St. John's Wort for Depression

St. John's Wort is as effective antidepressant for treating both moderate and severe depression.

Medicinal uses: St. John's Wort is one of our best herbal therapies for depression and numbing frustration. It seems to work best for those people who find things falling apart.

A German study has added weight to the argument that a herbal remedy is an effective treatment for depression. Researchers compared the effectiveness of St John's wort to anti-depressant drug paroxetine in treating moderate and severe depression.

The team found half of those with the condition improved when given the herb, compared with a third using the drug, the British Medical Journal reported.

St. John's Wort helps relieve pain, mental burnouts, anxiety, neuralgia and nervousness. It has been used to relieve phlegm obstructions in the chest and lungs. St. John's Wort also has been much help in correcting painful and irregular menstruations, after birth pains, bed wetting, bronchitis, lung congestion and uterine cramps.

Although its main claim is an antidepressant, it has a good record for many other uses. Our St. John's Wort is wild crafted from the mountains of western Montana and is very concentrated and highly active in hypercium. It may well be the most potent St. John's Wort on the market.

In the 19th and 20th centuries, American Eclectic physicians prescribed St. John's Wort to treat hysteria and nervous affections with depression. It was prescribed externally to treat wounds, bruises, sprains, and much more (Ellingwood, 1983; Felter and Lloyd, 1983; Felter, 1985; King, 1866; Snow, 1996; Upton, 1997).

Today, St. John's wort is official in the national pharmacopeias of Czechoslovakia, France, Poland, Romania, and Russia (Bruneton, 1995; Hobbs, 1989; Newall et al., 1996; Ph.Fr.X, 1990; Reynolds, 1993; Upton, 1997; USSR X, 1973).

In Germany, St. John's Wort is listed in the German Drug Codex, approved as a medicine in the Commission E monographs, and licensed as a standard medicinal tea infusion (Banz, 1998; Braun et al., 1997; DAC, 1991; Meyer-Buchtela, 1999; Schilcher, 1997; Wichtl and Bisset, 1994). It is used in psychiatric drugs in forms including dampoule (Hyperforat�), coated tablet (LI 160, Jarsin�, Lichtwer Pharma, Berlin), juice (Kneipp� Johanniskraut Pflanzensaft N), tea (Kneipp� Johanniskraut-Tee), and tincture (Psychotonin�M). It is used in some urological preparations affecting micturition (e.g., Inconturina�) (Kneipp�, 1996; Schilcher, 1997; Wichtl and Bisset, 1994).

In German pediatric medicine, St. John's Wort aqueous infusions, alcoholic fluid extracts, and some proprietary products (such as Sedariston�, a combination of St. John's Wort and Valerian (Valeriana officinalis) extracts are used to treat depressive states in young people - ADD, ADHD. For example, St. John's Wort is a component of a sedative tea for children, composed of 30% lemon balm leaf (Mellissa officinalis), 30% lavender flower (Lavandula officinalis), 30% passion flower herb (Passiflora spp.), and 10% St. John's Wort herb (Schilcher, 1997).

In the United States it is used in a wide range of dietary supplements in forms including alcoholic tincture, aqueous infusion (oral), oil infusion (topical), and dry standardized extract in capsules and tablets.

Our new liquid extract has shown to be very popular. St. John's Wort was featured in Newsweek magazine several years ago. They reported that millions of Germans are taking St. Johns Wort. It was featured as a natural Prozac. This potent liquid form is a natural mood booster. It is truly a quality product. ST. JOHN'S WORT helps in supporting the nervous system and bouts with depression.

The FDA is strengthening its warning that the antidepressant Paxil is associated with birth defects when it is taken during the first trimester of pregnancy. The FDA has reclassified the drug, which goes by the generic name paroxetine, as a "Category D" drug for pregnant women.

The classification means that studies in pregnant women have shown that the drug poses a risk to the fetus. Two studies of pregnant women who were taking Paxil during their first trimester have shown that their babies have heart defects at a rate that is twice the norm. The defects most often are holes in the walls of the chambers of the heart, which could require surgery.

60-9 St. John's Wort 450mg 100 capsules $14.95

47-20 St. John's Wort Liquid Extract 1 oz $15.95

47-22 St. John's Wort Liquid Extract 4 oz $39.95

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St. John's Wort Equivalent to World's Best-selling Antidepressant

St. John's wort (Hypericum perforatum L., Clusiaceae) is one of the world's best-researched phytomedicines. One criticism from the medical community, however, has been that most of the clinical research on St. John's wort (SJW) has matched it against the tricyclic antidepressants, rather than newer, more commonly used agents. It should be noted that during the time at which most SJW research was conducted, doctors favored the tricyclic antidepressants. Now, physicians claim that in order for research results to be truly meaningful, SJW must be compared with selective serotonin reuptake inhibitor (SSRI) antidepressants.

The latest clinical trial investigating the antidepressant effects of SJW does just that, by comparing it to fluoxetine (Prozac�) - the world's best selling antidepressant (Schrader, 2000). This German study was funded not by a pharmaceutical company, or by a company that manufacturers SJW extract, but by the German medical insurance system. The results were impressive. The study concluded, "�the two treatments are essentially equipotent in their antidepressant effects." Furthermore, the researchers asserted that there was "�no evidence to suggest an advantage in treating these patients with fluoxetine."

The randomized, double-blind, six-week study involved 240 outpatients from seven different internal medicine practices. One hundred and fourteen participants took fluoxetine at a dose of 20 mg twice daily; 128 took hypericum extract at a dose of 250 mg twice daily. The hypericum extract used in the study (Ze 117, Zeller AG, Switzerland) was a 50 percent ethanolic extract with an herb to extract ratio of 4-7:1. All patients were evaluated by psychiatrists using the Hamilton Depression Scale (HAM-D), a standard test used to evaluate symptoms of depression.

After six weeks of treatment, improvement in the two groups was nearly identical. Beginning with mean HAM-D scores of 19.5 and 19.65 for the fluoxetine and hypericum groups, respectively, at endpoint the two groups had scores of 12.2 and 11.54, respectively. The results were also virtually identical for sub-scores of the depression index. For example, the depression sub-score (4.0 vs. 3.7) and anxiety sub-score (2.7 vs. 2.5.) for SJW and Prozac, respectively, were deemed equivalent, as measured by the latest scientific research model, using what pharmaceutical science considers the best treatment for depression.

Perhaps more importantly, however, safety as measured by this study was far superior for SJW, which caused consistently fewer and less serious side effects. Of all the side effects reported in the study, 72 percent were reported by the fluoxetine group, and only 28 percent by the SJW group. In addition, side effects were much more serious in the fluoxetine group, and included "retching, dizziness, tiredness, anxiety-associated symptoms, and erectile dysfunction." The only significant side effect seen with SJW was gastrointestinal upset, but according to the researchers, this was "mild and did not compromise the efficacy or patient compliance."

On the other hand, the seriousness of side effects with fluoxetine "may have reduced the magnitude of its beneficial effects. Unlike severely depressed patients, those mildly affected are less tolerant of side effects of antidepressants." In fact, the authors pointed out that "patients with mild illnesses are often reluctant to accept treatments that cause side-effects that are as upsetting as the symptoms of their underlying disease." This may be reflected in the dramatic difference in "responder rate" in the study, which was 60 percent in the SJW group and only 40 percent among those taking fluoxetine. "Responders" were defined as those who had a reduction of 50 percent or more in depression score.

The authors summarize the results of this study in a way that clearly outlines the superiority of SJW as the medication of choice for mild to moderate depression. They noted, "A clear advantage of hypericum over fluoxetine with regard to safety seems incontrovertible, whether one considers the overall incidence of side-effects, the number of patients reporting events, or the type of event. The one type of event reported on hypericum, GI disturbance, is still less frequently reported for this treatment than for the synthetic antidepressant. When treating patients with mild to moderate depression, hypericum (in the form of St. John's wort Ze 117 extract tablet) should be considered as one of the first treatment options based upon both efficacy and safety, particularly in cases where treatment is a choice between fluoxetine and hypericum."
The SJW extract used as the test substance is standardized, but this detail was omitted from the research publication. Ze 117 is standardized to 0.5 mg hypericin per 250 mg tablet, according to the manufacturer's CEO (Hasler, 2000). - Rob McCaleb, HRF

[Hasler A. July 12, 2000. Personal communication.
Schrader E. Equivalence of a St. John's wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression. International Clinical Psychopharmacology 2000; 15(2): 61-68.]

Research References for St. John's Wort:

American Herbal Pharmacopoeia (AHP). St. John's Wort, Hypericum perforatum. Quality Control, analytical and therapeutic monograph. Santa Cruz (CA): American Herbal Pharmacopoeia; 1997.

Awang DVC. St. John's wort. CPJ-RPC 1991 Jan: 33-5. Cited in (USP 1998).

Barnes J, Anderson LA, Philipson JD. Herbal Medicines: A Guide for Healthcare Professionals. 2nd ed. London (UK): The Pharmaceutical Press; 2002.

Blumenthal MT, Goldberg A, Brinkmann J, ed. Herbal Medicine: Expanded Commission E Monographs. Boston (MA): Integrative Medicine Communications; 2000.

Bisset G, Wichtl M, eds. Herbal Drugs and Phytopharmaceuticals. 2nd ed. Medpharm GmbH Scientific Publishers. Stuttgart (Gr): CRC Press, 2001.

Brinker F. Herb Contraindications and Drug Interactions. 3rd ed. Sandy (OR): Eclectic Medical Publications; 2001.

British Herbal Pharmacopoeia (BHP). Exeter (UK): British Herbal Medicine Association;1983.

Brockm�ller H, Reum T, Bauer S, et al. Hypericin and pseudohypericin: pharmacokinetics andeffects on photosensitivity on humans. Pharmacopsychiatry 1997 Sept;30 (Suppl 2): 94-101. Cited in (USP 1998).

Chandler F, ed. Herbs: Everyday Reference for Health Professionals. Ottawa (ON): CanadianPharmacists Association and the Canadian Medical Association; 2000.

Chavez ML, Chavez PI. Saint John's wort. In: Monographs on Alternative Therapies. Hosp Pharm 1997; 32:1621-1632.

Cupp MJ. Toxicology and Clinical Pharmacology of Herbal Products. Totowa (NJ): Humana Press Inc.; 2000.

Di Carlo G, Borrelli F, Ernst E, Izzo A. St. John's wort: Prozac from the Plant Kingdom. Trends in Pharmacological Sciences 2001 June; 22(6): 292-297.

European Scientific Cooperative on Phytotherapy (ESCOP). Monographs on the Medicinal Usesof Plant Drugs. Exeter (UK): ESCOP; 1996.

H�nsgen KD, Vesper J, Ploch M. Multicenter double-blind study examining the antidepressant effectiveness of the Hypericum extract LI 160. Journal of Geriatric Psychiatry Neurology 1994; 7(Suppl 1): S12. Cited in (USP 1998).

Harrer G, H�bner WD, Podzuweit H. Effectiveness and tolerance of the Hypericum extract LI 160 compared to Maprotiline: a multicenter double-blind study. Journal of Geriatric Psychiatry Neurology 1994; 7(Suppl 1):S24. Cited in (USP 1998).

Jellin JM, Batz F, Hitchens K, ed. Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database. Stockton (CA): Therapeutic Research Faculty; 2003.

Kasper. Hypercium perforatum - a Review of Clinical Studies. Pharmacopsychiatry 2001 July; 34(1) p. S51 - S55.

Linde K, Ramirez G, Mulrow CD, et al. St. John's wort for depression - an overview and meta-analysis of randomized clinical trials. Br Med J 1996; 313: 253-258.

The Lawrence Review of Natural Products. St. John's wort. 1995 Jan: 1-2. Cited in (USP 1998).

McGuffin M, Kartesz JT, Leung AY, Tucker AO. Herbs of Commerce. 2nd ed. USA: The American Herbal Products Association; 2000.

Olin B, ed. St. John's wort monograph, in Facts and Comparisons. The Lawrence Review of Natural Products. St. Louis (MO): Facts and Comparisons, Inc.; 1995.

Sommer H, Harrer G. Placebo-controlled double-blind study examining the effectiveness of an Hypericum preparation in 105 mildly depressed patients. Journal of Geriatric Psychiatry Neurology, 1994; 7(Suppl 1): S9. Cited in (USP 1998).

Tyler VE. The Honest Herbal. New York (NY): Pharmaceutical Products Press;1993.

USDA, ARS, National Genetic Resources Program. Germplasm Resources Information Network - (GRIN). Hypericum perforatum [Internet] [National Germplasm Resources Laboratory, Beltsville, Maryland, cited December 12 2003]. Available from:

USP Botanical Monograph Series (USP). Hypericum (St. John's wort). The United States Pharmacopoeial Convention Inc.;1998.

Vorbach EU, H�bner WD, Arnoldt KH. Effectiveness and tolerance of the Hypericum extract LI 160 in comparison with Imipramine: randomized double-blind study with 135 outpatients. J Geriatr Psychiatry Neurol 1994;7( Suppl 1): S19-S23.

Woelk H, Burkard G, Gr�nwald J. Benefits and risks of the Hypericum extract LI 160: drug monitoring study with 3250 patients. J Geriatr Psychiatry Neurol 1994; 7(Suppl 1): S34-S38. Cited in (USP 1998).


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