St. John's wort (Hypericum perforatum L.)
Original Article: http://www.mayoclinic.com/health/st-johns-wort/NS_patient-stjohnswort
Extracts of Hypericum perforatum L. (St. John's wort) have been recommended traditionally for a wide range of medical conditions. The most common modern-day use of St. John's wort is the treatment of depression. Numerous studies report St. John's wort to be more effective than placebo and equally effective as tricyclic antidepressant drugs in the short-term treatment of mild-to-moderate major depression (1-3 months). It is not clear if St. John's wort is as effective as selective serotonin reuptake inhibitor (SSRI) antidepressants such as sertraline (Zoloft®).
Recently, controversy has been raised by two high-quality trials of St. John's wort for major depression that did not show any benefits. However, due to problems with the designs of these studies, they cannot be considered definitive. Overall, the scientific evidence supports the effectiveness of St. John's wort in mild-to-moderate major depression. The evidence in severe major depression remains unclear.
St. John's wort can cause many serious interactions with prescription drugs, herbs, or supplements. Therefore, people using any medications should consult their healthcare providers including their pharmacist prior to starting therapy.
Amber touch-and-heal, balm-of-warrior's wound, balsana, bassant, Blutkraut, bossant, Calmigen®, corancillo dendlu, devil's scorge, Eisenblut, flor de São João, fuga daemonum, goatweed hartheu, heofarigo on, herba de millepertius, herba hyperici, herrgottsblut, hexenkraut, hierba de San Juan, hipericão, hipérico, hipericon, HP, isorhamnetin, Jarsin, Johanniskraut, klammath weed, Liebeskraut LI 160, lord God's wonder plant, millepertius pelicao, perforate, pinillo de oro, PM235, pseudohypericin, rosin rose, SJW extract LI 160, St. John's wort WS 5572, STW 3-VI, tenturotou, Teufelsflucht, touch and heal, Walpurgiskraut (German), witcher's herb, WS 5572.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Depressive disorder (mild-to-moderate)St. John's wort has been extensively studied in Europe over the last two decades, with more recent research in the United States. Short-term studies (1-3 months) suggest that St. John's wort is more effective than placebo (sugar pill), and equally effective as tricyclic antidepressants (TCAs) in the treatment of mild-to-moderate major depression. Comparisons to the more commonly prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac®) or sertraline (Zoloft®), are more limited. However, other data suggest that St. John's wort may be just as effective as SSRIs with fewer side effects. Safety concerns exist as with most conventional and complementary therapies.
Somatoform disordersSomatoform disorders show physical symptoms that cannot be attributed to organic disease and appear to be of psychic origin. Early evidence shows that St. John's wort may help with somatoform disorders. Further research is needed to confirm these results.
Anxiety disorderOverall, there is currently not enough evidence to recommend St. John's wort for the primary treatment of anxiety disorders.
Atopic dermatitisEarly study of hypericum-cream in the topical treatment of mild to moderate atopic dermatitis shows positive results. Further studies are needed before a firm recommendation can be made.
Attention deficit hyperactivity disorder (ADHD) (children)It is unclear whether St. John's wort is an effective treatment in children with ADHD. More study is needed to confirm these findings.
Depression (children)There is not enough evidence to determine if St. John's wort is an effective treatment for depression in children younger than 18 years of age.
Nerve painEarly study shows that St. John's wort may help neuropathic (nerve) pain. Further research is needed to confirm these results.
Obsessive-compulsive disorder (OCD)There are a few reported cases of possible benefits of St. John's wort in patients with obsessive-compulsive disorder (OCD). Currently there is not enough scientific evidence to recommend St. John's wort for this condition.
Pain (burning mouth syndrome)It is unclear whether St. John's wort is an effective treatment for pain associated with burning mouth syndrome. More study is needed.
Pain relief (after surgery)It is unclear whether St. John's wort is an effective treatment for pain after surgery. More study is needed.
Peri-menopausal symptomsThere is currently not enough scientific evidence to recommend St. John's wort for this indication.
Premenstrual syndrome (PMS)Further studies are needed before a strong recommendation can be made.
Seasonal affective disorder (SAD)Despite some promising early data, there is currently not enough evidence to recommend St. John's wort for depressive disorder with seasonal pattern or Seasonal Affective Disorder (SAD).
Social phobiaResults of early study on the efficacy of St. John's wort in social phobia are unclear. More study is needed.
Depressive disorder (severe)Studies of St. John's wort for severe depression have not provided clear evidence of effectiveness.
Human immunodeficiency virus (HIV)Anti-viral effects of St. John's wort have been observed in laboratory studies, but were not found in one human study. Multiple reports of significant adverse effects and interactions with drugs used for HIV/AIDS, including protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), suggest that patients being treated for HIV/AIDS should avoid this herb. Therefore, there is evidence to recommend against using St. John's wort in the treatment of patients with HIV/AIDS.
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Abdominal discomfort or irritation, abrasions (topical), alcoholism, allergies, anti-inflammatory, anti-malarial, antioxidant, antiviral, asthma, athletic performance enhancement, bacterial skin infections (topical), bedwetting, benzodiazepine withdrawal, bruises (topical), burns (topical), cancer, chronic bowel irritation, chronic ear infections, colitis, contusions, dental pain, diarrhea, diuretic (increasing urine flow), dyspepsia, Epstein-Barr virus infection, fatigue, glioma (brain tumor), heartburn, hemorrhoids, herpes virus infection, hypnotic, immune function, influenza, insomnia, joint pain, liver protection from toxins, malaria treatment, menstrual pain, mood disorders (menopause), nicotine withdrawal, rheumatism, skin scrapes, sleep, snakebites, sprains, substance abuse, ulcers, weight loss, wound healing (topical).
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (over 18 years old)
Clinical trials have used a range of doses, including 0.17-2.7 milligrams of hypericin by mouth, and 900-1,800 milligrams of St. John's wort extract daily by mouth.
1.5% hyperforin (verum) has been applied to the skin for the treatment of atopic dermatitis.
Children (under 18 years old)
Clinical trials have used 150-1,800 milligrams of St. John's wort extract daily by mouth with good tolerability.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Infrequent allergic skin reactions, including rash and itching, are reported in human studies.
Side Effects and Warnings
In published studies, St. John's wort has generally been well tolerated at recommended doses for up to 1-3 months. The most common adverse effects include gastrointestinal upset, skin reactions, fatigue/sedation, restlessness or anxiety, sexual dysfunction (including impotence), sensitivity to light, dizziness, headache, and dry mouth. Several recent studies suggest that side effects occur in one to three percent of patients taking St. John's wort, and that the number of adverse events may be similar to placebo (and less than standard antidepressant drugs). Animal toxicity studies have found only non-specific symptoms such as weight loss. One small study reported elevated thyroid stimulating hormone (TSH) levels to be associated with taking St. John's wort.
It has been reported that St. John's wort may cause psychiatric symptoms such as suicidal and homicidal thoughts.
Delayed ejaculation has been reported in animal studies.
Pregnancy and Breastfeeding
There is not enough scientific evidence available to recommend use during pregnancy or breastfeeding.
This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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