St. John’s Wort ( Hypericum Perforatum ) is a shrubby plant with clusters of yellow flowers that have oval elongate petals. Its name is related to the date that the plant reaches its full bloom which is round 24 of June. The latter date is normally celebrated St. John’s the Baptists birthday. It can reach up to 80cm. It is abundant in valleys, hills, fences and generally in the wild. St. John’s Wort was once believed to ward off evil and relieve the body from evil spirits. In ancient Greece it was used for a wide range of ailments, including sciatica and poisonous reptile bites. Also comprised a folk remedy for kidney and lung ailments but its potential use was in neurological disorders.The most frequent application in medicine is against depression.

Active ingredient – mechanism

The major constituents in St. John’s wort include hypericin and other dianthrones, flavonoids, xanthones, and hyperforin. While it was previously thought the antidepressant actions of St. John’s wort were due to hypericin and the inhibition of the enzyme monoamine oxidase, current research has challenged this belief, focusing on other constituents, such as hyperforin, and flavonoids.

From a phytochemical point of view, St John’s wort is one of the best-investigated medicinal plants. A series of bioactive compounds has been detected in the crude material, namely flavonol derivatives, bioflavones, proanthocyanidines, phloroglucinols and naphthodianthrones. Although St John’s wort has been subjected to extensive scientific studies in the last decade, there are still many open questions about its pharmacology and mechanism of action. Initial biochemical studies reported that St John’s wort inhibits the synaptosomal uptake of serotonin, dopamine and noradrenaline (norepinephrine) with approximately equal affinity. This action is possibly due to the constituent hyperforin. St. John’s wort is able to act as an antidepressant, by making more of these neurotransmitters available to the brain.

Use and directions

There is a plethora of studies, St. John’s wort has been effective in reducing depressive symptoms in those with mild to moderate but not severe (called major) depression. When compared with tricyclic anti-depressants (medication frequently prescribed for this condition) such as imipramine, amitriptyline, doxepin, desipramine, and nortriptyline, St. John’s wort is equally effective, and has fewer side effects. This also appears to be true for another well known class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) including fluoxetine and sertraline. Yet it has to challenge the SNRIs ( Seretonine Noradrenaline Reuptake Inhibitors) like venlafaxine and duloxetine.

The herb is also use to reduce symptoms of alcoholism and possibly other forms of addiction.

In laboratory studies, St. John’s wort has demonstrated the ability to fight certain infections, including some bacteria that are resistant to the effects of antibiotics. More research is needed in this area to understand if these test tube findings will prove useful for people.
An early study suggests that St. John’s wort may be useful in relieving both physical and emotional symptoms of PMT (pre-menstrual tension)including cramps, irritability, food cravings, and breast tenderness.
Herbal specialists may recommend use of a tincture containing a combination of ginkgo, St. John’s wort, and rosemary to relieve symptoms associated with recovery from brain inflammation (viral encephalitis) such as cognitive impairment, visual and speech disturbances, and difficulty performing routine functions.

Used alone, St. John’s wort has improved mood in those suffering from SAD (a form of depression that occurs during the winter months because of lack of sunlight). This condition is often treated with photo (light) therapy. Effects may prove to be even greater when the herb is used in combination with light therapy.

Topical St. John’s wort is, at times, recommended by herbal specialists to reduce pain and inflammation and to promote healing by applying the agent directly to the skin. Preliminary laboratory tests are suggesting that this traditional use may have scientific merit.
Dose and directions

St. John’s wort can be obtained in many forms: capsules, tablets, tinctures, teas, and oil-based skin lotions. Chopped or powdered forms of the dried herb are also available. St. John’s wort products should be standardized to contain 0.3% hypericin.

• Dry herb (in capsules or tablets): The usual dose for mild depression and mood disorders is 300 to 500 mg (standardized to 0.3% hypericin extract), three times per day, with meals.
• Liquid extract (1:1): 40 to 60 drops, two times per day.
• Tea: Pour one cup of boiling water over 1 to 2 tsp of dried St. John’s wort and steep for 10 minutes. Drink up to 2 cups per day for four to six weeks.
• Oil or cream: To treat inflammation, as in wounds, burns or hemorrhoids, an oil-based preparation of St. John’s wort can be applied topically.

Internal dosages generally require at least eight weeks toget the full therapeutic effect.

Warnings – Precautions

People with a history of manic-depressive illness (bipolar disorder) or a less severe condition known as hypomania, should avoid use of St. John’s wort as it may trigger a manic episode.

St. John’s wort should not be taken by women who are pregnant, trying to become pregnant, or breastfeeding.

While laboratory research suggests that St. John’s wort may kill or inhibit the growth of human immunodeficiency virus (HIV; the virus that causes AIDS), St. John’s wort has serious interactions with medications used to treat people with the virus by reducing their effectiveness and causing intolerable side effects.

Because of the potential for serious interaction with medications used during surgery, patients should discontinue the use of St. John’s wort at least 5 days prior to surgery and should avoid taking it post surgery. Those under high doses will have to withdraw gradually from treatment earlier than 5 days.

Potential side effects from St. John’s wort are generally mild. They include stomach upset, hives or other skin rash, fatigue, restlessness, headache, dry mouth, and feelings of dizziness or mental confusion. Although not common, St. John’s wort can also make the skin overly sensitive to sunlight (called photodermatitis). Those with light skin who are taking St. John’s wort in large doses or over a long period of time should be particularly careful about sun exposure.

Contraindications – interactions with other medicine

It is likely that there are many drug interactions with St. John’s wort that have not yet been identified. St. John’s wort stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that metabolizes at least 50% of the drugs on the market .
Do not take St. John’s Wort along with:

Antidepressants,Digoxin,Immunosuppressive medications,indinavir and other protease inhibitors
Contraceptive pill,loperamide,reserpine,Fluvoxamine,statins,nefadozone,omeprazole, venzodiazepines,chemeotherapy, cyclosporine, digoxine, fluoxetine, ,fosamprenavir,paroxetine,phenelzine,sertraline,theophuylline/aminophylline,trazodone, , SSRIs, SNRIs(venlafaxine,duloxetine), tricyclic antidepressant and warfarin.

Note :

Dear Reader, St. John’s wort could potentially interfere with a large number of medications. Individuals taking any medication should, therefore, consult with a physician before taking St. John’s wort.

Furthermore, depression is a complex matter and itself is less likely treated solely by pharmaceutical means. Psychotherapy is imperative to reduce the possibility of reoccurrence in conjunction with relaxation/exercise methods. It is worthwhile mentioning the three main types of psychotherapy which are : interpersonall, cognitive-behavioral, and psychodynamic.

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