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St John's Wort
- Natures Miracle or Marketing Exercise

Over the past year or so, we have been asked many questions about the herb Saint John's Wort. Many people have tried this as an alternative to conventional antidepressants. Certainly, as alternative remedies are now actively being promoted in the media, we need to assess and gather all the information we can to make an informed decision. We have reviewed a great deal of the published material on this herb and leave it to you to make a decision based on your own specific situation.

SAINT JOHNS WORT (Hypericum perforatum) has been used as a medicinal herb since ancient times.

The word "hypericum" is derived from the Greek and translates to "above" and "icon". This was descriptive of St Johns Wort's use as a protection or shield against evil spirits. Hippocrates, in his time, used to prescribe Hypericum as a medicine for people.

The herb is called "St. John's wort" because the flower produced on the plant blooms around St. John's Day (June 24) in the northern hemisphere. Also, it was because when pressure is applied on the buds and flowers, a red pigment oozes out which was associated then with the St. John the Baptist's blood. St. John's wort can been seen in many parts of the world, including Europe, North America, Australia and Africa. In fact, this plant that has become a weed in some areas is now being seen as the next cash crop.

The flowers of St. John's wort bloom from November to February (Southern Hemisphere). They are yellow in color and have little black specks.

The ancient use of St. John's wort was mainly as a part of spiritual ritual to shield from spirits. In the more recent dark age and medieval texts, its benefit as a medicine were cited.

In the United States, the earliest recorded mention of St. John's wort may have been by Griffith (1847), who stated that the herb can be taken as an oil or ointment for ulcers, tumors and as a diuretic. Generally, St. John's wort has been used for ailments such as nervous disorders, depression, neuralgia, kidney problems and wounds and burns. (1)

The main component of St Johns Wort is hypericin. This is the component most referred to by the herbalists and in promotion in the media. There are, however, a number of other compounds with reported medicinal/ biological activity. These include xanthones, flavonoids, carotenoids, and phloroglucinol derivatives. The number of compounds in St. John's wort's may help to explain the diversity of its medicinal uses such as:

• Treatment for wounds.
• Anti-viral medicine eg. herpes simplex types 1 and 2, influenza.
• Antidepressant

As we are all aware, the most prominent promotion of St John's wort is as an antidepressant. In Germany, it is claimed that more than 50% of depression, anxiety, and sleep disorders are treated with hypericum. Only 2% are treated with Prozac. These are interesting figures. Certainly this would demonstrate the effectiveness of hypericum as an alternative to conventional prescribed antidepressants. But, as with all products that are promoted for a specific purpose, we need to look at the "proof" over a large population base. That is, what do the researchers say. Studies, mostly conducted in Germany, have found that St. John's wort reduces feelings of depression, anxiety, apathy and worthlessness. Researchers are not totally sure how St. John's wort chemically acts on the brain as a treatment for depression (perhaps via the serotonin).

St. John's wort appears to be most effective for mild to
moderate depression rather than for severe depression.

What do the Researchers say ...?

We will review some of the data available. It is important to know before we take something that it is all that people claim it is. Certainly, due to the added media coverage of this herb and it's increasing popularity, there are researchers in the USA taking a more intense interest in it. For instance, the National Institutes of Health (NIH) recently launched the first U.S. clinical trial of St. John's wort.

Previous studies on St. John's wort include:

Until there is more research into the effectiveness, the side effects and other aspects related to taking St Johns wort, people should take care about if and how they take St Johns wort.

Don't use it if you are already on a standard antidepressant,
and certainly consult your doctor before taking it.

What are the Effects of St John's Wort?

Individuals on St. John's wort have noticed the following positive benefits:

• Improvement in mood with a sense of wellbeing
• More alertness and energy
• Feelings of procrastination are gone. There is motivation to get things done, such as work projects, house cleaning, etc.
• A greater interest in being social and interacting with friends, going to parties, and meeting new people.

Side effects reported:

• Overalertness, restlessness, and insomnia can occur.
• Another known potential side-effect of St. John's wort is that it may cause phototoxicity in fair-skinned people, and it therefore may be prudent for these people not to expose themselves to strong sunlight when taking the herb. Photosensitization has occurred in the form of toxic skin reactions in grazing animals who have ingested large amounts of St. John's wort. There is at least one reported case of a woman experiencing a similar reaction after taking St. John's wort extract for three years. So it would be prudent to wear protective clothing or a sunscreen before exposure to the sun or ultraviolet lamps.
• Fatigue
• Stomach upset, and
• Allergic reactions (by many of our clients)

Other possible long-term adverse effects are not known. .

It may take up to six weeks to see results after beginning to use St John's Wort.

No studies have examined the long-term effects of using the herb. Medical consequences of long-term use are currently not known. We recommend individuals be supervised by a health care practitioner while taking St. John's wort. Until more information is available, use of this herb should be limited to six months. (10)

Factors to Consider

It is clear that more research is needed before we fully understand how this herb works.

There are many people who may feel that St John's Wort may be of benefit to them. However, there are certain factors that need to be considered. Most importantly, if you are already taking an antidepressant, it is absolutely important that you consult with your doctor about your decision.

It is not a matter of switching one for the other. You must be under medical supervision when tapering off from a conventional prescribed antidepressant. Also, there is no research on the best way to change from using a conventional antidepressant to St Johns wort. This is why is it very important to keep your doctor in the picture. If this doctor prescribed the antidepressant, they will (hopefully) have the required knowledge in how to taper you off the antidepressant and to determine the period afterward that it may be safe to begin taking St John's wort.

The other point, it is important to consult your doctor for such a move, regardless of whether you take an antidepressant or not. This way, your doctor is informed and can note this in your medical records. They can review possible interaction with other medication you may be currently taking. If problems arise later, this is a factor that can be added into the equation of the whats and hows. Some people we have had contact with have had side-effects from taking St Johns wort that were rather disconcerting. If their doctor had not known they were using St Johns wort, then the doctor is led on a wild goose chase looking for the possible causes of their side-effect symptoms.

The other factor to remember, if St. John's wort is combined with the wrong drug, there can be negative consequences.

Also, St. John's wort is not recommended as the sole treatment in major depression. It is only used for mild to moderate depression.

My final note: If you begin to take St John's wort, make sure you inform your doctor. If you experience any symptoms or side-effects after beginning to take St John's Wort, then report back to your doctor. They may be able to ascertain the cause of the symptoms - St John's Wort or other causes?

What to look for when purchasing St John's Wort?

St. John's Wort is officially classified as a dietary supplement. It is not regulated.

You can buy it almost anywhere without a prescription and there is no standard pill or dose. Some may include hypericin as the active ingredient; some may not. Some may include other supplements, like ginkgo biloba or kava kava.

It is important to look for a product that is by a reputable manufacturer.

The catch with St. John's Wort is that it can probably be used to treat mild to moderate depression. But you can get the same results with regular exercise, meditation, therapy or psychotherapy. And then you wouldn't have to take a pill at all...

More information--Read all about it

Upton R, et al. St. John's Wort (Hypericum Perforatum): Quality Control, Analytical and Therapeutic Monograph. Santa Cruz, CA: American Herbal Pharmacopeja, 1997. p. 4.

Hobbs, C. "St John's wort: Hypericum Perforatum." HerbalGram. 18/19:24-33 (1989).

Pati K, Degidio A. Vitamin and Herbal Digest: Vitamins, Herbs & Supplements.. Burlingame,

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