St. John's Wort
What is it? Overview Usage Side Effects and Warnings
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St. John's Wort Usage

Written by FoundHealth.

Usages

Effect of St. John's Wort on Depression

St. John’s Wort works as a monoamine (MAO) inhibitor, preventing MAOs from breaking down certain neurotransmitters in the brain. Therefore, it increases the amount and time of mood elevating...

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Effect of St. John's Wort on Fibromyalgia

St. John's wort may be helpful for fibromyalgia because it relieves depression and promotes restful sleep. St John's wort has been used as a herbal remedy for various health problems for...

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Effect of St. John's Wort on Low Back Pain and Sciatica

St. John's Wort, though most commonly known as a popular treatment for depression, acts as a "tonic" for regenerating nerve tissue, which can help in the treatment of sciatica and/or other forms...

Read more about Low Back Pain and Sciatica and St. John's Wort.

Effect of St. John's Wort on Bipolar Disorder

St. John's Wort is quite possibly the most commonly prescribed herb for the treatment of depression. Since depression is one major component of bipolar disorder, St. John's Wort might be recommended...

Read more about Bipolar Disorder and St. John's Wort.

What Is St. John's Wort Used for Today?

Today, St. John's wort is a widely used treatment for depression in Germany, other parts of Europe, and the United States. The evidence-base for its use approaches that of many modern prescription drugs at the time of their first approval.

Most studies of St. John's wort have evaluated individuals with major depression of mild to moderate intensity. This contradictory-sounding language indicates that the level of depression is more severe than simply feeling "blue." However, it is not as severe as the most severe forms of depression. Typical symptoms include depressed mood, lack of energy, sleep problems, anxiety, appetite disturbance, difficulty concentrating, and poor stress tolerance. Irritability can also be a sign of depression.

Taken as a whole, research suggests that St. John's wort is more effective than placebo and approximately as effective as standard drugs. Furthermore, St. John's wort appears to cause fewer side effects than many antidepressants. However, the herb does present one significant safety risk: it interacts harmfully with a great many standard medications. (See Safety Issues for details.)

St. John’s wort has also shown promise for treatment of severe major depression. 1 Note: St. John's wort alone should never be relied on for the treatment of severe depression. If you or a loved one feels suicidal, unable to cope with daily life, paralyzed by anxiety, incapable of getting out of bed, unable to sleep, or uninterested in eating, see a physician at once. Professional care may be lifesaving.

Besides depression, St. John’s wort has also been tried for many other conditions in which prescription antidepressants are thought useful, such as attention deficit disorder , 2 anxiety , insomnia , 3 menopausal symptoms , 4 premenstrual syndrome (PMS) , 5 seasonal affective disorder (SAD) , 6 and social phobia. 7 However, there is as yet no convincing evidence that it offers any benefit for these conditions. One substantial double-blind study did find St. John's wort potentially helpful for somatoform disorders (commonly called psychosomatic illnesses). 8 Standard antidepressants are also often used for diabetic neuropathy and other forms of neuropathy (nerve pain). However, a small double-blind, placebo-controlled trial failed to find St. John's wort effective for this purpose. 9 Another study failed to find St. John's wort helpful for obsessive-compulsive disorder. 10 St. John’s wort contains, among other ingredients, the substances hypericin and hyperforin. Early reports suggested that St. John's wort or synthetic hypericin might be useful against viruses such as HIV , but these haven't panned out. 11 However, there is some evidence hyperforin may be able to fight certain bacteria, including some that are resistant to antibiotics. 12 Note: This evidence is far too preliminary to count St. John's wort as an effective antibiotic.

Based on weak evidence that hypericin might have anti-inflammatory properties, St. John’s wort cream has been tried as a treatment for eczema , with some promising results. 13 One interesting double-blind study evaluated a combination therapy containing St. John's wort and black cohosh in 301 women with general menopausal symptoms as well as depression. 14 The results showed that use of the combination treatment was significantly more effective than placebo for both problems.

In a small placebo-controlled trial, hypericin extract showed no benefit for burning mouth syndrome , a poorly understood condition in which a person experiences ongoing moderate to severe pain in the tongue and/or mouth. 15

References

  1. Szegedi A, Kohnen R, Dienel A, Kieser M. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine. BMJ. 330(7490):503.
  2. Weber W, Vander Stoep A, McCarty RL, Weiss NS, Biederman J, McClellan J. Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children and adolescents: a randomized controlled trial. JAMA. 299(22):2633-41.
  3. Schulz H, Jobert M. The influence of hypericum extract on the sleep EEG in older volunteers [in German; English abstract]. Nervenheilkunde. 1993;12:323-327.
  4. Grube B, Walper A, Wheatley D. St. John's Wort extract: efficacy for menopausal symptoms of psychological origin. Adv Ther. 16(4):177-86.
  5. Stevinson C, Ernst E. A pilot study of Hypericum perforatum for the treatment of premenstrual syndrome. BJOG. 2000;107:870-876.
  6. Martinez B, Kasper S, Ruhrmann S, et al. Hypericum in the treatment of seasonal affective disorders. J Geriatr Psychiatr Neurol. 1994;7(Suppl 1):S29-S33.
  7. Kobak KA, Taylor LV, Warner G, Futterer R. St. John's wort versus placebo in social phobia: results from a placebo-controlled pilot study. J Clin Psychopharmacol. 25(1):51-8.
  8. Müller T, Mannel M, Murck H, Rahlfs VW. Treatment of somatoform disorders with St. John's wort: a randomized, double-blind and placebo-controlled trial. Psychosom Med. 66(4):538-47.
  9. Sindrup SH, Madsen C, Bach FW, Gram LF, Jensen TS. St. John's wort has no effect on pain in polyneuropathy. Pain. 91(3):361-5.
  10. Kobak KA, Taylor LV, Bystritsky A, Kohlenberg CJ, Greist JH, Tucker P, Warner G, Futterer R, Vapnik T. St John's wort versus placebo in obsessive-compulsive disorder: results from a double-blind study. Int Clin Psychopharmacol. 20(6):299-304.
  11. Gulick RM, McAuliffe V, Holden-Wiltse J, Crumpacker C, Liebes L, Stein DS, Meehan P, Hussey S, Forcht J, Valentine FT. Phase I studies of hypericin, the active compound in St. John's Wort, as an antiretroviral agent in HIV-infected adults. AIDS Clinical Trials Group Protocols 150 and 258. Ann Intern Med. 130(6):510-4.
  12. Schempp CM, Pelz K, Wittmer A, Schöpf E, Simon JC. Antibacterial activity of hyperforin from St John's wort, against multiresistant Staphylococcus aureus and gram-positive bacteria. Lancet. 353(9170):2129.
  13. Schempp M, Hezel S, Simon C. Topical treatment of Atopic dermatitis with Hypericum creamA randomised, placebo-controlled, double-blind half-side comparison study. Hautarzt. 2003;54:248-253.
  14. Uebelhack R, Blohmer JU, Graubaum HJ, Busch R, Gruenwald J, Wernecke KD. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol. 107(2 Pt 1):247-55.
  15. Sardella A, Lodi G, Demarosi F, Tarozzi M, Canegallo L, Carrassi A. Hypericum perforatum extract in burning mouth syndrome: a randomized placebo-controlled study. J Oral Pathol Med. 37(7):395-401.
 
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