Hypericum perforatum /St. John’s wort is a sprawling, leafy herb that grows in open, disturbed areas throughout much of the world’s temperate regions. The use of this species as an herbal remedy to treat a variety of internal and external ailments dates back to the time of the ancient Greeks. Since then, it has remained a popular treatment for anxiety, depression, cuts, and burns. Recent research suggests the effectiveness of this herb in treating other ailments, including cancer, inflammation-related disorders, and bacterial and viral diseases, and as an antioxidant and neuroprotective agent. Pharmaceutical companies, particularly in Europe, prepare standard formulations of this herb that are taken by millions of people. Worldwide annual sales of products made from SJW presently exceed several billion dollars. Further, SJW produces dozens of biologically active substances, although two—hypericin (a naphthodianthrone) and hyperforin (a lipophilic phloroglucinol)—have the greatest medical activity. Other compounds, including the flavonoids rutin, quercetin, and kaempferol, also appear to have medical activity. H. perforatum has been intensively studied on isolated tissue samples, using animal models and through human clinical trials. The effectiveness of SJW as an antidepression agent is particularly well studied, and the underlying
Indications of Hypericum Perforatum
- Depression – Taking St. John’s wort extracts by mouth improves mood and decreases nervousness and tiredness related to depression. It seems to be about as effective as many prescription drugs. The American College of Physicians-American Society of Internal Medicine guidelines suggest that St. John’s wort can be considered an option along with prescription medications for short-term treatment of mild depression. However, since St. John’s wort causes many drug interactions, the guidelines suggest it might not be a good choice for many people. St. John’s wort might not be as effective for more severe cases of depression.
- Antibacterial and Antiviral Properties – As noted in 11.1, extracts of H. perforatum have been used over thousands of years to treat cuts, abrasions, and other wounds. Its usefulness in reducing inflammation is well known, and appears to be related, at least in part, to its ability to serve as an antibacterial agent. Recent research also suggests that it is useful in combating viruses.
- Anticancer Properties – Hyperforin and hypericin have also been examined for their anticancer properties. According to Schempp et al. (2002), hyperforin inhibits tumor cell growth in vitro. The mechanism involves induction of apoptosis (programmed cell death) through the activation of caspases, which are cysteine proteases that trigger a cascade of proteolytic cleavage occurrences in mammalian cells. Hyperforin also causes the release of cytochrome c from isolated mitochondria. Mitochondrial activation is an early event in hyperforin-mediated apoptosis, and hyperforin inhibits tumor growth in vivo (Schempp et al. 2002).
- Antioxidant and Neuroprotective Properties – Recent research shows that extracts of H. perforatum decrease oxidative stress and consequently prevent neurotoxicity, inflammation, and gastrointestinal problems. Flavonoid-rich extracts of H. perforatum (FEHP) are effective against hydrogen peroxide-induced apoptosis in PC12 cells (a cell line derived from the pheochromocytoma of the rat adrenal medulla). Standard extracts of H. perforatum can prevent DNA fragmentation and shrinkage of cells as a result of hydrogen peroxide activity (Lu et al. 2004). Thus, FEHP may effectively treat oxidative stress-related neurodegenerative disorders such as Parkinson’s and Alzheimer’s diseases (Zou et al. 2010).
- Anti-Inflammatory Activity – H. perforatum shows promise as an anti-inflammatory agent. Rats fed doses of SJW showed decreased levels of blood and bowel enzymes associated with colonic inflammation (Dost et al. 2009), and had lower incidences of gastric ulcers (Cayci and Dayioglu 2009). Sosa et al. (2007) found that lipophilic extracts of H. perforatum had greater anti-inflammatory activity than did ethylacetic or hydroalcoholic extracts. Quercetin and I3,II8-biapigenin, the two major oil extracts of SJW, showed particular anti-inflammatory and gastroprotective activity (Zdunic et al. 2009).
- Symptoms related to menopause – Most research shows that taking St. John’s wort by mouth can help reduce hot flashes and other symptoms of menopause. Some evidence suggests that specific combinations of St. John’s wort plus black cohosh (Remifemin; Remifemin Plus; Gynoplus) can also improve some symptoms of menopause such as hot flashes and mood changes. But not all St. John’s wort combination products seem to be beneficial.
- Wound-Healing Agent – As noted in Section 11.3, H. perforatum extract has been used over thousands of years as a wound-healing agent. Controlled studies investigating this claim are surprisingly sparse. Ozturk et al. (2007) found that chicken embryonic fibroblasts exposed to SJW extract demonstrated enhanced collagen production, followed by the polygonal shape activation of fibroblast cells that is responsible for wound closure. Applying an ointment containing St. John’s wort three times daily for 16 days seems to improve wound healing and reduce scar formation after a Cesarean section (C-section).
- The condition of mental feelings causing bodily symptoms – Treatment with a specific St. John’s wort product (LI 160, Lichtwer Pharma) daily for 6 weeks seems to reduce symptoms of somatization disorder.
- Pain in the mouth (burning mouth syndrome) – Taking St. John’s wort three times daily for 12 weeks does not reduce pain from burning mouth syndrome.
- Hepatitis C infection – Taking St. John’s wort by mouth does not seem to be effective for treating adults with hepatitis C infection.
- HIV/AIDS – Taking St. John’s work by mouth does not seem to be effective for treating HIV-infected adults.
- Irritable bowel syndrome (IBS) – Early research shows that taking a specific St. John’s wort extract (St. John’s Wort Extract Extra Strength, Enzymatic Therapy) twice daily is not effective for reducing symptoms of IBS.
- Nerve pain – Taking St. John’s wort by mouth does not seem to relieve nerve pain in diabetic or non-diabetic people.
- Social nervousness – Taking St. John’s wort daily does not seem to improve social nervousness.
- A procedure to widen blocked arteries (angioplasty) – Early research shows that in people who do not respond to a prescription blood thinner medication called clopidogrel or Plavix and aspirin, taking St. John’s wort three times daily for 2 weeks after a procedure to clear blocked arteries might improve outcomes of the procedure. It is thought that St. John’s wort might help the blood thinning medications work better in some people.
- Attention deficit-hyperactivity disorder or ADHD – A report of 3 males aged 14-16 with ADHD showed that taking St. John’s wort daily for 4 weeks might improve attention and activity. But other research shows that taking a St. John’s wort extract for 8 weeks does not improve ADHD symptoms in children ages 6-17 years.
- A genetic condition of that causes bilirubin to build up in the body – A case report shows that taking St. John’s wort by mouth three times daily for two 8-week periods might decrease bilirubin levels, reduce jaundice, and improve fatigue in people with this condition.
- Brain tumor – Early research shows that taking hypericin, a chemical in St. John’s wort, by mouth for up to 3 months might reduce tumor size and improve the survival rate in people with brain tumors.
- Herpes – Early research suggests that using a specific combination of St. John’s wort and copper sulfate pentahydrate might help reduce symptoms, including stinging, burning and pain, in people with cold sores or genital herpes.
- A migraine headache – Early research suggests that taking a specific St. John’s wort product three times daily improves migraine pain but does not reduce how often migraines occur.
- Obsessive-compulsive disorder or OCD – The evidence about the effectiveness of St. John’s wort for OCD is not clear. Study results have been mixed.
- Plaque psoriasis – Early research suggests that applying St. John’s Wort liquid or ointment to the skin decreases the severity and the size of psoriasis patches.
- Premenstrual syndrome – The evidence about the use of St. John’s wort for treating PMS is not clear. Some early research suggests that St. John’s wort might help reduce PMS symptoms, including sleep problems, confusion, crying, headache, tiredness, food cravings, and swelling, by as much as 50% in some women. However, other research shows that taking St. John’s wort does not reduce nervousness or other PMS symptoms.
- Mood condition related to changes in the season – Early studies suggest that St. John’s wort might help improve symptoms of nervousness, decreased sex drive, and sleep problems in people with seasonal mood changes. It is useful alone or in combination with light therapy.
- Smoking cessation – Early research suggests that taking a St. John’s wort extract once or twice daily starting one week before and continuing for 3 months after quitting smoking does not improve long-term quit rates.
- Tooth pulling – Early research suggests that applying a homeopathic St. John’s wort preparation does not improve dental pain after a tooth is pulled or after dental surgery.
- Feeling sad or anxious often or all the time
- Not wanting to do activities that used to be fun
- Feeling irritable‚ easily frustrated‚ or restless
- Having problems with sleep and feeling tired
- Eating more or less than usual or having no appetite
- Experiencing pain that doesn’t improve with treatment
- Having trouble concentrating, remembering details, or making decisions
- Feeling guilty, worthless, or helpless
- Thinking about suicide or hurting yourself.
- Chronic fatigue syndrome (CFS)
- Extreme tiredness (chronic fatigue syndrome)
- Muscle pain
- Nerve pain
- Pain in the lower back or hip that radiates to the leg (sciatica)
Statistics of Hypericum Perforatum
- St. John’s wort (Hypericum perforatum) is a flowering plant.
- The flowers are used to make liquid extracts, pills, and teas. The popular herbal therapy is often used to ease symptoms of depression. People have been using St. John’s wort for centuries.
- A Cochrane systematic review found that St. John’s wort can be effective in treating major depression.
- A 2016 review of 35 studies concluded that St. John’s wort reduced symptoms of mild to moderate depression more than a placebo and similar to prescription antidepressants.
- A 2017 analysis of 27 studies determined that St. John’s wort had similar effects on mild to moderate depression as antidepressants. Those researchers also noted that fewer people stopped taking St. John’s wort, compared to antidepressants.
- Another study indicated St. John’s wort can be effective in treating wounds, bruises, burns, and sores. However, the Food and Drug Administration (FDA) has not approved the substance for depression or any other medical condition.
- The FDA, in fact, classifies St. John’s wort as a dietary supplement, not a drug. Therefore, the agency doesn’t test it for safety and effectiveness.[#]
The dosage of Hypericum Perforatum
For mild to moderate low mood or depression
- In most studies, St. John’s wort extract was standardized to 0.3% hypericin content and used at doses of 300 mg 3 times daily.
- Some studies have used St. John’s wort extract standardized to 0.2% hypericin at doses of 250 mg twice daily.
- St. John’s wort extract standardized to 5% hyperforin has been used at doses of 300 mg 3 times daily.
For symptoms of menopause
- St. John’s wort extract containing 0.2 mg/mL hypericin, taken in doses of 20 drops 3 times daily for 2 months has been used.
- St. John’s Wort 300mg 3 times daily for 3-4 months has been used.
- For the condition of mental feelings causing bodily symptoms (somatization disorder) – a specific extract (LI 160, Lichtwer Pharma) 600 mg/day has been used.
- For wound healing – An ointment containing a 5% St. John’s wort extract applied three times daily beginning 24 hours after a C-section and continued for 16 days has been used.
- For mild to moderate depression in child – 150-300 mg of St. John’s wort three times daily for 8 weeks in children 6-17 years-old has been used. A specific St. John’s wort extract (LI 160, Lichtwer, Pharma) 300-1800 mg in three divided doses daily for up to 6 weeks has been used.
Side effects of Hypericum Perforatum
Side effects are uncommon but St John’s wort may cause
- stomach upsets
- sleep disturbances
- a dry mouth
- skin rash
- increased sensitivity to sunlight
Drug Interactions of Hypericum Perforatum
- Data information is not available