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St Johns Wort

St. John's Wort is a bushy perennial plant with numerous yellow flowers. It has a 2,000+ year history of safe and effective usage in many folk and herbal remedies as a nerve tonic, St. John's Wort is now widely used as a mild antidepressant. It is a potent antiviral and antibacterial that is being investigated as a treatment for AIDS. It has earned a place as one of the best herbs for mood elevation with controlled studies that have shown positive results in treating patients with mild to moderate depression (see below.) Improvement was shown with symptoms of sadness, helplessness, hopelessness, anxiety, headache and exhaustion with no reported side effects.

Its action is based on the ability of the active ingredient, hypericin to inhibit the breakdown of neurotransmitters in the brain. The herb also inhibits monoamine oxidase (MAO) and works as a serotonin reuptake inhibitor (SRI); both are actions similar to drugs prescribed for depression. In Germany, nearly half of depression, anxiety, and sleep disorders are treated with hypericin. St. John's Wort should not be taken with any other antidepressants, it is not effective for severe depression, and no one should stop taking any prescribed medications for depression without proper medical care.

St John's Wort Clinical Studies


Linde K, Ramirez G, Mulrow CD, Pauols A, Weidenhammer W, Melchart D. St. John's Wort for depression - an overview and meta-analysis of randomized clinical trials. British Med.J. 1996;313:253-58.

Johne A, Brockmöller J, Bauer S, Maurer A, Langheinrich M, Roots I. Pharmacokinetic interaction of digoxin with an herbal extract from St. John's Wort (Hypericum perforatum). Clin.Pharmacol. Ther. 1999;66:338-45.

Piscitelli SC, Burstein AH, Chaltt D, Alfaro RM, Falloon J. Indinavir concentrations and St. John's Wort. Lancet 0 AD/2/12;355:547-48.

Nebel A, Schneider BJ, Baker RK, Kroll DJ. Potential metabolic interaction between St. John's Wort and theophylline. Ann.Pharmacother. 1999;33:502.

Ruschitzka F, Meier PJ, Turina M, Lüscher TF, Noll G. Acute heart transplant rejection due to Saint John's wort. Lancet 0 AD/2/12;355:548-49.

Ha HR, Chen J, Freiburghaus AU, Follath F. Metabolism of theophylline by cDNA-expressed human cytochromes P450. Br.J.Clin.Pharmacol. 1995;39:321-26.

Kronbach T, Fischer V, Meyer UA. Cyclosproine metabolism in human liver: identification of a cytochrome P-450III gene family as the major cyclosporine-metabolizing enzyme explains interactions of cyclosporine with other drugs. Clin.Pharmacol.Ther. 1988;43:630-35.

Beyond Prozac: Antidotes for Modern Times, Michael J. Norden.

"Significantly More Effective" than Fluoxetine (Prozac®) (2005)
A study published in October of 2005 comparing hyperforin-rich Hypericum (St. John's Wort) extract to the antidepressant drug fluoxetine (Prozac®) and placebo again confirmed the effectiveness of high-quality Hypericum extract for depression. In this randomized, controlled, double-blind trial, the 135 patients with major depressive disorder were given either fluoxetine 20mg/day, Hypericum extract 900mg/day, or placebo for twelve weeks. By the end of the twelve weeks, the patients taking Hypericum experienced a 48% greater reduction in symptoms of depression than those taking fluoxetine. (Symptoms were measured using the HAM-D, the standard scale to measure depression. From an average HAM-D score of 19.7 at the beginning of the study, HAM-D scores dropped to an average of 10.2 in the Hypericum group and 13.3 in the fluoxetine group.) Moreover, a larger portion of those taking Hypericum experienced complete remission of depression than patients taking fluoxetine (38% vs. 30%). The researchers concluded that, "Overall, St John's wort appeared to be safe and well tolerated... St John's wort was significantly more effective than fluoxetine."

Equally Effective to Sertraline (Zoloft®) with 28% Fewer Side Effects (2005)
A double-blind, multi-center German study3 from 2005 found Hypericum extract (612mg/day) to be equally effective to sertraline (Zoloft®) (50mg/day) after 12 weeks and possibly more effective after 24 weeks for the treatment of moderate depression. The number of patients responding and the average reduction in symptoms were nearly identical between the two groups after twelve weeks, and during during weeks 13-24 symptoms in the patients taking Hypericum actually dropped 160% more than in those taking sertraline. Furthermore, the number of patients reporting adverse events (side effects) was 28% lower in the hypericum group versus the sertraline group.

More Effective than Paroxetine (Paxil®) for Moderate to Severe Depression (2005)
Just recently completed in early 2005 and published in the British Medical Journal, this study1 examining 251 adults with moderate to severe depression again demonstrated the effectiveness of hyperforin-rich Hypericum extract for the treatment of depression. Patients were given either 900mg/day Hypericum extract or 20mg/day paroxetine (the prescription antidepressant Paxil®) for six weeks. For patients who did not respond quickly, doses were doubled after two weeks. After six weeks, symptoms of depression decreased 57% in the group taking hyperforin-rich Hypericum and only 45% in the group taking paroxetine. Patients taking Hypericum were 42% less likely than patients taking paroxetine to experience negative side effects. The researchers concluded that, "In the treatment of moderate to severe major depression, Hypericum extract... is at least as effective as paroxetine and is better tolerated." The Hypericum extract used in this trial was standardized to 3-5% hyperforin.

More Effective than Placebo, Similar to SSRIs (2002)
A study at the University of Vienna4 analyzed three double-blind, randomized multicenter trials, during which 544 out-patients suffering from mild to moderate depression according to DSM-IV criteria received 900mg/day Hypericum extract or placebo over a treatment period of 6 weeks. The researchers concluded that "Hypericum extract reduced the symptoms of depression more effectively than placebo. However, the herbal drug was particularly effective in the core symptoms of the disorder. The results indicate that Hypericum extract accelerated the recovery from depression in a rather general manner, by influencing all investigated signs and symptoms of the disease. The drug's therapeutic profile was thus found to be similar to the profile of selective serotonin reuptake inhibitors."

Safe and More Effective than Placebo (2002)
A French study6 published in the American Journal of Psychiatry again confirmed the efficacy of Hypericum extract. The double-blind, randomized, placebo-controlled trial with 375 patients concluded that "Hypericum extract was found to be safe and more effective than placebo for the treatment of mild to moderate depression."

As Good or Better than Prozac® or Tofranil® (2002)
A recent overview5 of all available research considered 34 controlled, double-blind trials of Hypericum extracts in some 3000 patients suffering from depression. The majority of the studies used the Hamilton Rating Scale of Depression as the efficacy criterion. Hypericum extract dosage ranged from 300 mg to 1200 mg. All placebo-controlled studies showed Hypericum extract to be significantly superior to placebo. Furthermore, "results with Hypericum were as good or even better than with imipramine [Tofranil®] or fluoxetine [Prozac®]." The researcher went on to conclude that "in the medically supervised treatment of mild to moderate depression, doses of approximately 500-1000 mg of extract per day of these preparations of St. John's Wort are of comparable efficacy to synthetic antidepressants in their normally prescribed dosages."

Comparable to Prozac® but with Fewer Side Effects, Particularly Effective for Anxiety (2001)
A German study7 published in Pharmacopsychiatry compared Hypericum extract (500mg/day) with fluoxetine (Prozac® 20mg/day) in a randomized, double-blind multicenter trial including 240 patients. "The HAMD responder rate was 60% in the [Hypericum extract] group compared to 40% in the fluoxetine group (p=.005). Particularly, there was a marked decrease of depressive agitation (pre-post comparison: 46%) and anxiety symptoms (44%) during therapy with St. John's Wort... There was no statistically significant differences between the treatment groups. Adverse events occurred in 28 patients (25%) in the fluoxetine group and in 18 (14%) of the St. John's Wort group... An especially interesting overall observation is that [Hypericum extract] is particularly effective in depressive patients suffering from anxiety symptoms. St. John's Wort revealed better safety and tolerability data than fluoxetine."

"At Least As Effective As Sertraline [Zoloft®]" After Seven Weeks (2001)
A study8 from 2000 performed at a hospital in New York state compared standardized Hypericum (St. John's Wort) extract to the prescription antidepressant sertraline (Zoloft®) in people with mild to moderate depression. Patients received 600 mg/day Hypericum extract or 50 mg/day sertraline for the first week and 900 mg/day Hypericum extract or 75 mg/day sertraline for the following six weeks. Clinical response (at least 50% reduction in symptoms) was observed in 47% of patients taking Hypericum versus only 40% taking sertraline. The researchers concluded that, "The hypericum extract was at least as effective as sertraline in the treatment of mild to moderate depression."

 

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