Dr. Gary Null
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 A placebo-controlled, randomized, double-blind study examined the effects of a st. john's wort extract, LI 160, on patients suffering from moderately severe depression. While 66 percent of those receiving treatment responded positively, only 27 percent of the controls did so.
U. Schmidt and H. Sommer, "Johanniskraut-Extrakt zur ambulanten Therapie de Depression. Aufmerksamkeit und Reaktionsvermogen bleiben erhalten" [St. John's Wort Extract in the Ambulatory Therapy of Depression: Attention and Reaction Ability are Preserved], Fortschr. Med. 111, no. 19 (July 10, 1993): 339-42. |
J. E. Williams, O.M.D.
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 St. John's wort, which include stomach upset, dizziness, headache, dry mouth, and restlessness. Sensitivity to sunlight is also a reported reaction to this herb. Drug interactions to one of the active components, hypericin, have been reported. If you are taking other antidepressants, anticoagulants, and/or digoxin for your heart, do not use st. john's wort while you are on these drugs. The standard dosage is 300 mg of the extract, taken three times daily. |
Ray Strand, M.D.
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 As well, st. john's wort in combination with black cohosh may be contraindicated, which means it should not be used during pregnancy and lactation due to potential uterine stimulation, which could lead to a miscarriage.16
Ginkgo biloba has become a popular herb for a wide variety of medical problems, the most common being hardening of the arteries. Several studies have shown that Ginkgo biloba helps increase the circulation of blood in the brain and extremities. |
David Hoffman, FNIMH, AHG
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 John's wort oil (Hypericum perforatum) can be effective. Make st. john's wort oil in late summer by picking fresh blossoms and putting them into oil:
Fresh, just-opened
Hypericum perforatum flowers 100 g (4 oz)
Olive or sunflower oil 1 pint (Vi liter)
Crush the flowers in a tablespoon of the oil and place in a clear glass container. Pour the rest of the oil over the flowers and mix well. Leave the container open in a warm place for three to five days, then seal the container well and place it in sunshine or another warm place for three to six weeks. |
Heather Boon, BScPhm, PhD and Michael Smith, BPharm, MRPharmS, ND
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 Cases describing possible drug interactions between st. john's wort and the following drugs have been reported:
• Combined oral contraceptive (resulting in breakthrough bleeding).102'103
• Cyclosporin (resulting in decreased cyclosporin levels).102 104 110
• Digoxin (resulting in decreased digoxin levels).111
• General anesthesia (resulting in delayed emergence).112
• Indinivir (resulting in decreased indinivir levels).113
• Nefazadone (resulting in symptoms of serotonin syndrome).114
• Paroxetine (resulting in symptoms of serotonin syndrome).115
• Phenprocoumon. |
| ANTI-RETROVIRAL EFFECTS
Relatively recent investigations into the potential anti-retroviral activity of st. john's wort have paralleled the search for other effective treatments for HIV infection and AIDS. Antibacterial and anti-fungal effects of some constituents have been demonstrated in vitro.914 Anti-viral activity against Sindbis, human poliovirus-1, and herpes simplex virus-1 has been found in vitro.15 Murine cytomegalovirus, and human immunodefficiency virus-1 (HIV-1) were also inactivated in vitro. |
David Hoffman, FNIMH, AHG
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| The study involved 105 outpatients with depressions of short duration who received either 300 mg of st. john's wort extract three times a day or placebo three times a day.3
A Prescription for Moderate Depression
Hypericum perforatum 2 parts
Avena sativa 1 part
Artemisia vulgaris 1 part
Dosage: up to 5 ml of tincture three times a day for at least 1 month
Table 16.7. |
volker schulz and Rudolf Hansel
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 But comparisons of the actual and apparent pharmacodynamic effects of synthetic antidepressants in the wake of therapeutic studies with st. john's wort (Schulz, 2000,2002 a, 2003 a; HDT Study Group, 2002; Timothy et al., 2002) show how misleading this standard can be when it is applied to whole classes of medications. |
C. P. Khare
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 The extract at a dosage of 300 mg 3 times a day was found to be as effective in relieving symptoms of depression as standard antidepressants (1992-1994)-
Research indicates that other constituents, such as xanthones and flavonoids also contribute to the medicinal actions of st. john's wort.
Studies have demonstrated that the antidepres-sive effect may be due to the presence of a monoamine oxidase inhibiting function in the active agents. The effect may be largely due to the ability of the herb to inhibit the reuptake of serotonin.
St. |
| The red oil of st. john's wort is used externally as an antiseptic and tissue healer for wounds and burns and to relieve cramp and nerve pain.
The oil is also given, under medical supervision, internally for gastric inflammation and peptic ulcers, and oesophagitis.
For external use creams, ointments and sprays are sold over-the-counter. Standardized extract in the form of capsules are also sold. Even plant juice is available. |
| German Commission E monograph on st. john's wort lists psychovegetative disturbances, depressive states, fear, and nervous disturbances as clinical indications for the extract. It recognized the drug's efficacy in the following areas:
> Anxiety
> Depressed moods
> Inflammation of the skin
> Blunt injuries
> Wounds and burns (first degree).
The herbalists of Europe have long used the herb as a tonic for anxiety, tension, insomnia, depression; for menopause hot flushes, night sweats, depression, irritability, lack of concentration, and fatigue. |
Richard P. Brown, M.D., and Patricia L. Gerbarg, M.D.
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 We've heard about Gingko biloba, kava kava, ginseng, st. john's wort, and numerous other popular herbs. Why the tidal wave of interest?
The number-one reason that people turn to alternative treatments like herbs is that conventional treatments have failed to make them well. What's more, the public is increasingly aware that an ounce of prevention is vastly preferable to the disruptive, costly, and often painful interventions that are necessary to fight disease once it gains a foothold. |
Phyllis A. Balch, CNC
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 Brain/nervous system Ashwagandha, astragalus, bayberry, bilberry, blessed thistle, blue cohosh, catnip, celery, chamomile, chaste tree, devil's claw, dong quai, eyebright, fennel, fenugreek, feverfew, ginger, ginseng, goldenseal, gotu kola, guarana, hops, jaborandi, kava kava, kudzu, lavender, lemongrass, licorice, marshmallow, motherwort, muira puama, oat straw, passionflower, peppermint, plantain, rosemary, sage, St. |
Josef A. Brinckmann and Michael P. Lindenmaier
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 The monograph of the commission E indicates a daily dosage of 2—4 g st. john's wort herb or corresponding preparations. In this example, the daily dosage is attained with a single tablet.
Example 2:
A kava-kava preparation is labeled as follows: one dragee contains 90 mg dry extract (drug-to-extract ratio 13—20:1). From the mean value (16.5:1), the corresponding amount of kava-kava rhizome can be calculated; 90x16.5 = 1485 mg. Thus, 90 mg extract corresponds to about 1.5 g dried kava rhizome. |
| In folk medicine, st. john's wort is used to treat gastritis and gallbladder illnesses. The oil macerate form (Oleum Hyperici) [extracted with olive, sunflower or preferably wheatgerm oil] is used for external application to wounds and burns; historically, it would never have been missing from the blacksmith's workshop. Oleum Hyperici does not contain any hypericin but rather reddish-brown lipophilic breakdown products, flavonoids and hyperforins [15], respectively, and the degradation product of the hyperforins, orthoforin [16]. |
| Hyperici herba — st. john's wort). In herb shops and natural food stores, however, herbal tea drugs will remain popular products. The main objectives for the 4th edition of this book are still the same: to offer healthcare practitioners a comprehensive description of all aspects of herbal drugs used for tea preparation and for the production of phytopharmaceuticals and to serve as a reference. As in the previous editions, the drugs used for the isolation of pure compounds (such as Digitalis, Secale cornutum, Curare etc.) have not been considered. |
| Dose and Mode of administration
Pour about 150 ml boiling water over 1— 2 teaspoonfuls of st. john's wort. Steep for about 10 min and then pass through a tea strainer.
Unless otherwise prescribed, drink 1-2 freshly prepared cups of tea regularly in the morning and evening.
6.4 Duration of use
Regular use for several weeks or months is normally required before the effect takes place.
6.5 Storage
Store protected from light and moisture.
Stationary phase: 5 x 10 cm silica gel 60 F254 (plates or foil).
Test solution: 1. |
| Reference solution (2 ul) 3: st. john's wort (3 ul) hyperoside (0.31) and quercetin (0.81). The characteristic TLC chromatogram of the test solution shows several intense yellow fluorescent zones, of which the most intense ones correspond to the zones of the reference compounds. A red fluorescent double-zone with Rf 0.61 and 0.65 is due to hypericin and pseudohypericin.
Adulteration: Occurs relatively frequently with other Hypericum species, which can be recognized by their stem fragments: The most common adulterant Hypericum macula-turn Crantz has quadrangular stems; Hypericum montanum L. |
| Kneipp® Nerve Tea; Good Earth® Medicinals™ Tea for Sleep = Kiinzle® Nerven Schlaftee), and with st. john's wort (e.g. Sidroga® Anti-Stress Tea).
Phytomedicines: A dry extract of melissa leaf is a component of a cream used in the treatment of Herpes simplex infections (Type I and II). Product example: Lomaherpan® Creme (same as U.S. products Herpilyn® and Heqna-lieve®; 0.05 g dry extract per 5 g cream, drug-to-extract ratio 70:1, solvent:-water, with allantoin 1 %). A pressed juice of fresh melissa herb is used as a sedative (Kneipp® Melisse Pflanzensaft). |
volker schulz and Rudolf Hansel
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| The worldwide attention that has been focused on the st. john's wort phenomenon has caused many experts to reexamine the question of who and what contribute most to the effectiveness of antidepressant pharmacotherapy.
In a meta-analysis of more than 80 studies on new synthetic antidepressants, the Agency for Health Care Policy and Research in the United States found an average response rate of 32 % to placebo versus 50 % to the antidepressants (Mulrow et al., 1999). Calculations showed that in 22 major treatment studies using SJW extracts (Tables 2.4,2.5 |
C. P. Khare
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| English: Common st. john's wort, Klamath Weed.
Parts used
Whole plant.
Dose
Powder 3-6 g. Classical use
Used in Unani medicine as an emmenagogue and diuretic. Seeds are given in the fourth-day fever, mixed with Sudaab (Ruta graveolens) seeds. Fruits are also used.
Powder of dry leaves is dusted over infected wounds. A paste of leaves is also applied over wounds, sores, ulcers, and burns; and is massaged over neurological affections, rheumatic inflammations, lumbago. Leaves are also prescribed internally. |
volker schulz and Rudolf Hansel
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| Some common sources of plant juices are birch leaves, nettle, watercress, st. john's wort, garlic, dandelion, lemon balm, European mistletoe, radish, English plantain, and horsetail.
|m Solid Dosage Forms
Powdered extracts and concentrates must be protected from light, oxygen, and moisture. This is best accomplished by processing them into solid dosage forms such as granules, tablets, coated tablets, and capsules. Preparing medications in a form appropriate for their intended use also permits more accurate dosing. |
Donald R. Yance, j r.,C.N., M.H., A.H.G., with Arlene Valentine
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 For example, many people today are using the herb st. john's wort (Hypericum perforatum) as a natural remedy for depression. Most over-the-counter varieties of this product are standardized to the hypericin content but, as recent information on this sacred plant indicates, hypericin is not the ingredient responsible for its antidepressant effects. st. john's wort has many constituents, including a number of flavonoids, that together with hypericin have a powerful healing effect. |
volker schulz and Rudolf Hansel
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| The efficacy rate (responders: horizontal bar for synthetic drugs, upper star for st. john's wort [SJW]) remained unchanged at 40-70 % of patients.The rate of adverse drug reactions (ADR: slanted bar for synthetic drugs, lower star for SJW) has fallen from approximately 50 % to 20 % of patients for synthetic drugs.The rate for SJW is approximately 2 %!
(or would have been) better to save those funds. Figure 1.8 traces the development of antidepressants since the late 1950s up to the present day. |
| Extracts from st. john's wort have proven highly effective in the treatment of mild to moderate depression and have even shown value in severe depressive disorders (Linde et al., 1996; Wong et al. 1998; Kasper, 2001; Schulz, 2002), and extracts from the kava root (Piper methysticum rhizome) have shown efficacy as anxiolytic drugs (Volz and Hansel, 1994; Volz, 1997; Pittler and Ernst, 2000).
Except for ginkgo and kava, the findings on psychotropic plant drugs were compiled by Commission E in 1984 and 1985. |
| Selection of 12 controlled clinical studies in patients with depressive disorders treated with a st. john's wort extract produced with 80% methanol in water (v/v).
First author, year Cases
Daily dose
Duration
Reference
Responders
(extract)
(days) therapy
(hypericum vs. reference therapy)
Lehri, 1993
50
450-900 mg
28
Placebo
42% vs. 25%
Sommer,1994
105
450-900 mg
28
Placebo
67% vs. 28%
Harrer, 1994
102
900 mg
28
Maprotiline
61 %vs.67%
Hubner,1994
39
900 mg
28
Placebo
70% vs. 47%
Vorbach,1994
135
900 mg
42
Imipramine
64% vs. |
Jack Challem
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 Add 1 point _
Do you take herbal supplements such as st. john's wort, ginseng, ginkgo, or any other?
Add 1 point _
Your score on quiz 3: _
Initial interpretation and ranking:
0 Low. You do not take any anti-inflammation supplements, either because you do not need them or because you are not aware of them.
1-3 Moderate. You take some anti-inflammation supplements, which offer some protection.
4-8 High. You take numerous anti-inflammation supplements, suggesting that you are trying to reverse a chronic inflammatory condition. |
Richard P. Brown, M.D., and Patricia L. Gerbarg, M.D.
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| These include aloe vera, black cohosh, echinacea, garlic, ginger, ginkgo, ginseng, saw palmetto, st. john's wort, and valerian, among numerous others. Most of these herbs have achieved their prominence in the marketplace because they have been the subjects of the most clinical research.
The past 10 to 20 years have witnessed an explosion in the scientific study of herbal formulations. |
Earl Mindell, R.Ph., Ph.D.
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 By the end of the study, more than two-thirds of the st. john's wort group showed improvement, versus only 28 percent in the placebo group. The researchers concluded that st. john's wort had an antidepressive effect in the treatment of mild and moderate depression that was at least as effective as some traditional antidepressants, but without any undesirable side effects.
Kava kava—This member of the pepper family is found mainly in Micronesia, Melanesia, and Polynesia. Several European countries have approved kava preparations in the treatment of nervous anxiety, insomnia, and restlessness. |
Ray Strand, M.D.
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| Under this legislation, a manufacturer could claim that st. john's wort could improve one's mood but could not claim that it could help depression. Ginseng provides another example: its makers could promote it as helping give the body energy but not as a treatment for chronic fatigue.
If a manufacturer does make a claim on the product label, it must add, "This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease. |
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