St. John's wort: effective medicine for depression, infection, & more

Called Hypericum perforatum in botany, St. John's Wort is a rapidly-spreading perennial that is widely distributed in Europe, Asia, northern Africa and as a non-native in the United States. The name Hypericum, meaning "over an apparition," comes from the belief that "the herb was so obnoxious to evil spirits that only a whiff would cause them to fly away," explains James Duke in his Handbook of Medicinal Herbs (1986).

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Hypericum perforatum has been known since Greek and Roman times. Its medicinal virtues were described by Dioscorides (1st century A.D.), Galen (2nd century A.D.), and Pliny in book XXIV of his Historiarum mundi. In 1557, P. Mattioli wrote about Hypericum in his Discorsi, in which St. John's Wort was indicated as a diuretic, emmenagogue and antimalarial; it was especially recommended for the treatment of scalds and burns.

St. John's Wort derived the first part of its Anglo-Saxon name from the ancient belief that the plant should be gathered on, or about, St. John's Day (or Midsummer's Day), when it comes into flower. Wort is from Middle English, meaning "root," or "herb."

And although not Middle English, technically, we have the following glowing entry on St. John's Wort in John Gerarde's Herball, or Generall Historie of Plantes (1597):

St. John's Wort, with his flowers and seed boyled and drunken, proketh urine, and is right good against stone in the bladder, and stoppeth the laske. The leaves, flowers, and seeds stamped, and put into a glass with oyle olive, and set in the hot sunne for certain weeks together, [...] and sunned in like manner, doth make an oyle of the color of blood, which is a most precious remedy for deep wounds and those that are thorow the body, for sinews that are pricked, or any wound with a venomed weapon.

Curiously, it seems that, in 1892 (as per Charles Millspaugh), the herb's benefits were not as well appreciated: "This European immigrant has become so thoroughly naturalized with us as to become a very troublesome weed upon our farmlands where its rapid and rank growth render it difficult to exterminate and very exhausting to the soil."

Containing such compounds as quercetin, quercitrin, isoquercitrin, rutin, hyperoside, sitosterol, hypericin and pseudohypericin, St. John's Wort is today prized for its anti-depressive and anti-viral effects.

Anti-depressant effects. In general, compounds which exhibit antidepressant effects interfere with brain levels of what are called amines (such as serotonin, noradrenaline, adrenaline and dopamine). It is suggested that hypericin, the most-studied active component in St. John's Wort, interferes with these levels by "antagonizing" enzymes, such as monoamine oxidase (or MAO), which are responsible for the breakdown of the amines.

On the basis of an extensive analysis of the literature in 1995, researchers Ezio Bombardelli and Paolo Morazzoni concluded that "hypericin is to be considered a MAO inhibitor [...] and [that this review] would confirm the supposition that it is the active constituent in the Hypericum extract."

From 1979 through 1993, approximately 25 controlled clinical trials have looked into the antidepressive effectiveness of St. John's Wort.

In one of 25 placebo-controlled antidepression clinical trials conducted between 1979 and 1993, G. Harrer and H. Sommer studied 105 outpatients with "neurotic depression" or "depressive irritations," treating them for one month with 900 mg/day of St. John's Wort extract. In the treated group, 28 out of 42 patients (67%) responded successfully to the supplementation.

In another randomized, placebo-controlled, double-blind study, W.D. Hubner, et al. (1995), reported their results with 39 depressive patients who were treated for four weeks with St. John's Wort extract (900 mg/day). The results revealed an overall improvement in the treated group. Nearly 70 percent of the supplemented patients were free of depressive symptoms (such as inertia, fatigue, and disturbed sleep) after four weeks of treatment.

St. John's Wort's effects on memory and concentration in depression were tested by S. Lehrl, et al. (1993), on 50 depressive patients who were also supplemented for four weeks. The results of the study indicated a significant improvement in concentration, receptivity and memory during the four-week period.

In light of all the studies, Bombardelli and Morazzoni further concluded that "the antidepressive activity of Hypericum-based preparations for oral administration has been clinically demonstrated, and confirmed by recent clinical trials."

Anti-viral/anti-AIDS activities. Since 1985, the anti-viral action of substances contained in St. John's Wort has been widely studied, with proven anti-viral effects being demonstrated against: vesicular stomatitis, influenza virus and herpes simplex types I and II (Lavie, 1986/1988); and retrovirus infections (Lavie, 1987/1989), such as HIV and Friend leukemia virus.

In fact, Bombardelli and Morazzoni state that "other experimental data confirmed that hypericin and pseudohypericin inhibit retroviral infections by unconventional mechanisms and that the potential therapeutic application of these compounds could be represented by diseases such as AIDS."

On the basis of hypericin/HIV studies by Hudson, et al. (1993), Lenard, et al. (1993), and Degar, et al. (1992), two facts seems clear: (1) the hypericin inactivated HIV, and (2) it was, however, necessary for the patients to receive some exposure to visible light in order for the compound's effects to be activated. Conversely, fair-skinned people, in general, should be cautious when using St. John's Wort (especially as a tea), since exposure to bright sunlight can cause temporary sunburn-like skin reactions.

Bombardelli and Morazzoni conclude their review on a note of cautious optimism: "It is possible to say that the antiviral activity of hypericin and pseudohypericin is now well defined from an experimental point of view, but their potential therapeutic value for human retro-viral-induced diseases remains unknown, and awaits clinical investigation, including pharmacokinetic (pharmacological-activity) studies."

In recent years, St. John's Wort has been used as an anti-inflammatory and antibiotic (antibacterial). It has been used specifically for: insomnia, vitiligo [skin condition], gastritis, hemorrhoids, bladder troubles, bronchitis, catarrh (mucous inflammation, including rhinitis), consumption, diarrhea, dysentery, dysmenorrhea (difficult or painful menstruation), enuresis (non-physical-based urinary incontinence), jaundice, rabies, bronchial asthma, neuralgia, fibrositis, sciatica and rheumatic pain, bruises, and menopause-triggered irritability, in addition to use in minor depression and retroviral infection, as discussed above.

For most nutritional needs, one 250 mg/day capsule of St. John's Wort, which has been standardized to contain 0.3% to 0.5% hypericin, is suggested as a dietary supplement.

REFERENCES

"Drug Record for Hypericin." National Institute of Allergy and Infectious Disease, AIDS Clinical Trials Information Service (ACTIS), Rockville, Md. (Phone: 1-800-TRIALS-A, Fax: 301-738-6616).

Bombardelli, Ezio, and Morazzoni, Paolo. "Hypericum perforatum," Fitoterapia 66:43-68, 1995.

Duke, James A. Handbook of Medicinal Herbs. Boca Raton, Fla.: CRC Press, 1986.

Foster, Steven, and James A. Duke. A Field Guide to Medicinal Plants: Eastern and Central North America. Boston: Houghton Mifflin Company, 1990, p. 114.

Gerarde, John. Herball, or Generall Historie of Plantes, 1597. [Quoted in Millspaugh, 1892]

Harrer, G., and Sommer, H. [Title unavailable] Munch. Med. Wschr. 135:305, 1993.

Hubner, W.D., et al. [Title unavailable] Nervenheilkunde 12:278, 1993. [Quoted in Bombardelli and Morazzoni, 1995]

Lehrl, S., et al. [Title unavailable] Nervenheilkunde 12:281, 1993. [Quoted in Bombardelli and Morazzoni, 1995]

Mattioli, P. I Discorsi. Venice, Italy, 1557, p. 447. [Quoted in Bombardelli and Morazzoni, 1995]

Millspaugh, Charles F. American Medicinal Plants. New York: Dover, 1892/1974.

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