Saint Johns Wort
Hypericum perforatum L. St. John’s Wort
Family: Guttiferae
Description: “Upright rhizomatous perennial, woody at the base, with blunt, linear-ovate leaves [with ‘perforated’ appearance when held to light]. Yellow, 5-petalled, gland-dotted flowers, 2cm across appear in summer. H 30-60cm, S 15-45cm.” Bown, 1995: 141.
Habitat: Light sandy or gravelly soil, preferably in sun; native to uncultivated ground, roadsides, woods, meadows and hedgerows in Europe and temperate Asia; ‘weed’ under statutory control in Canada and Australia.
Harvest: Between woody-stem and newer growth as flowering begins; may then get second growth. [AD]
Parts used: Aerial parts; flowering tops for ‘oil’ and cream;
Dosage: 1:5 2-4ml, FE 1-2ml, dried 2-4g daily;
Actions:
-ANTI-VIRAL,
-NERVINE,
-ANTI-DEPRESSANT,
-VULNERARY,
-ANTISEPTIC, (Mills and Bone, 2000);
-ANALGESIC (Mills, 1993);
Indications:
-“bruising to nervous system”; [AD questionnaire]
-Physiological afflictions of NS: spinal injuries, neuralgia, sciatica, ME [AD];
-Muscular rheumatism;
-Mild psychological disorders: excitability, menopausal anxiety and nervousness;
-Mild to moderate depression*; in combination for severe depression;
-SAD in addition to light therapy*;
-Menopause*;
-Aerobic endurance in athletes*;
-Treatment and prevention of acute and chronic infections caused by enveloped viruses, eg. cold sores, shingles**;
-Conditions requiring increased nocturnal melatonin levels, eg. circadium rhythm-associated sleep disorders**; alcoholism**; potential anti-cancer treatment**; (Mills and Bone, 2000)
External usage: Ointment and infused oil for the treatment of wounds, bruises and shingles (Mills and Bone, 2000). AD recommends infusion better for burns as oils tend to be ‘heating’.
Safety: Relatively safe, AD suggests good for treating nervous disorders in children.
Studies have shown fewer side effects in treatments in place of tricyclic anti-depressants, especially in elderly patients or those with pre-existing heart conditions. Also cannot be used to overdose.
Adverse effects with recommended dose are rare but should be used with caution following any signs indicating potential allergic reaction and with those with known photosensitivity; avoidance of excessive sunlight is advisable while taking high doses. (Mills and Bone)
Alison Broughton (see below) reports that most frequently noted side-effects were gastrointestinal irritation (0.6%), allergic reaction (0.5%), tiredness (0.4%) and restlessness (0.3%).
Contra-indications: Use during pregnancy and lactation not recommended “without professional advice”. Not suitable for treating severe depression (Mills andBone);
Interactions: Caution should always be exercised if patients already on orthodox medication and those prescribed should be monitored for any symptoms of serotonin syndrome, such as confusion, fever, shivering, muscle spasms. (Mills and Bone) Interaction with selective serotonin reuptake inhibitors, such as PROZAC, may produce too “speedy” effect.
Some studies indicate that it may lead to speeding up of liver metabolism via cytochrome P450 enzymes and may therefore affect the efficacy of other drugs. Of particular note are: CYCLOSPORINS (do not prescribe), AIDS drugs (avoid prescribing until further research), THEOPHYLLINE, CONTRACEPTIVE PILL and DIJOXIN. The latter should be safe as long as blood levels have been monitored on a regular basis. Re the Pill, while there have been very few indeed incidences of some breakthrough bleeding, no pregnancies have been reported. [AD]
People over-70 are at particular risk of drug interaction because of reduced metabolic capacity, reduced glomerular filtration rate and poor diet. For further details, see Broughton and Denham: Hypericum and drug interactions, EJHM vol 5, issue 2.
Key Constituents (Mills and Bone):
-NAPTHODIANTHRONES, 0.05-0.6% (usually up to 0.2%), including hypericin and pseudohypericin,
-Flavonoids,
-Phenolics, including hyperforin,
-Procyanidins,
-Essential oil;
Pharmacology: Collectively the napthodianthrones, hypericin and pseudohypericin, are known as ‘total hypericin’ (TH) and are responsible for the red colour of the extracts. They show restricted solubility in most solvents, but more than 40% is extractable from the crude herb when preparing a tea with water at 60-80 degrees. This increase in solubility suggests the possible presence of factors in the herb which modify the solubility of napthodianthrones.
The hypericins have been the focus of most anti-depressant research, exhibiting monoamine oxidase inhibition, inhibition of catechol-O-methyl transferase and selective inhibition of serotonin uptake at post-synaptic receptors. The flavonoid amentoflavone may also account for some antidepressant and sedative action as when isolated it has been shown to bind in vitro to the brain benzodiazepine receptors, with a similar but weaker action as diazepam. (Alison Broughton: The sunshine herb, EJHM: vol 4, issue 3)
Hyperforin exhibits potent antimicrobial activity and was attributed to the herb’s vulnerary activity. However, studies in vitro demonstrate it is also an active re-uptake inhibitor of serotonin, dopamine, noradrenaline and gamma-aminobutyric acid [a naturally occurring tranquilizer]. (Broughton) All this would suggest that it is the synergy of the total constituents that is responsible for the herbs potency, rather than any one in isolation.
A wide variety of studies have demonstrated its anti-viral and antidepressant activities; anti-tumour, antibacterial, ‘alcoholism-support’ and wound healing activities also shown. See Mills and Bone p543-546.
Clinical trials: Success has been had in treating the symptoms suffered by HIV-positive patients. In another trial, patients showed stable or increasing CD4 counts and a high resistance to infection. For further details, see Mills and Bone. This antiviral activity may also prove efficacious in treating ME and viral hepatitis.
Many trials have been conducted to investigate its antidepressant and anti-anxiety activity. Mills and Bone conclude that ‘hypericum is a well-tolerated and effective alternative to standard anti-depressants in the treatment of mild to moderate depression, particularly when side effects with the drugs become intolerable to the patient.’ Helmut Woelk’s study (AD handout 30.1.01) concludes similarly that it is therapeutically equivalent to imipramine (a TCA) in treating mild to moderate depression but patients tolerate hypericum better.
Toxicology: Has very low toxicity (Mills and Bone).
History: Common name derives from the herbs flowering on St John’s day in midsummer or Penelope Ody suggests from the Knights of St John of Jerusalem, who used it to treat wounds on Crusade battlefields. It was believed that it could ward away evil spirits which led it to being hung above doorways and is in accordance with the translation of the Greek ‘to overcome hyper the apparition ikon’. Matthew Wood asserts it is the plant of The Little People.
The chemical study of Hypericum began in 1830 with the isolation of hypericin by Bucher, who named the compound hypericum red (Broughton).
Traditional and Practitioner sources:
“Use the infusion for anxiety, nervous tension, irritability or emotional upsets, especially if associated with the menopause or PMS.
Take the tincture for at least 2 months for longstanding nervous tension leading to exhaustion and depression. For childhood bedwetting, give 5-10 drops at night.” Penelope Ody, 1993: 68
“The indications for this plant are when there is nervous over-stimulation or excitation which may also involve pain, inflammation, etc., with the evidence of such trauma on the skin.” Dorothy Hall, 1998: 267
“ANTI-INFLAMMATORY AND TISSUE HEALER; RELAXING RESTORATIVE;
…for the treatment of a number of conditions where tension and exhaustion combine. St John’s Wort has aspecific application for…the symptoms of menopausal syndrome, the hot flushes, night sweats, depression, fatigue, irritability , lack of concentration, fluid retention and so on, were recognised as symptoms of debility long before a hormonal factor was implicated. The modern practitioner still finds advantage in treating menopausal problems primarily as symptoms of depletion, requiring restorative and convalescent measures. St John’s wort seems to have an ideal balance of qualities for this task: it is even felt by many of those who use it to have a hormonal influence as well.” Simon Mills, 1993: 513
“Sedative nervine for muscular twitching and chloreiform movements -especially indicated for nerve injuries to the extremities and teeth/ gums. Promotes elimination of catabolic waste products.
Individual indications:
-Painful injuries to sacral spine and coccyx. Traumatic shock.
-Haemorrhoids with pain/bleeding.
-Facial neuralgia after dental extractions, toothache -massage face with diluted oil.
-Neurasthenia, chorea, depression.” Priest and Priest, 1983:80
“The neurophysiology of hunger and satiety is complex. The hypothalamus has appetite receptors that specifically react to hunger signals conveyed by neurotransmitters. Serotonin has been demonstrated to produce a feeling of fullness. High amounts of dopamine inhibit feelings of hunger. Low levels of serotonin and dopamine stimulate appetite and eating. Since Hypericum can enhance serotonin and dopamine activity, it may help normalise the brain biochemistry of some people who overeat.” Dr Harold Bloomfield, 1998: 90
“St John’s wort gets people on the high road to health by improving assimilation of food, and this promotes tissue cleansing. It is more of a tonic than a cleanser, but it is the appropriate cleanser when the patient is too weak to bear stronger medicines. It decongests the liver and removes mild tension that accompanies this. It harmonises the stomach, spleen, pancreas, liver and gallbladder, so that weak digestive organs are not pushed over by a too-strong action of the liver.” Herbalist Fred Siciliano quoted by Matthew Wood, 1997:313