics
- monoamine Oxidase Inhibitors (MAOI's)
- Selective serotonin Reuptake Inhibitors (SSRI's - we will also include the MSRI's, or Mixed serotonin Reuptake Inhibitors in this category, since it was through the same mode of inquiry as the SSRI's that they were developed)
A little on brain chemistry will help to understand the action of these drugs. The human brain is teeming with chemicals, in fact, if you look closely enough, it's all chemicals! Without getting into philosophical discussions, suffice it to say that it would appear to some that all thoughts and all emotions have their chemical counterparts that can be studied under the microscope. If you're not comfortable with this sort of reductionistic view of the psyche, relax, there is plenty we don't know and plenty of room for alternative or supplemental models of understanding. It is only that the method of inquiry currently being pursued by medical science is that of "isolate and tweak", which, so far has had its rewards.
Two of the major chemical players in the brain when it comes to depression, are neurotransmitters known as serotonin and norepinephrine. These neurotransmitters, like all neurotransmitters, work something like the way keys fit into locks. On the one side there's the neurotransmitter, or the key, and on the other the lock, known as the receptor site. Every neurotransmitter has a specific receptor site that only it, or chemicals with similar structures "fit" into. When a neurotransmitter is received at its receptor site, information is transmitted, whether it's a feeling of well being (serotonin, norepinephrine, et. al.), euphoria (opiates, for example), pain (acetaldehyde - i.e., the chemical metabolite of alcohol that yields the infamous "hangover"), a rush of excitement (epinephrine, also known as adrenaline), or some other chemical information. Once a chemical is received it is eaten up by another chemical called an enzyme. Monoamine oxidase is one of these enzymes. Think of enzymes as performing a janitorial chore in your brain.
One by one, let's look at how these agents work:
Trycyclics are wide ranging in their action on the brain's neurotransmitters and for this reason are termed "dirty". This is not "dirty' as in "bad" or containing dirt, but unselective in the brain chemicals that they affect. They affect the re-uptake of both serotonin and norepinephrine, allowing these two chemicals to hang around longer and do their thing before they are eaten up by the enzymes. Tricyclics also affect other brain chemicals, but for simplicities' sake, we will only address serotonin and norepinephrine.
MAOI's, as their name implies, work on the "lock" side of the reaction, by blocking the action of the monoamine oxidase, the enzyme that eats serotonin and norepinephrine. By blocking their reuptake, serotonin and norepinephrine are left to work their action for longer periods of time (MAOI's vary in their ability to block MAO, there is usually enough left to eventually degrade the neurotransmitters, it only takes longer). The problem with MAOI's is that they leave the brain open to the action of other chemicals (other amines) as well, not just serotonin and norepinephrine. This means that a person taking an MAOI has to avoid certain sources of otherwise harmless chemicals. These sources unfortunately include chocolate, aged cheeses, red wines, fava beans and many other commonly enjoyed foods. The repercussions of an accidental ingestion of these foods (actually, the tyramines they contain) while under the influences of an MAOI is staggering, and can range from hypertensive or hypotensive crisis to stroke and, possibly, death.
SSRI's, also as their name implies, affect only the reuptake of serotonin, and are thus considered "clean" in their action. They have proven quite effective in treating depression.
Undesired Side Effects
The main complaint with modern anti-depressant therapy is that of undesired side effects. The tricyclics are antihistiminic, which leads to dry mouth, hypostatic blood pressure (dizziness on standing from a relaxed position), constipation, urinary retention, carbohydrate cravings, excessive drowsiness, blurred vision and others. In short, the tricyclics are hard to tolerate, owing to these side effects. The MAOI's - well, if you can consider stroke a "side effect"... These aren't used often anymore. The best, the "clean", or specific drugs, the SSRI's, have a whole host of their own side effects as well: agitation, insomnia, loss of libido, and impotence are among them.
IF YOU ARE ALREADY ON ONE OF THESE DRUGS...
You should know that these side effects are not always present, and will almost always subside upon stopping the drug. Do not, under any circumstance stop your medication abruptly, or without contacting your attending physician! Do not under any circumstance mix these drugs and St. John's Wort.
Hypericin, Hyperforin and How St. John's Wort Works
Most studies on St. John's Wort were done on leaf standardized to 0.3% hypericin. This always was ONLY a marker compound - a reference or bench mark - to help control the studies and used by various pharmacopoeias in establishing guidelines. In other words, nothing antidepressant about hypericin itself has ever been established, although there is mounting evidence that hyperforin is a 5-HT serotonin reuptake inhibitor. Hyperforin is the second compound to have been identified from this plant and suspected as having antidepressant effects. Hyperforin is naturally present in St. John's Wort leaf in the amount of about 4% - no special process is needed to get this. This is why we have ALWAYS sold St. John's Wort standardized to 0.3% hypericin and supplemented with whole leaf (this ensures that nothing is left out, since we really don't KNOW what it is that makes this plant work). Initially it was thought that St. John's Wort's antidepressant effects were due to MAO inhibition - probably an incorrect hypothesis since the MAO inhibiting activity of St. John's Wort is minimal at best. We are left with the question, HOW does it work? Some interesting hypothesis have been proposed; here are two of them:
The Immune System Modulation Hypothesis
Cytokines are mediators involved in cell-to-cell communications. Interleukins are types of cytokines involved in hemopoesis (regeneration of red blood cells) and immune response. One of these is a protein called interleukin-6 (IL-6) (there are 12 known interleukins). IL-6 is also involved in cellular functions in the nervous system. Specifically, IL-6 activates the hypothalamic-pituitary-adrenal axis, resulting in increased production of Corticotropin-releasing hormone (or "CRH") - the hypothalamic peptide which stimulates corticotropin release from the pituitary gland. Increased production of corticotropin means release of adrenaline, which means STRESS! St. John's Wort has been demonstrated through in vitro experiments to greatly reduce the release of IL-6. This hypothesis has not been tested in vivo, but it is compelling because it provides a hypothetical link between St. John's Wort's known immune system and antidepressant effects.16
The SSRI Hypothesis
Simply put, there is a great deal of evidence accumulating that hyperforin selectively blocks the reuptake of serotonin.3,4,9,14,17 If this is found to be true, what we will have is a naturally occurring SSRI - like Prozac! Studies have shown that hyperforin alone produces results comparable to that of whole St. John's Wort leaf.3 Another study compared St. John's Wort with differing hyperforin content and identical hypericin content.9 That with the greater hyperforin content came out on top.
What We Know
In the end, like the now obsolete MAOI hypothesis, neither of the above hypotheses may prove true - maybe both will; fortunately this has little impact on practical application. We know that it does work, and we know what methods of standardization produce the desired results. While we wait for the answer, any product that is standardized to 0.3% hypericin AND contains whole leaf should have a hyperforin content of about 4% and will work.
Side Effects
Orally, St. John's Wort is generally well tolerated, in clinical trials adverse reactions were similar to placebo and lower than conventional antidepressants. However, side effects can occur and may include insomnia, vivid dreams, restlessness, anxiety, agitation, irritability, gastrointestinal discomfort, diarrhea, fatigue, dry mouth, dizziness and headache. In rare cases it may also cause skin rashes, paresthesia, and hypoglycemia. Chronic use can also cause increased photosensitivity leading to photodermatitis. The threshold dose range for increased photosensitivity appears to 5 mg to 10 mg of hypercin per day.
Interactions
St. John's Wort has many possible interactions with prescriptions drugs including any types of antidepressants, antihistamines and narcotics. Please consult a healthcare professional regarding concurrent use of St. John's Wort and any medication.
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Label Facts
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Supplement Facts
Serving Size: 1 Capsules
Servings per container: 90 |
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Amount Per Serving |
% Daily Value |
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| St. John's Wort Extract (0.3% Hypercin) |
300 mg |
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| St. John's Wort Leaf (ground) |
100 mg |
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Other ingredients: Cellulose (plant fiber), modified cellulose.
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Dietary Restrictions
 Vegetarian capsule used and a vegetarian formula.
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References
- Blumenthal, Mark; Goldberg, Alicia; Brinckmann, Josef, Eds,; Tyler, VarroE, PhD, ScD. Herbal Medicine: Expanded Commission E Monographs. American Botanical Council, 2000.
- Blumenthal, Mark; Busse, Werner R; Goldberg, Alicia; Gruenwald, Joerg, PhD; Hall, Tara; Riggins, Chance W.; Rister, Robert S., Eds, Klein, Sigrid, PhD; Rister, Robert S, Trans, Tyler, VarroE, PhD, ScD. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, 1998.
- Chatterjee SS, Bhattacharya SK, Wonnemann M, Singer A, Muller WE. Hyperforin as a possible antidepressant component of hypericum extracts. Life Sci 1998;63(6):499-510.
- Chatterjee SS, Noldner M, Koch E, Erdelmeier C. Antidepressant activity of hypericum perforatum and hyperforin: the neglected possibility. Pharmacopsychiatry 1998 Jun;31 Suppl 1:7-15.
- Ernst E. Second thoughts about safety of St John's wort. Lancet. 1999 Dec 11;354(9195):2014-6.
- Gobbi M, Valle FD, Ciapparelli C, Diomede L, Morazzoni P, Verotta L, Caccia S, Cervo L, Mennini T. Hypericum perforatum L. extract does not inhibit 5-HT transporter in rat brain cortex. Naunyn Schmiedebergs Arch Pharmacol 1999 Sep;360(3):262-9.
- Gruenwald, Joerg, PhD; Brendler, Thomas, BA; Jaenicke, Christof, MD. PDR for Herbal Medicines. Medical Economics Company, 1998.
- Kaehler ST, Sinner C, Chatterjee SS, Philippu A. Hyperforin enhances the extracellular concentrations of catecholamines, serotonin and glutamate in the rat locus coeruleus. Neurosci Lett 1999 Mar 12;262(3):199-202.
- Laakmann G, Schule C, Baghai T, Kieser M. St. John's wort in mild to moderate depression: the relevance of hyperforin for the clinical efficacy. Pharmacopsychiatry 1998 Jun;31 Suppl 1:54-9.
- Lavie, G. et. al. "Hypericin as an Inactivator of Infectious Viruses in Blood Components." Transfusion. 1995, May 35(5): 392-400.
- Linde, K. et al. St. John's Wort for depression-an overview and meta-analysis of randomised clinical trials. BMJ 1996: no 7052, vol.313
- McGuffin M, Hobbs C, Upton R, Goldberg A, Eds. American Herbal Products Association's Botanical Safety Handbook. CRC Press LLC. 1997.
- Mishenkova IL et al., Antiviral Properties of St. John's Wort and preparations produced from it. Tr S'ezda Mikrobiol Ukr 1975:222-3.
- Muller WE, Singer A, Wonnemann M, Hafner U, Rolli M, Schafer C. Hyperforin represents the neurotransmitter reuptake inhibiting constituent of hypericum extract. Pharmacopsychiatry 1998 Jun;31 Suppl 1:16-21.
- Murray, Michael, ND; Pizzorno, Joseph, ND. Encyclopedia of Natural Medicine, second ed. Prima Publishing, Rocklin. 1999.
- Pizzorno, Joseph, ND; Murray, Michael T, Eds. Textbook of Natural Medicine, second ed. Churchill Livingstone, 1999.
- Singer A, Wonnemann M, Muller WE. Hyperforin, a major antidepressant constituent of St. John's Wort, inhibits serotonin uptake by elevating free intracellular Na+1. J Pharmacol Exp Ther 1999 Sep;290(3):1363-8.
Double Blind Trials Comparing Saint John's Wort to Synthetic Antidepressants (no placebo)
- Behnke, K., G. S. Jensen, H. J. Graubaum and J. Gruenwald (2002). "Hypericum perforatum versus fluoxetine in the treatment of mild to moderate depression." Adv Ther 19(1): 43-52.
- Brenner, R., V. Azbel, S. Madhusoodanan and M. Pawlowska (2000). "Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: a double-blind, randomized pilot study." Clin Ther 22(4): 411-9.
- Czekalla, J., M. Gastpar, W. D. Hubner and D. Jager (1997). "The effect of hypericum extract on cardiac conduction as seen in the electrocardiogram compared to that of imipramine." Pharmacopsychiatry 30 Suppl 2: 86-8.
- Friede, M., H. H. Henneicke von Zepelin and J. Freudenstein (2001). "Differential therapy of mild to moderate depressive episodes (ICD-10 F 32.0; F 32.1) with St. John's wort." Pharmacopsychiatry 34 Suppl 1: S38-41.
- Harrer, G., W. D. Hubner and H. Podzuweit (1994). "Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: a multicenter double-blind study." J Geriatr Psychiatry Neurol 7 Suppl 1: S24-8.
- Johnson, D., H. Ksciuk, H. Woelk, E. Sauerwein-Giese and A. Frauendorf (1994). "Effects of hypericum extract LI 160 compared with maprotiline on resting EEG and evoked potentials in 24 volunteers." J Geriatr Psychiatry Neurol 7 Suppl 1: S44-6.
- Vorbach, E. U., W. D. Hubner and K. H. Arnoldt (1994). "Effectiveness and tolerance of the hypericum extract LI 160 in comparison with imipramine: randomized double-blind study with 135 outpatients." J Geriatr Psychiatry Neurol 7 Suppl 1: S19-23.
Double-Blind Placebo-Controlled Trials
- Hansgen, K. D., J. Vesper and M. Ploch (1994). "Multicenter double-blind study examining the antidepressant effectiveness of the hypericum extract LI 160." J Geriatr Psychiatry Neurol 7 Suppl 1: S15-8.
- Hubner, W. D., S. Lande and H. Podzuweit (1994). "Hypericum treatment of mild depressions with somatic symptoms." J Geriatr Psychiatry Neurol 7 Suppl 1: S12-4.
- Kalb, R., R. D. Trautmann-Sponsel and M. Kieser (2001). "Efficacy and tolerability of hypericum extract WS 5572 versus placebo in mildly to moderately depressed patients. A randomized double-blind multicenter clinical trial." Pharmacopsychiatry 34(3): 96-103.
- Laakmann, G., C. Schule, T. Baghai and M. Kieser (1998). "St. John's wort in mild to moderate depression: the relevance of hyperforin for the clinical efficacy." Pharmacopsychiatry 31 Suppl 1: 54-9.
- Philipp, M., R. Kohnen and K. O. Hiller (1999). "Hypericum extract versus imipramine or placebo in patients with moderate depression: randomised multicentre study of treatment for eight weeks." Bmj 319(7224): 1534-8.
- Sommer, H. and G. Harrer (1994). "Placebo-controlled double-blind study examining the effectiveness of an hypericum preparation in 105 mildly depressed patients." J Geriatr Psychiatry Neurol 7 Suppl 1: S9-11.
- Witte, B., G. Harrer, T. Kaptan, H. Podzuweit and U. Schmidt (1995). "[Treatment of depressive symptoms with a high concentration hypericum preparation. A multicenter placebo-controlled double-blind study]." Fortschr Med 113(28): 404-8.
For Further Reading
- Daoust, Gene and Joyce. 40-30-30 Fat Burning Nutrition.Del Mar: Wharton, 1996. The definitive guide to eating 40-30-30! A must for the serious dieter.
- Hawken, C.M. St. Johns Wort. Pleasant Grove: Woodland, 1997. An informative, if brief, introduction to the many uses of St. John's Wort.
- Kramer, Peter D. Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. New York: Viking, 1993. A thorough and fascinating look at anti-depressants, the way they work, and the implications they have on our understanding of the self.
- Norden, Michael J., MD. Beyond Prozac: Brain-Toxic Lifestyles, Natural Antidotes & New Generation Antidepressants. New York: Regan Books, 1996. This book addresses much more than just depression; it addresses sleep, diet, mineral and vitamin supplementation and many other topics. It is really about how to feel better through better habits.
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