St. John's Wort
St. John's wort
Description
Hypericum perforatum is the most medicinally important species of the Hypericum genus, commonly known as St. John's wort or Klamath weed. There are as many as 400 species in the genus, which belongs to the Clusiaceae family. Native to Europe, St. John's wort is found throughout the world. It thrives in sunny fields, open woods, and gravelly roadsides. Early colonists brought this plant to North America, and it has become naturalized in the eastern United States and California, as well as in Australia, New Zealand, eastern Asia, and South America. As of 2004, St. John's wort is one of the most commonly used herbs in the United States, especially among women.
The entire plant, particularly its round black seeds, exudes a slight turpentine-like odor. The woody-branched root spreads from the base with runners that produce numerous stalks. The simple dark green leaves are veined and grow in opposite, oblong, or oval pairs on round branching stalks that reach as high as 3 ft (91.4 cm). Tiny holes, visible when the leaf is held to the light, are actually transparent oil glands containing a chemical known as hypericin. These characteristic holes inspired the species name, Perforatum, which is the Latin word for "perforated." The bright yellow star-shaped flowers, often clustered in groups of three, have five petals. Black dots along the margins of the blossom contain more hypericin. The flowers bloom in branching flat-topped clusters atop the stalks, around the time of the summer solstice. St. John's wort, sometimes called devil's flight or grace of God, was believed to contain magical properties that ward off evil spirits. Its generic name, Hypericum, is derived from a Greek word meaning "over an apparition." The herb was traditionally gathered on midsummer's eve, June 23. This date was later celebrated in the Christian Church as the eve of the feast day of St. John the Baptist. This folk custom gave the plant its popular name. The Anglo-Saxon word "wort" means "medicinal herb."
General use
St. John's wort has been known for its medicinal properties as far back as Roman times. On the battlefield, it was a valued remedy that promoted healing from trauma and inflammation. The herb is regarded as a vulnerary, and can speed the healing of wounds, bruises , ulcers, and burns . It is also popularly used as a nervine for its calming effect, easing tension and anxiety , relieving mild depression , and soothing women's mood swings during menopause . The bittersweet herb is licensed in Germany for use in mild depression, anxiety, and sleeplessness. It is said to be helpful in nerve injury and trauma, and was used in the past to speed healing after brain surgery. Its antispasmodic properties have been thought to ease uterine cramping and menstrual difficulties. St. John's wort may also be used as an expectorant.
The hypericin in St. John's wort possesses antiviral properties that are said to be effective against certain cancers. An infusion of the plant taken as a tea has been helpful in treating bedwetting in children. The oil has been used internally to treat colic , intestinal worms , and abdominal pain . The plant's medicinal parts are its fresh leaves and flowers. This herbal remedy has been extensively tested in West Germany, and is dispensed throughout Germany as a popular medicine called Johanniskraut. Commercially prepared extracts are commonly standardized to contain 0.3% hypericin.
Clinical studies
In contrast to early European reports made in the 1980s, more recent clinical studies tend to undermine the
claims made for St. John's wort as a possible treatment for HIV infection and depression. As of 2002, health care professionals and regulatory agencies in Europe were advised to warn AIDS patients that St. John's wort decreases the effectiveness of drugs known as HIV protease inhibitors. In addition, the National Center for Complementary and Alternative Medicine (NCCAM) in the United States released the results of a large-scale multi-site study in April 2002, which reported that St. John's wort is no more effective than a placebo for treating major depression of moderate severity. The study was also published in the Journal of the American Medical Association. Additional studies being conducted in several countries are researching the interactions between St. John's wort and various types of prescription medications.
Preparations
An oil extract can be purchased commercially or prepared by combining fresh St. John's wort flowers and leaves in a glass jar with sunflower or olive oil. The container should be sealed with an airtight lid, and placed on a sunny windowsill for four to six weeks. It should be shaken daily. When the oil absorbs the red pigment, the mixture is strained through muslin or cheesecloth, and stored in a dark container. The medicinal oil maintains its potency for two years or more. The oil of St. John's wort has been known in folk culture as "Oil of Jesus." This oil forms a rub used for painful joints, varicose veins , muscle strain, arthritis, and rheumatism. Placed in a compress, it can help to heal wounds and inflammation, and relieve the pain of deep bruising.
An infusion is made by pouring one pint of boiling water over 1 oz (28 g) of dried herb, or 2 oz (57 g) of fresh, minced flower and leaf. It is steeped in a glass or enamel pot for five to 10 minutes, then strained and covered. The tea should be consumed while it is warm. A general dose is one cup, up to three times daily.
To prepare a capsule, the leaves and flowers are dried, and ground with a mortar and pestle into a fine powder. The mixture is then placed in gelatin capsules. The potency of the herb varies with the soil, climate, and harvesting conditions of the plant. A standardized extract of 0.3% hypericin extract, commercially prepared from a reputable source, is more likely to yield reliable results. Standard dosage is up to three 300 mg capsules of 0.3% standardized extract daily.
A tincture is prepared by combining one part fresh herb to three parts alcohol (50% alcohol/water solution) in a glass container. The mixture is placed in a dark place, and shaken daily for two weeks. Then it is strained through muslin or cheesecloth, and stored in a dark bottle. The tincture should maintain potency for two years. Standard dosage, unless otherwise prescribed, is 0.24–1 tsp added to 8 oz (227 g) of water, up to three times daily.
A salve can be made by warming 2 oz (57 g) of prepared oil extract in a double boiler. Once warmed, 1 oz (28 g) of grated beeswax is added and mixed until melted. The mixture is poured into a glass jar and allowed to cool. The salve can be stored for up to one year. The remedy keeps best if refrigerated after preparation. The salve is useful in treating burns, wounds, and soothing painful muscles. It is also a good skin softener. St. John's wort salve may be prepared in combination with calendula extract (Calendula officinalis ) for application on bruises.
Precautions
There are a number of important precautions to observe in using St. John's wort. Pregnant or lactating women should not use the herb at all. Persons taking prescription antidepressants of any kind should not use St. John's wort at the same time, as the herb may precipitate a health crisis known as serotonin syndrome. Serotonin syndrome is potentially life-threatening, and is characterized by changes in level of consciousness, behavior, and neuromotor functioning as a result of increased levels of the neurotransmitter serotonin in the central nervous system. Drug interactions are the most common cause of serotonin syndrome. Several cases of serotonin syndrome have been reported in patients who were taking St. John's wort by itself or in combination with SSRIs, fenfluramine (Pondimin), or nefazodone (Serzone). Persons using the herb should discontinue it a minimum of two weeks prior to any surgery requiring general anesthesia, as it interacts with a number of intravenous and inhaled anesthetics.
It is also important for persons using St. John's wort to purchase the herb from a reputable source, as the quality of herbal products sold in the United States and Canada varies widely. One study of 10 popular herb samples, including St. John's wort, reported in 2003 that each herb had "a large range in label ingredients and recommended daily dose (RDD) across available products." The researchers recommended that physicians and consumers pay very close attention to labels on over the counter (OTC) herbal products.
In addition to the herb's potential risks to humans, it can be toxic to livestock. Toxic effects in cattle include reports of edema of the ears, eyelids, and the face due to photosensitization after the animal eats the herb. Exposure to sunlight activates the hypericin in the plant. Adverse effects have been reported in horses, sheep, and swine, including a staggering gait and blistering or peeling of the skin. Smaller animals, such as rabbits, suffer severe side effects from accidental ingestion of St. John's wort. The Veterinary Botanical Medicine Association (VBMA), which was founded in 2002 as an offshoot of the American Veterinary Medical Association (AVMA), offers a page on its website for reporting adverse effects of St. John's wort or any other herb in cats, dogs, or other animals.
Side effects
When used either internally or externally, the herb may cause photodermatitis in humans with fair or sensitive skin, following exposure to sunlight or other sources of ultraviolet light. There have also been some case reports of side effects in breast-feeding women taking hypericum extract. Changes in the nutritional quality and flavor of the milk, as well as reduction or cessation of lactation, have been reported. In addition, St. John's wort has been known to cause headaches, stiff neck, nausea or vomiting , and high blood pressure in susceptible individuals.
Interactions
St. John's wort has a number of problematic interactions with many drugs. It has been reported to interact with amphetamines, asthma inhalants, decongestants, diet pills, narcotics, tryptophan and tyrosine (amino acids ), as well as antidepressant medications and certain foods. It has also been reported to interfere with the effectiveness of birth control pills as well as with indinavir (Crixivan) and other AIDS medications. Moreover, anesthesiologists have reported that the herb increases bleeding time in patients under general anesthesia. Patients should always consult a mainstream health practitioner before using St. John's wort, and should discontinue taking it at least two weeks prior to major surgery.
Resources
BOOKS
Blumenthal, Mark. The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines. American Botanical Council, Boston: Integrative Medicine Communications, 1998.
Bown, Deni. The Herb Society of America, Encyclopedia of Herbs & Their Uses. New York: DK Publishing, Inc., 1995.
Foster, Steven, and James A. Duke. A Field Guide to Medicinal Plants. New York: Peterson Field Guides, Houghton Mifflin Company, 1990.
Hoffmann, David. The New Holistic Herbal. Massachusetts: Element Books, 1992.
McIntyre, Anne. The Medicinal Garden. New York: Henry Holt and Company Inc., 1997.
PERIODICALS
Deshmukh, R., and K. Franco. "Talking to Patients About St. John's Wort." Cleveland Clinic Journal of Medicine 70 (November 2003): 990.
Finfgeld, D. L. "Serotonin Syndrome and the Use of SSRIs." Journal of Psychosocial Nursing and Mental Health Services 42 (February 2004): 16–20.
Garrard, J., S. Harms, L. E. Eberly, and A. Matiak. "Variations in Product Choices of Frequently Purchased Herbs: Caveat Emptor." Archives of Internal Medicine 163 (October 27, 2003): 2290–95.
Henderson, L., Q. Y. Yue, C. Bergquist, et al. "St. John's Wort (Hypericum perforatum ): Drug Interactions and Clinical Outcomes." British Journal of Clinical Pharmacology 54 (October 2002): 349–56.
Hodges, P. J., and P. C. Kam. "The Peri-Operative Implications of Herbal Medicines." Anaesthesia 57 (September 2002): 889–99.
Hypericum Depression Trial Study Group. "Effect of Hypericum perforatum (St. John's Wort) in Major Depressive Disorder: A Randomized, Controlled Trial." Journal of the American Medical Association (JAMA) 287 (April 10, 2002): 1807–14.
Pfrunder, A., M. Schiesser, S. Gerber, et al. "Interaction of St. John's Wort with Low-Dose Oral Contraceptive Therapy: A Randomized Controlled Trial." British Journal of Clinical Pharmacology 56 (December 2003): 683–90.
Steinbach, Harvey, M.D. "Serotonin Syndrome: How to Avoid, Identify, and Treat Dangerous Drug Interactions." Current Psychiatry Online 2 (May 2003). <http://www.currentpsychiatry.com/2003_05/0503_serotonin.asp>.
Yu, S. M., R. M. Ghandour, and Z. J. Huang. "Herbal Supplement Use Among US Women, 2000." Journal of the American Medical Women's Association 59 (Winter 2004): 17–24.
ORGANIZATIONS
American Botanical Council. P.O. Box 201660, Austin, TX 78720-1660.
Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857. (888) 463-6332. <http://www.fda.gov>.
Herb Research Foundation. 1007 Pearl St., Suite 200, Boulder, CO 80302. (303) 449-2265. <http://www.herbs.org>.
National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P. O. Box 7923, Gaithersburg, MD 20898-7923. (888) 644-6226. Fax: (866) 464-3615. <http://nccam.nih.gov>.
Veterinary Botanical Medicine Association (VBMA). c/o Susan G. Wynn, DVM, 334 Knollwood lane, Woodstock, GA 30188. E-mail: [email protected]. <http://www.vbma.org>.
OTHER
National Center for Complementary and Alternative Medicine (NCCAM) Fact Sheet. St. John's Wort and the Treatment of Depression. Bethesda, MD: NCCAM, 2002. <http://nccam.nih.gov/health/stjohnswort/>.
National Center for Complementary and Alternative Medicine (NCCAM) press release, 9 April 2002. "Study Shows St. John's Wort Ineffective for Major Depression of Moderate Severity." <http://nccam.nih.gov/news/2002/stjohnswort/pressrelease.htm>.
Clare Hanrahan
Rebecca J. Frey, PhD
St. John's Wort
St. John's Wort
Definition
St. John's wort (also sometimes called Saint John's wort) is the common name for any member of a group of annual or long-living perennial herbs and shrubs with attractive five-petaled golden-yellow flowers. It is used by some people as a way to decrease the symptoms
of anxiety, depression, and various sleep disorders. St. John's wort is classified in the kingdom Plantae, division Magnoliophyta, class Magnoliopsida, and order Malpighiales. It is usually classified within the family Hypericaceae but is also sometimes found within the family Clusiaceae. Its genus is Hypericum.
When St. John's wort is used to refer to the herb used to treat illnesses such as depression, it is the species informally called Common St. John's wort. Sometimes also called Goat weed, hypericum, and Klamath weed, it is the most plentiful species of St. John's wort in the world. It is classified as genus/species Hypericum perforatum. As a perennial herb, St. John's wort has the ability to produce complicated underground creeping stems, called rhizomes. Its above-ground stems are straight and upright, branched within its upper half, and able to grow up to one meter (three feet) in height.
Besides H. perforatum, St. John's wort can also refer to the other species of St. John's wort including scrubby St. John's wort (Hypericum prolificum), great St. John's wort (Hypericum ascyron), and Jerusalem star, or rose of Sharon (Hypericum calycimum). In all, about 370 species of the genus Hypericum are found around the world.
Supposedly, the plant genus (Hypericum) was given its name—from the Greek words hyper (above) and eikon (picture)—in reference to John the Baptist, the first century a.d. Jewish religious leader. The exact reason for the naming is in question. Some of the possible reasons for its name include: the blooming of
KEY TERMS
Anticoagulants —Blood thinners.
Antiseptic —Medicine used to control infection.
Astringent —Substance that brings tissues together.
Extract —A compound in which something has been taken out so that it is now in a more purified state.
Placebo —An inactive substance (such as a sugar pill) used as a control in experiments.
Perennial —Reoccurring, as a plant that comes back for more than one growing season.
Rhizome —An underground creeping stem.
its yellow flowers in June around the time of John the Baptist's birth; the presence of the flower at a feast of John the Baptist; and the hanging of the flower over pictures in houses to supposedly protect against evil on St. John's day.
Purpose
St. John's wort has been used for centuries to medically treat mental disorders such as depression and anxiety. The ancient Greek civilization is known to have used it for this purpose. Early Native Americans used it as anti-inflammatory (to control inflammation), antiseptic (to control infection), and astringent (to bring tissues together) medicines. The flowers of the plant have been used to treat depression, anxiety, and insomnia; sedate people; as a treatment for malaria; and a balm for burns, insect bites, and wounds. In recent history, parts of the plant have been used within herbal tea.
However, it is also considered a poisonous weed in over twenty countries. St. John's wort is considered a toxic weed that invades more productive plants and flowers. When eaten by domesticated animals, such as cows and horses, it can cause problems in the central nervous system, abortion in pregnant females, and even death.
Today, the flowers of the St. John's wort contains hypericin, a chemical that supposedly has anti-inflammatory and antidepressant properties. The Hypericum extract, which is obtained from H. perforatum is used in the United States as a popular herbal medicine (alternative to standard medicine) for the treatment of mild depression. In the United States, according to the National Institutes of Health (NIH), St. John's wort is one of the leading herbal products sold. This sales volume is in large part due to the fact that, according to the NIH, depression affects nearly 19 million U.S. citizens annually, about 6% of the population.
The part of the St. John's wort used within such products are the flowers. They are reduced down to concentrated extracts; that is, specific non-essential substances that are removed to leave behind desired chemicals in a concentrated form. St. John's wort is sold in most countries as over-the-counter medicines in capsules and tablets, and as prepared herbal tea bags (in which boiling water is added to the dried herb and steeped). In other countries, such as Germany, it is used for mild depression more frequently than artificially made medically approved antidepressants.
The composition of St. John's wort and how it works is not well known nor understood. Some scientific evidence suggests it is useful for treating mild to moderate depression. Other recent reports state that it has no effect for treating major depression of moderate severity.
Description
The St. John's wort plant is easily identified by its leaves and flowers. The toothless, stalkless, narrow, oblong leaves are yellowish-green in color, opposite to each other, and have tiny translucent spots scattered throughout the tissues and obvious black dots on the lower surface. When held up to light, the leaves appear to be perforated, which gives them their Latin species name perforatum. The leaves also contain glands that contain oil. The flowers are clustered with five petals. Each flower is about 12 to 20 millimeters (0.47 to 0.79 inch) long. The flowers are bright yellow in color with black dots. The five-petaled clusters grow up to 2.5 centimeters (about one inch) in diameter. The flowers bloom between April and July (late spring and early summer in the northern hemisphere). When the flowers or seed pods are crushed, a reddish purple liquid is produced.
As a genus, St. John's wort is native to the subtropical and temperate regions of Asia Minor, China, Europe, India, North America, and Russia and the other countries of the former Soviet Union. H. perforatum is actively cultivated in parts of southeastern Europe. It is indigenous to Europe but has been introduced into areas of the Americas.
Precautions
The use of H. perforatum for the treatment of various medical problems has not been adequately documented. Previous clinical studies have largely concentrated on its effectiveness in clinically recognized depression,
Some studies show it is effective in mild to moderate depression while other studies show no benefit over placebos. Recent studies include a 2004 study called the Cochrane Review, which included 27 later studies. The results show that St. John's wort was significantly superior to placebos and similarly effective as general antidepressant medicines.
Between 1998 and 2005, numerous medical studies showed St. John's wort to be generally more effective than placebos and generally of equal effectiveness when compared to standard antidepressants, but with fewer negative side affects.
In 2002, the National Institutes of Health (NIH) funded a large and well designed research study called the Hypericum Depression Trial Study Group. Three organizations within the NIH coordinated the study: the National Center for Complementary and Alternative Medicine (NCCAM), the Office of Dietary Supplements (ODS), and the National Institute of Mental Health (NIMH). Three hundred, forty patients diagnosed with major depression of moderate severity were subjected to a double-blind placebo-controlled trial comparing St. John's wort to placebo. St John's wort was found to be no more effective than placebo.
St. John's wort has also been studied as a treatment for anxiety, obsessive-compulsive disorder, HIV (human immunodeficiency virus), atopic dermatitis (sometimes called eczema, a skin condition), and social phobia. In treatment of these illnesses, the results did not show anything conclusive about a positive affect that St. John's wort has on reducing symptoms. In all cases, there is insufficient evidence to make any recommendations.
In addition, the use of St. John's wort for such problems as premenstrual syndrome, depressed mood, seasonal depressive disorder, and somatoform (psychologically induced) disorders is controversial within the medical community.
Interactions
Both the German Commission E, which is responsible for review of herbal and other alternative therapies, and the european scientific cooperative on phytotherapy have reviewed St. John's wort and found no interactions with other drugs.
How St. John's wort works is not known. Some studies preliminarily indicate that it might stop nerve cells in the brain from reabsorbing serotonin, a neuro-transmitting chemical messenger. Other studies show it might reduce levels of a protein involved in the body's immune system. There are many chemical compounds within St. John's wort. The major active ingredients in St. John's wort are believed to be hyperforin (thought to help in the treatment of depression and combat bacteria) and hypericin (believed to be an antibiotic). Flavonoids (a possible antioxidant) and tannins (might help with diarrhea, blood-clotting, and hemorrhoids ), which are also contained in St. John's wort, could be active ingredients, too.
St. John's wort may cause increased sensitivity to artificial light and light from the Sun. It may make some people sunburn more easily than normal. Some research shows that it may cause infertility in both men and women.
Other common side effects can be anxiety, dizziness, dry mouth, fatigue and weakness, gastrointestinal symptoms, headache, sleeping disorders, muscle cramping, nausea, and restlessness. More infrequently occurring side effects include: anorexia, constipation or diarrhea, increased periods of blood pressure and pulse, heartburn, increased sweating, loss of hair on scalp and eyebrows, numbness, tingling and nerve pain or damage, tremors, increased sweating and flushing (marked redness in face and other body areas), and tremors.
According to the National Institutes of Heath, when St. John's wort is ingested, it can alter the way that the body uses other drugs. In some circumstances, interactions can be dangerous. Some of these drugs include: drugs that treat HIV such as indinavir (Crixivan®); drugs that fight cancer such as irinotecan (Campto®); drugs that lower cholesterol such as lovastatin (Mevacor®), nifedipine (Procardia®), and midazolam (Versed®); drugs that reduce the rejection of transplanted organs such as cyclosporine (Sandimmune®); drugs that strengthen contractions of the heart muscle such as digoxin (Lanoxin®); drugs that act as anticoagulants (blood thinners) such as warfarin (Coumadin®); drugs that treat depressants such as amitriptyline (Elavil®); and drugs that control thyroid conditions such as levothyr-oxine (Synthroid®).
Complications
St. John's wort is generally well tolerated by the human body. Scientific studies show that the body readily accepts it at recommended doses for up to one to three months. Sometimes, if St John's wort is discontinued suddenly, there may be unfavorable withdrawal symptoms.
As with any ingested medicinal or herbal substance, there is always risk with taking too large an amount or having it react negatively with something else. Because St. John's wort is a dietary supplement the U.S. Food and Drug Administration (FDA) does not regulate it. Consequently, the strength and quality of it is not predictable within products sold by manufacturers. Products can differ from company to company, and more surprisingly, can change from batch to batch within a company. Information on labels can also be misleading because such data is not regulated by the FDA.
Parental concerns
If children have depression, St. John's wort is not a proven therapy for its treatment—in fact, it is not a proven therapy for the treatment of any depressed person. Parents of children suspected of being depressed should contact a medical professional for assistance. Effective treatments are available. Patients should be aware that if St. John's wort is used with standard anti-depressant therapies, it can cause side affects such as anxiety, confusion, headache, and nausea.
Medical professions also commonly warn pregnant or lactating women about taking St. John's wort. No adverse effects have been documented with the use of St. John's wort. However, because there are no published safety and health data, these women are advised to avoid the use of St. John's wort. Likewise, parents are advised not to give St. John's wort to their young children because of a lack of scientific evidence as to its safety.
Resources
BOOKS
Linde, K., and C.D. Mulrow. St.John's wort for depression (Cochrane Review) In: “The Cochrane Library”. Chi-chester, UK: John Wiley and Sons, Ltd., 2004.
Singh, Amrit Pal. Compendia of World's Medicinal Flora. Enfield, NH: Science Publishers, 2006.
Van Wyk, Ben-Erik, and Michael Wink. Medicinal Plants of the World: An Illustrated Scientific Guide to Important Medicinal Plants and Their Uses. Portland, OR: Timber, 2005.
PERIODICALS
Hypericum Depression Trial Study Group. “Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial” Journal of the American Medical Association. (2002) 287:1807–1814.
Szegedi, A, R. Kohnen, A. Dienel, and M. KIeser. “Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomized controlled double blind non-inferiority trial versus paroxetine” British Medical Journal. 330 (7490): 503–506.
OTHER
St. John's Wort (Hypericum perforatum). Natural Standard, Harvard Medical School. June 23, 2005 [Cited March 21, 2007]. <http://nccam.nih.gov/health/stjohnswort/sjwataglance.htm>.
St. John's Wort (Hypericum perforatum) and the Treatment of Depression. National Center for Complementary and Alternative Medicine. March 2004 [Cited March 21, 2007]. <http://nccam.nih.gov/health/stjohnswort/sjwataglance.htm>.
ORGANIZATIONS
Office of Dietary Supplements (ODS), National Institutes of Health. Home page of ODS. [accessed March 21, 2007] <http://dietary-supplements.info.nih.gov/>.
National Center for Complementary and Alternative Medicine (NCCAM). Home page of NCCAM. [accessed March 21, 2007] <http://nccam.nih.gov/>.
William Arthur Atkin
St. John's Wort
St. John's Wort
Definition
Hypericum perforatum is the most medicinally important species of the Hypericum genus, commonly known as St. John's wort. There are as many as 400 species in the genus, which is part of the Guttiferae family. Native to Europe, St. John's wort is found throughout the world. It thrives in sunny fields, open woods, and gravelly roadsides. Early colonists brought this valuable medicinal to North America, and the plant has become naturalized in the eastern United States and California, as well as in Australia, New Zealand, eastern Asia, and South America.
The entire plant, particularly the round, black seed, exudes a slight, turpentine-like odor. The woody, branched root spreads from the base with runners that produce numerous stalks. The simple, dark green leaves are veined and grow in opposite, oblong-obvate pairs on round, branching stalks that reach 3 ft (91.4 cm) high. Tiny holes, visible when the leaf is held to the light, are actually transparent oil glands containing the chemical photo sensitizer known as hypericin. These characteristic holes inspired the species name, perforatum, Latin for perforated. The bright yellow, star-shaped flowers, often clustered in a trio, have five petals. Each blossom has many showy stamens. Black dots along the margins of the blossom contain more of the red-pigmented chemical hypericin. The herb is also useful as a dye. The flowers bloom in branching, flat-topped clusters atop the stalks in mid-summer, around the time of the summer solstice. St. John's wort, sometimes called devil's flight or grace of God, was believed to have magical properties to ward off evil spirits. It's generic name hypericum is derived from a Greek word meaning "over an apparition." The herb was traditionally gathered on mid-summer's eve, June 23. This date was later christianized as the eve of the feast day of St. John the Baptist. This folk custom gave the plant its popular name. The Anglo-Saxon word wort means medicinal herb.
Purpose
St. John's wort has been known for its numerous medicinal properties as far back as Roman times. It was a valued remedy on the Roman battlefields where it was used to promote healing from trauma and inflammation. The herb is vulnerary and can speed the healing of wounds, bruises, ulcers, and burns. It is popularly used as a nervine for its calming effect, easing tension and anxiety, relieving mild depression, and soothing emotions during menopause. The bittersweet herb is licensed in Germany for use in cases of mild depression, anxiety, and sleeplessness. It is useful in circumstances of nerve injury and trauma, and has been used to speed healing after brain surgery. Its antispasmodic properties can ease uterine cramping and menstrual difficulties. St. John's wort acts medicinally as an astringent, and may also be used as an expectorant. The hypericin in St. John's wort possesses anti-viral properties that may be active in combating certain cancers, including many brain cancers. An infusion of the plant, taken as a tea, has been helpful in treating night-time incontinence in children. The oil, taken internally, has been used to treat colic, intestinal worms, and abdominal pain. The medicinal parts of St. John's wort are the fresh leaves and flowers. This valuable remedy has been extensively tested in West Germany, and is dispensed throughout Germany as a popular medicine called, Johnniskraut. Commercially prepared extracts are commonly standardized to 0.3% hypericin.
Clinical studies
A 1988 study at New York University found the antiviral properties in hypericin, a chemical component of Hypericum, to be useful in combating the virus that causes AIDS. Additional studies are under way through the Federal Drug Administration (FDA) to determine the effectiveness of the herb as a treatment for AIDS. Hypericin extract has also been reported to inhibit a form of leukemia that sometimes occurs after radiation therapy. Numerous clinical studies have found hypericum preparations to have an antidepressive effect when used in standardized extracts for treatment of mild depression. Clinical trials continue with this important herbal anti-depressant, particularly in view of its relative lack of undesirable side effects in humans.
Preparations
An oil extract can be purchased commercially or prepared by combining fresh flowers and leaves of St. John's wort in a glass jar and sunflower or olive oil. Seal the container with an airtight lid and leave on a sunny windowsill for four to six weeks, shaking daily. The oil will absorb the red pigment. Strain through muslin or cheesecloth, and store in a dark container. The medicinal oil will maintain its potency for two years or more. The oil of St. John's wort has been known in folk culture as "Oil of Jesus." This oil makes a good rub for painful joints, varicose veins, muscle strain, arthritis, and rheumatism. Used in a compress it can help to heal wounds and inflammation, and relieve the pain of deep bruising.
An infusion is made by pouring one pint of boiling water over 1 oz (28 g) of dried herb, or 2 oz (57 g) of fresh, minced flower and leaf. Steep in a glass or enamel pot for five to 10 minutes. Strain and cover. Drink the tea warm. A general dose is one cupful, up to three times daily.
Capsule: Dry the leaves and flowers and grind with mortar and pestle into a fine powder. Place in gelatin capsules. The potency of the herb varies with the soil, climate and harvesting conditions of the plant. A standardized extract of 0.3% hypericin extract, commercially prepared from a reputable source, is more likely to yield reliable results. Standard dosage is up to three 300 mg capsules of 0.3% standardized extract daily.
A tincture is prepared by combining one part fresh herb to three parts alcohol (50% alcohol/water solution) in glass container. Set aside in dark place, shaking the mixture daily for two weeks. Strain through muslin or cheesecloth, and store in dark bottle. The tincture should maintain potency for two years. Standard dosage, unless otherwise prescribed, is 0.24-1 tsp added to 8 oz (237 ml) of water, up to three times daily.
A salve is made by warming 2 oz (59 ml)of prepared oil extract in double boiler. Once warmed, 1 oz (28 g) of grated beeswax is added and mixed until melted. Pour into a glass jar and cool. The salve can be stored for up to one year. The remedy keeps best if refrigerated after preparation. The salve is useful in treating burns, wounds, and soothing painful muscles. It is also a good skin softener. St. John's wort salve may be prepared in combination with calendula extract (Calendula officinalis ) for application on bruises.
Precautions
Consult a physician prior to use. Pregnant or lactating women should not use the herb. Individuals taking prescribed psychotropic medications classified as selective serotonin reuptake inhibitors, or SSRI, such as Prozac, should not simultaneously use St. John's wort. Many herbalists also discourage use of St. John's wort by individuals taking any other anti-depressant medication.
Cattlemen dislike the shrub because there have been some reports of toxicity to livestock that overgraze in fields abundant with the wild herb. Toxic effects in livestock include reports of edema of the ears, eyelids, and the face due to photosensitization after ingestion of the herb. Exposure to sunlight activates the hypercin in the plant. Adverse effects have been reported in horses, sheep, and swine and include staggering, and blistering and peeling of the skin. Toxicity is greater in smaller mammals, such as rabbits.
Side effects
When used either internally or externally, the herb may cause photo-dermatitis in humans with fair or sensitive skin when exposed to sun light or other ultraviolet light source. There have been some reports of changes in lactation in some nursing women taking the hypericum extract. Changes in the nutritional quality and flavor of the milk, and reduction or cessation of lactation have also been reported. It can also cause headaches, stiff neck, nausea and vomiting, and high blood pressure.
Interactions
St. John's wort can interact with amphetamines, asthma inhalants, decongestants, diet pills, narcotics, and amino acid tryptophan and tyrosine, as well as certain foods. Reactions range from nausea to increased high blood pressure. Consult a practitioner prior to using St. John's wort.
Resources
ORGANIZATIONS
American Botanical Council. PO Box 201660, Austin, TX 78720-1660.
OTHER
Herb Research Foundation. 〈http://www.herbs.org〉.
KEY TERMS
Antispasmodic— Relieves mild cramping or muscle spasm.
Expectorant— Promotes the discharge of mucus from respiratory system.
Nervine— Soothes and calms the nervous system.
Vulnerary— Heals wounds, bruises, sprains, and ulcers.
St. John's wort
St. John's wort
Definition
St. John's wort is a perennial, yellow-flowering plant that grows in the wild throughout Europe and is now found also in North America. The plant tends to be in blossom in the month of June, around the day considered to be the birthday of John the Baptist; hence its popular name. The plant's Latin name is Hypericum perforatum.
St. John's wort has been used as a popular herbal folk remedy for centuries. More recently, practitioners of conventional Western medicine have been exploring its utility for treating depression and anxiety.
Purpose
Writings since the Middle Ages have described using St. John's wort as treatment for inflammation, injuries, burns, muscle pain, anxiety, high blood pressure, stomach problems, fluid retention, insomnia , hemorrhoids, cancer, and depression. Research conducted over the 1990s in Europe studied the efficacy of St. John's wort for the treatment of depression and anxiety. Research protocols have been developed in the United States to study the same issues, to determine appropriate dosages, to develop standard formulations, and to define whether it can be used for all forms of depression or only for more mild forms of the condition.
Description
Research has yet to completely explain how St. John's wort affects the brain in depression. It is, however, thought to change the balance of chemicals in the brain in much the same way as selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), and monoamine oxidase inhibitors (MAOIs). The active ingredients are thought to be compounds called hypericin and pseudohypericin, although researchers are attempting to identify other chemicals that may be involved in the herb's effectiveness.
The leaves and flowers of St. John's wort are both used. St. John's wort is available as pills, capsules, extracts, dried herbs for tea, and oil infusions for skin applications.
Recommended dosage
Because dosages of herbal preparations are not always standardized, it is important to discuss with a knowledgeable practitioner the most reliable form of St. John's wort. Recommendations call for 300–500 mg (of a standardized 0.3% hypericin extract) three times daily. It can take four to six weeks to notice the antidepressant effects of this preparation.
Alternatively, one to two teaspoons of dried St. John's wort can be put into a cup of boiling water and steeped for 10 minutes to make tea. The recommended dosage of tea is one to two cups daily. Again, four to six weeks may be necessary in order to notice improvement in symptoms of depression.
Precautions
The following precautions should be considered and discussed with a knowledgeable practitioner before St. John's wort is taken:
- Some people may become more sensitive to the sun.
- Patients taking MAOIs must carefully avoid taking St. John's wort due to serious adverse effects of combining the two.
- Because the effects of St. John's wort are still being studied, pregnant and breast-feeding women should avoid its use.
- Depression can be a serious, even life-threatening, condition; therefore, it is imperative that depressed patients using St. John's wort are carefully monitored.
Side effects
People taking St. John's wort may develop one or all of the following side effects:
- skin rash due to sun sensitivity—the most common side effect
- headache, dizziness, dry mouth, constipation
- abdominal pain, confusion, sleep problems, and high blood pressure are less frequently experienced
Interactions
Again, a knowledgeable professional should be consulted before St. John's wort is taken to determine the appropriateness of its use and avoid serious interactions. Interactions include:
- Possible decrease in effectiveness of reserpine, warfarin, theophylline, immunosuppressant medications such as cyclosporine, and antiviral drugs such as indinavir.
- Dangerous interactions when used with other antidepressant medicines (especially MAOIs), digoxin, and loperamide.
- Interactions with oral birth control pills. St. John's wort may interfere with the effectiveness of birth control pills, increasing the risk of pregnancy; an alternative form of birth control should be considered while taking St. John's wort. In addition, women taking both birth control pills and St. John's wort may notice bleeding between menstrual periods.
See also Depression and depressive disorders
Resources
BOOKS
Blumenthal, Mark and others, eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council,1998.
PERIODICALS
Zink, Therese and Jody Chaffin. "Herbal 'Health' Products: What Family Physicians Need to Know." American Family Physician 58 (October 1, 1998): 1133.
Rosalyn Carson-DeWitt, M.D.
St. John's Wort
St. John's Wort
General term for the plant species Hypericum. In classical mythology, the summer solstice was a day dedicated to the sun, and was believed to be a day on which witches held their festivities. St. John's Wort was its symbolic plant. People used to judge from it whether their future would be lucky or unlucky, as it grew they read in its progressive character their future lot. This traditional lore carried over into the Christianera, when this festival period was dedicated to St. John's Wort or root. It became a talisman against evil.
In one of the old Scottish romantic ballads, a young lady falls in love with a demon, who tells her:
Gin you wish to be leman mine [my lover] Lay aside the St. John's Wort and the vervain.
When hung up on St. John's Day, together with a cross over the door, this plant was supposed to keep out the devil and other evil spirits. To gather the root at sunrise on St. John's Day and to retain it in the house, gave luck to the family in their undertakings, especially in those begun on that day.
hypericum
hy·per·i·cum / hīˈperikəm/ • n. a yellow-flowered plant of a genus that includes the St. John's worts and rose of Sharon. • Genus Hypericum, family Guttiferae.