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St. John's Wort

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St. John's wort (Hypericum perforatum L.)

Background

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.

Synonyms

Amber touch-and-heal, balm-of-warrior's wound, balsana, bassant, Blutkraut, bossant, corancillo dendlu, devil's scorge, Eisenblut, flor de Sao Joa, fuga daemonum, goatweed hartheu, heofarigo on herba de millepertius, herba hyperici, herrgottsblut, hexenkraut, hierba de San Juan, hipericao, hiperico 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, tenturotou, Teufelsflucht, touch and heal Walpurgiskraut, witcher's herb, WS 5572.

Evidence

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.

Uses based on scientific evidence	Grade^*
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.	A
Anxiety disorder Overall, there is currently not enough evidence to recommend St. John's wort for the primary treatment of anxiety disorders.	C
Atopic dermatitis Early 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.	C
Depressive disorder (severe) Studies of St. John's wort for severe depression have not provided clear evidence of effectiveness.	C
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.	C
Peri-menopausal symptoms There is currently not enough scientific evidence to recommend St. John's wort for this indication.	C
Premenstrual syndrome (PMS) Further studies are needed before a recommendation can be made.	C
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).	C
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.	D
Social phobia Results of early study fail to provide evidence for the efficacy of St. John's wort in social phobia.	D

*Key to grades

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;

F: Strong scientific evidence against this use.

Grading rationale

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, alcoholism, allergies, anti-inflammatory, antiviral, athletic performance enhancement, bacterial skin infections (topical), bedwetting, bruises (topical), benzodiazepine withdrawal, burns (topical), cancer, chronic bowel irritation, chronic ear infections, dental pain, diarrhea, diuretic (increasing urine flow), Epstein-Barr virus infection, fatigue, glioma, heartburn, hemorrhoids, herpes virus infection, influenza, insomnia, joint pain, liver protection from toxins, malaria treatment, menstrual pain, nerve pain, pain relief, rheumatism, skin scrapes, snakebites, sprains, ulcers, wound healing (topical).

Dosing

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 (18 years and older)

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 treatment of atopic dermatitis.

Children (younger than 18 years)

There is not enough scientific data to recommend St. John's wort in children.

Allergies

Infrequent allergic skin reactions, including rash and itching, are reported in human studies.

Notes:

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EditText of this page (last edited February 16, 2008)