St. John’s Wort

substances in St. John’s Wort that are shown to have biological activity.
Describe the prevalence of depression in America.

moderate depression compared to placebo.
Describe the main concern of St. John’s Wort intake with regard to drug interactions.

insomnia, and headaches.
Used on first degree burns and healing of other wounds.

around St. John’s day and wort is an Old English term for plant.
Plant name: Hypericum
Perforatum
Traditional Uses:
Anti-inflammatory, Sedative,
Diuretic, Anti-malarial,
Vulnerary

shown to have biological activity.

daily.
Nature’s Way 350 mg .3% hypericin – take 2 daily.

during which there is either depressed mood or the loss of interest or pleasure in nearly all activities and 4 additional symptoms:
Change in appetite or weight
Change in sleep
Change in psychomotor activity
Decreased energy
Feelings of worthlessness or guilt
Difficulty thinking, concentrating, or making decisions
Recurrent thoughts of death

at least 2 other symptoms with history of depressed mood for at least 2 years.

in women than men.
Costing the nation
44 billion/year.

or norepinephrine
Substances having positive effects on depression should impact levels of these neurotransmitters

serotonin uptake in post-synaptic receptors from a reduction in serotonin receptors.
Decreased uptake of dopamine and norepinephrine by SJW has been observed.

fatigue, and insomnia.
Symptoms not as common with SJW.
SJW is less expensive

Double-Blind, Randomized, Multicentre Study Human Psychopharmacology (1998) 13

Specific Aim
Evaluate the clinical efficacy of hypericum extract
against placebo.
Study Design
Prospective, double-blind, randomized, placebo-
controlled, multicenter study
Subjects
162 patients (54 men, 108 women)
>18 years old
With mild to moderate depression (16-24 HAMD score)

Double-Blind, Randomized, Multicentre Study Human Psychopharmacology (1998) 13

Treatment
2 x 250 mg/day ZE117 .5mg hypericin or placebo
6 weeks
Compliance
Monitored by providing medication in a MEMS-4 container, which has a built in computer chip to record opening dates and times.
Outcome Measures
Hamilton Depression Score – improvement of 50% from baseline or a total score of 10 or less.

Double-Blind, Randomized, Multicentre Study Human Psychopharmacology (1998) 13

Results
Compliance rate of 88.9%
Mean HAMD Scores
Placebo group 18.76 → 17.89
Active group 20.13 → 10.53
Demonstrates that hypericum extract is an effective treatment for mild to moderate depression.

A double-blind, placebo-controlled trial The American Journal of Psychiatry (2002) 159:8

Specific Aim
Investigate the antidepressant efficacy and safety of Hypericum perforatum extract.
Study Design
Double-blind, placebo-controlled, multi-center trial.
Subjects
Age 18 to 65
Had a current major depressive episode meeting the DSM-IV criteria
HAMD score between 18 and 25
375 patients

A double-blind, placebo-controlled trial The American Journal of Psychiatry (2002) 159:8

Treatment
3 x 300 mg/day .12-.28% hypericin or placebo
6 weeks
Outcome Measures
HAMD 50% lower than at baseline

A double-blind, placebo-controlled trial The American Journal of Psychiatry (2002) 159:8

Results
Percent of responders was significantly higher for St. John’s Wort (52.7%) than for placebo (42.3%).
Adverse Effects
SJW: 30% Placebo: 37%

Trial JAMA (2002) 287:14

Specific Aim
To test the efficacy and safety of a well characterized Hypericum Perforatum extract in major depressive disorder.
Study Design
Randomized, double-blind, parallel group, outpatient trial of hypericum, sertraline, or placebo treatment.
Subjects
Outpatients meeting DSM-IV criteria
Minimum score of 20 on HAMD
340 patients

Trial JAMA (2002) 287:14

Treatment
900 mg/day .12-.28% hypericin or
Sertraline or
Placebo
8 weeks
Could receive increased amounts after weeks 3 or 4 if CGI score was above 3 or 4.
Outcome Measures
Clinical Global Impressions Scales for Severity (CGI) score of 1 or 2 and
Decrease in HAMD score at least 50% and
HAMD score of 9 to 12

Trial JAMA (2002) 287:14

Results
Full response rates at acute phase exit did not differ between placebo and either hypericum or sertraline.
Study fails to support efficacy of H Perforatum in moderately severe major depression.

trials British Medical Journal (1996)

Objective
To investigate if extracts of St. John’s wort are more effective than placebo in the treatment of depression, are as effective as standard antidepressive treatment and have fewer side effects than standard antidepressant drugs.
Trials
23 randomized trials including total of 1757 outpatients with mild or moderately severe depressive disorders. 15-placebo controlled, 8-compared with another drug treatment.

trials British Medical Journal (1996)

Treatment
Hypericin varied .4 to 2.7 mg
300 mg to 1000 mg
4 to 8 weeks

trials British Medical Journal (1996)

Hypericum vs. Placebo
HAMD: significant effect of hypericum over placebo. Average 4.4 points better.
Hypericum vs. Standard Antidepressants
HAMD scores slightly better with hypericum than standard

trials British Medical Journal (1996)

Side Effects
Hypericum 19.8%
Standard 52.8%
Conclusion
Good evidence that hypericum is better than placebo. Insufficient evidence that SJW works as well as antidepressants.

to physicians from Committee on Safety of Medicine

with possible loss of HIV suppression
Warfarin
Reduced anticoagulant effects and need for increased dose
Cyclosporin
Reduced blood levels with risk of transplant rejection

risk of unintended pregnancy
Anticonvulsants
Reduced blood levels with risk of seizures
Digoxin
Reduced blood levels and loss of control of heart rhythm or heart failure

of control of asthma
Triptans & SSRIs
Increased serotonergic effects with increased incidence of adverse reaction