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New hope from an old herb
St. John's wort ("wort" is Old English for "plant") is the herbal antidepressant. Herbalists have known this for many years, but interest widened after the 1996 publication of a major study in the British Medical Journal.
Researchers from Ludwig Maximillian University in Munich, Germany, and the Audie Murphy VA Medical Center in San Antonio, Texas, analyzed 23 previously published studies of St. John's wort, which included 1,757 people suffering mild to moderate depression. Among the subjects taking placebos, 22% reported significant relief of depression using standard tests. But among the subjects taking St. John's wort, the figure was 55% -- a significant difference.
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Latest News
The studies of St. John's wort for depression have tested the herb on people suffering mild-to-moderate depression. But it can also help those with severe depression, according to a new study.
At a recent conference sponsored by New York University, Norman Rosenthal, M.D., chief of environmental psychiatry at the National Institute of Mental Health in Bethesda, Maryland, described a study that tested the herb on 209 people with severe depression. At double the usual dose, St. John's wort produced significant benefits. Dr. Rosenthal recommended it especially for the elderly because it causes so few side effects and does not interact with other medications (except other antidepressants).
Existing Medical Research
Since the publication of the major 23-study analysis in the British Medical Journal, other studies have confirmed St. John's wort's value as an antidepressant:
- In a German trial involving 209 people with depression, researchers compared the effects of the herb (600 mg of a standardized extract) to those of the pharmaceutical antidepressant imipramine (Tofranil, 50 mg). Response was defined as an improvement of at least 50% in a standard test of mood. Participants taking St. John's wort were a little less likely to respond (35% vs. 41% of those taking imipramine). But the herb group reported significantly fewer and less severe side effects. Only one person taking St. John's wort withdrew from the study because of side effects, but among those taking imipramine, eight withdrew.
- At the University of Salzburg, Austria, researchers gave 105 depression sufferers either a placebo or St. John's wort for four weeks. Based on standard psychiatric tests of mood, those taking the herb improved significantly more than those taking nothing. Few of the people taking St. John's wort reported any side effects.
Only about 1% of people taking St. John's wort report side effects, and they are generally mild: abdominal upset, allergic reactions, fatigue, and restlessness. Prescription antidepressants are considerably more likely to cause side effects.
Initially, scientists believed that St. John's wort relieved depression because it was a natural monoamine oxidase (MAO) inhibitor, one class of antidepressant. But people taking MAO inhibitors must restrict their diets or suffer significant side effects. Meanwhile, people who took St. John's wort did not experience side effects when they ate the foods forbidden to those taking MAO inhibitors. Now it appears that St. John's wort is a natural Prozac, or selective serotonin reuptake inhibitor (SSRI).
The dose used in most research has been 300 mg of St. John's wort extract (containing 0.3% hypericin, one of the active constituents) three times a day. It usually takes four to six weeks to experience the mood-elevating effects of St. John's wort.
Meanwhile, several studies have confirmed St. John's wort's traditional use in topical wound healing. Compounds in the plant's red oil (hypericin and others) have antibiotic action and help prevent wound infection. Other compounds (flavonoids) help reduce wound inflammation. One German study showed that compared with conventional treatment, an ointment containing St. John's wort extract substantially reduced the healing time of burns.
Additional studies are currently underway at Maryland's National Institutes of Health.
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Common Uses
St. John's wort may be helpful in treating the following:
- Mild to moderate depression
- Moodiness
- Anxiety
- Minor external wounds
- Bruises
Remember that no health claims for St. John's wort have been evaluated by the FDA.
Historical and Folkloric Use
The leaves and flowers of St. John's wort contain special glands that release a red oil when pinched. Early Christians named the plant in honor of John the Baptist because it released its blood-red oil around August 29, the anniversary of the saint's beheading.
St. John's wort has been used in herbal medicine for more than 2,000 years. It has been primarily considered a wound treatment, but it's use as a treatment for depression dates back to the 16th century.
The Roman naturalist Pliny (A.D. 23 to 79) was among the first to recommend St. John's wort to treat snakebite and other wounds. His formula: soak the plant in wine and apply it to the wound. The first London Pharmacopoeia (1618) advised chopping St. John's wort flowers, immersing them in oil, and placing the mixture in the sun for three weeks. The resulting tincture was a standard treatment for wounds and bruises for more than 100 years. During the American Civil War, botanical medicine authority Charles Millspaugh, M.D., touted St. John's wort's value as a wound treatment: "Lacerations of parts rich in nerves yield nicely to this drug."
The Greeks and Roman also believed that St. John's protected against witches' spells. Christians adopted the pagan belief that St. John's wort repelled evil spirits, and they burned the herb in bonfires on St. John's Eve, June 23, to purify the air, drive away evil spirits, and ensure healthy crops. This poem from around 1400 summed up the popular view: St. John's wort doth charm all witches away/ If gathered at midnight on the saint's holy day. In the Middle Ages, mental illness was often blamed on witchcraft, so it appears that the herb's use against witches led to its use, starting 500 years ago, as a treatment for "melancholia and illnesses of the imagination" -- in other words, depression.
Starting in the late 19th century, St. John's wort fell from favor as a wound treatment because "old school" herbalists and physicians who used herbs were supplanted by university trained, "new school" doctors, who preferred laboratory-synthesized pharmaceuticals. The arrival of antibiotics signaled the end of St. John's wort as a wound treatment.
But quietly, herbalists continued to use St. John's wort as antidepressant, as evidenced by a medical journal report from 1939. Today, St. John's wort is rarely used to treat wounds, but widely used to treat depression.
Dosage and Administration
St. John's wort can be found in numerous forms:
- Capsules and tablets
- Teas
- Liquid extracts
- Infused oils
- Oils (external use)
- Ointments and creams (external use)
- Dried leaves and flowers
All are available commercially, but you can also make your own concoctions:
Tea: simmer one to two teaspoons of dried St. John's wort with one cup of boiling water for 15 minutes. Drink up to three cups daily.
Infused oils: steep St. John's wort in almond or olive oil for approximately six weeks, until the oil turns bright red.. Apply to minor skin wounds.
Tinctures: add one-half teaspoon of St. John's wort to eight ounces of water. Drink this concoction three times per day.
Ointments and creams: heat the leaves in either hot petroleum jelly or beeswax mixed with almond oil. Apply the ointment onto the affected areas.
Storage
Keep all forms of St. John's wort in cool, dry areas.
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How to Use St. John's Wort Safely
Follow package directions. Do not exceed label dosage.
St. John's Wort is unlikely to cause adverse reactions at recommended dosages. However, abdominal upset, allergic reactions, fatigue, and restlessness are possible. If side effects become significant, stop using St. John's Wort.
In livestock, St. John's Wort may cause skin sensitivity to sunlight. To date, this has not been reported in people. But if you have fair skin and burn easily, be aware of this possibility and take precautions against over-exposure to sunlight. In addition, some experts report that the sun in combination with St. John's Wort can activate a substance called hypericin, which can damage proteins in the eyes when they're exposed to bright light.
A new 1999 study suggests that St. John's Wort may interact with Lanoxin, a drug used in treatment of congestive heart failure, and possibly reduce the drug's effectiveness.
In addition, the U.S. Food and Drug Administration (FDA) has issued a bulletin warning about such drug interactions. Besides certain drugs used to treat congestive heart failure, according to the FDA, studies have also shown that St. John's Wort may lessen the effectiveness of some AIDS/HIV antiviral medications. Specifically, these drugs include the protease inhibitors (PIs) and possibly the non-nucleoside reverse transcriptase inhibitors (NNRTIs).
It is strongly recommended that you discuss the use of St. John's Wort with your doctor first if you are taking these kinds of medications.
Do not take St. John's Wort if you are already taking antidepressant medication or other psychiatric medication. If you'd like to switch from a pharmaceutical medication to St. John's Wort, ask your doctor to help you make the transition.
If you are pregnant or nursing, consult a physician before using St. John's Wort.
If you are a parent interested in giving St. John's Wort to a child or teen, consult a physician first.
Contact your doctor if, after two to three weeks of continuous use, you feel no significant benefit has occurred.
Possible Side Effects
- Headaches
- Stomach irritation
- Nausea
- Vomiting
- Photosensitivity, which may lead to sunburned skin or possible eye damage
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Sources & Further Reading
Books
1. American Botanical Council. The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council/Integrative Medicine Comunications, Boston, 1998.
2. Duke, J. The Green Pharmacy. Rodale Press, Emmaus, PA. 1997.
3. Castleman. M. The Healing Herbs. Rodale Press, Emmaus, PA. 1991.
4. Tyler, V. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Pharmaceutical Products Press/Hawthorn Press, NY. 1994.
5. Weiner, M. and J. Weiner. Herbs That Heal: Prescription for Herbal Healing. Quantum Books, Mill Valley, CA. 1994.
6. Werbach, M. and M. Murray.Botanical Influences on Illness. Third Line Press, Tarzana, CA 1994.
Find more books on health and wellness at  barnesandnoble.com.
Articles
1. Anon. "St. John's Wort," The Review of Natural Products, 11-97.
2. Lieberman, S. "Treating Depression with St. John's Wort," Alternative & Complementary Therapies, 6-98.
3. Linde, K. et al. "Meta-Analysis of Clinical Trials of St. John's Wort for Depression," British Medical Journal (1996) 313:253.
4. Sherman, C. "St. John's Wort Used In Severe Depression," Family Practice News, 4-1-5-98.
5. Sommer, H. et al. "Placebo-Controlled Double-Blind Study Examining the Effectiveness of a Hypericum Preparation in 105 Mildly Depressed Patients," J. of Geriatric Psychiatry and Neurology (1994) 7(Suppl. 1):S9.
6. Vorbach, E.U. et al. "Efficacy and Tolerability of St. John's Wort Extract vs. Imipramine in Patients with Depressive Episodes," Pharmacopsychiatry (1997) 30(Suppl):81.
7. Weil, A. Andrew Weil's Self-Healing Newsletter, 7-97.
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