Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-16T22:23:10.173Z Has data issue: false hasContentIssue false
  • English
  • Français

St. John's Wort:Clinical Status in Psychiatry

Published online by Cambridge University Press:  07 November 2014

Samantha E. Meltzer-Brody
Get access Rights & Permissions [Opens in a new window]

Abstract

Depression and anxiety are among the top 10 health problems for which complementary and alternative therapies (CATs) are most frequently used, and medicinal herbs are among the most popular of these treatments. St. Johns wort(Hypericum perforaturn) is a perennial herb that has become a widely used depression therapy. Extracts of hypericum have shown affinity for receptors within multiple neurochemical systems. The primary active substance responsible for the antidepressant effect is not well defined, but most work has concentrated specifically on the hypericin and hyperforin components. Although hypericum has demonstrated significant antidepressant and antianxiety effects in multiple studies, there are several recent studies that do not support the previous evidence. In all reported studies, hypericum extracts have been well tolerated. In addition, new psychiatric uses for hypericum in obsessive-compulsive disorder, generalized anxiety disorder, menopausal symptoms, and alcohol dependence have been reported. Because patients are choosing to pursue CAT as a first-line therapy, psychiatrists will need to have a better understanding of phytomedicines used for treating depression and anxiety, and thus be better prepared to serve as effective allies of their patients.

Type
Feature Articles
Information
CNS Spectrums , Volume 6 , Issue 10: Empirical Evaluations of Selected Herbal Remedies , October 2001 , pp. 835 - 840
Copyright
Copyright © Cambridge University Press 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Eisenberg, DM, Kessler, RC, Foster, C, et al. Unconventional medicine in the United States. N Engl J Med. 1993;328:246–252.CrossRefGoogle ScholarPubMed
2. Ernst, E, Rand, JI, Stevinson, C. Complementary therapies for depression. Arch Gen Psychiatry. 1998;55:1026–1032.CrossRefGoogle ScholarPubMed
3. Astin, JA. Why patients use alternative medicine: results of a national study. JAMA. 1998;279:1548–1553.CrossRefGoogle ScholarPubMed
4. Eisenberg, DM, Davis, RB, Ettner, SL, et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA. 1998;280:1569–1575.CrossRefGoogle ScholarPubMed
5. Kessler, RC, Soukup, J, Davis, RB, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Arch Gen Psychiatry. 2001;158:289–294.Google ScholarPubMed
6. Upton, R. St. John's Wort (Hypericum perforatum) American Herbal Pharmacopia. Santa Cruz, CA: American Herbal Pharmacopia (published in herbalgram 40), 1999;1–32.Google Scholar
7. Blumenthal, M, Busse, WR, Goldberg, A, et al. , eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998.Google Scholar
8. Physicians Desk Reference for Herbal Medicines, 2nd ed. Montvale, NJ: Medical Economics Company; 2000.Google Scholar
9. National Center for Complementary and Alternative Medicine. St. John's Wort fact sheet (publication Z-02). National Institutes of Health, Bethesda, Md; 1999.Google Scholar
10. Greeson, JM, Sanford, B, Monti, DA. St. John's wort (hypericum perforatum): a review of the current pharmacological, toxicological and clinical literature. Psychopharmacology (Berl). 2001;153:402–414.CrossRefGoogle ScholarPubMed
11. Gaster, B, Holroyd, J. St. John's wort for depression: a systematic review. Arch Intern Med. 2000;160:152–156.CrossRefGoogle ScholarPubMed
12. Wagner, H, Bladt, S. Pharmaceutical quality of Hypericum extracts. J Geriatr Psychiatry Neurol. 1994;7(suppl 1) S65–68.CrossRefGoogle ScholarPubMed
13. Nangia, M, Syed, W, Doraiswamy, PM. Efficacy and safety of St. John's wort for the treatment of major depression. Public Health Nutr. 2000;3:487–494.CrossRefGoogle ScholarPubMed
14. Suzuki, O, Katsumata, Y, Oya, M, et al. Inhibition of monoamine oxidase by hypericin. Planta Medicine. 1984;50:272–274.CrossRefGoogle ScholarPubMed
15. Cott, JM. In vitro receptor binding and enzyme inhibition by hypericum perforatum extract. Pharmacopsychiatry (Berl). 1997;30(suppl 2):108–112.CrossRefGoogle ScholarPubMed
16. Chatterjee, SS, Noldner, M, Kode, E, et al. Antidepressant activity of hypericum perforatum and hyperforin: the neglected possibility. Pharmacopsychiatry (Berl). 1998;31(suppl 1):7–15.CrossRefGoogle ScholarPubMed
17. Singer, A, Wonnemann, M, Miller, WE. Hyperforin, a major antidepressant constituent of St. John's Wort, inhibits serotonin uptake by elevating free intracellular Na+. J Pharmacol Exp Therapy. 1999;290:1363–1368.Google Scholar
18. Kaehler, ST, Sinner, C, Chatterjee, SS, Philippu, A. Hyperforin enhances the extracellular concentrations of catecholamines, serotonin and glutamate in the rate locus ceruleus. Neurosci Lett. 1999;262:199–202.CrossRefGoogle Scholar
19. Laakmann, G, Schule, C, Baghai, T, Kieser, M. St. John's wort in mild to moderate depression: the relevance of hyperforin for the clinical efficacy. Pharmacopsychiatry (Berl). 1998;31:54–59CrossRefGoogle ScholarPubMed
20. Thiede, HM, Walper, A. Hypericin inhibition of MAO and COMT by hypericum extracts and hypercin. J Geriatr Psychiatry Neurol. 1994;7(suppl 1):S54–56.CrossRefGoogle Scholar
21. Bladt, S, Wagner, H. Inhibition of MAO by fractions and constituents of Hypericum extract. J Geriatr Psychiatry Neurol. 1994;7(suppl 1):S57–59.CrossRefGoogle Scholar
22. Cott, J. Medical plants and dietary supplements: sources for innovative treatments or adjuncts? Psychopharmacol Bull. 1995;31:131–137.Google ScholarPubMed
23. Muller, WE, Rolli, M, Schafer, C, Hafner, U. Effects of hypericum extract (LI 160) in biochemical models of antidepressant activity. Pharmacopsychiatry. 1997;30(suppl 2):102–107.CrossRefGoogle ScholarPubMed
24. Rolli, M, Schafer, C, Muller, WE. Effect of hypericum extract (LI 160) on neurotransmitter receptor binding and synaptosomal uptake systems. Pharmacopsychiatry (Berl). 1995;28:207.Google Scholar
25. Neary, JT, Bu, Y. Hypericum LI 160 inhibits uptake of serotonin and norepinephrine in astrocytes. Brain Res. 1999;816:358–363.CrossRefGoogle ScholarPubMed
26. Schrader, E, on behalf of the Study Group. Equivalence of St. John's wort extract and fluoxetine: a randomized controlled study in mild-moderate depression. Int Clin Psychopharmacol. 2000;15:61–68.CrossRefGoogle Scholar
27. Baureithel, KH, Butner, KB, Engesser, A, Bukard, W, Schaffer, W. Inhibition of benzodiazepine in vitro by amentoflavone, a constituent of various species of hypericum. Pharm Acta Helv. 1997;72:153–157.CrossRefGoogle ScholarPubMed
28. Thiele, B, Brink, I, Ploch, M. Modulation of cytokine expression by Hypericum extract. J Geriatr Psychiatry Neurol. 1994;7(suppl l):S60–62.CrossRefGoogle ScholarPubMed
29. Miller, AL. St. John's wort (Hypericum perforatum); Clinical effects on depression and other conditions. Altern Med Rev. 1998;33:18–26.Google Scholar
30. Franklin, M, McGavin, C, Reed, A, Cowen, PJ. Effect of hypericum perforatum on salivary cortisol in health male volunteers. J Psychopharmacology. 1998;30:A16.Google Scholar
31. Raffa, RB. Screen of receptor and uptake-site activity of hypericin components of St. John's wort reveals sigma receptor binding. Life Sci. 1998;62:265–270.CrossRefGoogle ScholarPubMed
32. Linde, K, Ramirez, G, Mulrow, CD, Pauls, A, Weidenhammer, W, Melchart, D. St. John's wort for depression—overview and meta-analysis of randomized clinical trials. BMJ. 1996;313:253–258.CrossRefGoogle Scholar
33. Shelton, RC, Keller, MB, Gelenberg, A, et al. Effectiveness of St. John's wort in major depression: a randomized controlled trial. JAMA. 2001;285:1978–1986.CrossRefGoogle ScholarPubMed
34. Linde, K, Mulrow, CD. St. John's wort for depression. The Cochrane Database of Systematic Reviews. The Cochrane Library, The Cochrane Collaboration, 1999, vol4.Google Scholar
35. Kim, HL, Streltzer, J, Goebert, D. St. John's wort for depression: A meta analysis of well-defined clinical trials. J Nerv Ment Dis. 1999;187:532–538.CrossRefGoogle ScholarPubMed
36. Volz, HP, Laux, P. Potential treatment for subthreshold and mild depression: a comparison of St. John's wort extracts and fluoxetine. Compr Psychiatry. 2000;41(suppl 1):133–137.CrossRefGoogle ScholarPubMed
37. Woelk, H. Comparison of St. John's wort and imipramine for treating depression: randomized controlled trial. BMJ. 2000;321:536–539.CrossRefGoogle Scholar
38. Wheatley, D. LI 160, an extract of St. John's wort versus amitriptyline in mildly to moderately depressed outpatients—a controlled 6-week clinical trial. Pharmacopsychiatry (Berl). 1997;30(suppl 2):77–80.CrossRefGoogle ScholarPubMed
39. Montgomery, SA, Hubner, WD, Grigoleit, HG. Efficacy and tolerability of St. John's wort extract compared to placebo in patients with a mild to moderate depressive disorder. Phytomedicine. 2000;7:107.Google Scholar
40. Vorbach, EU, Arnoldt, KH, Hubner, WD. Efficacy and tolerability of St. John's wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD-10. Pharmacopsychiatry (Berl). 1997;30(suppl 2):81–5.CrossRefGoogle ScholarPubMed
41. Taylor, LVH, Kobak, KA. An open-label trial of St. John's wort (Hypericum perforatum) in obsessive-compulsive disorder. J Clin Psychiatry. 2000;61:575–578.CrossRefGoogle ScholarPubMed
42. Davidson, JRT, Connor, KM. St. John's wort in generalized anxiety disorder: three case reports. J Clin Psychopharmacology. In press.Google Scholar
43. Grube, B, Walper, A, Wheatley, D. St. John's wort extract: efficacy for menopausal symptoms of psychological origin. Adv Ther. 1999;16:177–186.Google ScholarPubMed
44. Rezvani, AH, Overstreet, DH, Yang, Y, Clark, E. Attenuation of alcohol intake by extract of hypericum perforatum (St. John's wort) in two different strains of alcohol-preferring rats. Alcohol Alcohol. 1999;34:699–705.CrossRefGoogle ScholarPubMed
45. Woelk, H, Burkard, G, Grunwald, 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.CrossRefGoogle ScholarPubMed
46. Brockmoller, J, Reum, T, Bauer, S, Kerb, R, Hubner, WD, Roots, I. Hypericin and pseudohypericin: pharmacokinetics and effects on photosensitivity in humans. Pharmacopsychiatry. 1997;30(suppl 2):94–101.CrossRefGoogle ScholarPubMed
47. Bove, GM. Acute neuropathy after exposure to sun in a patient treated with St. John's wort. Lancet. 1998;352:1121–1122.CrossRefGoogle Scholar
48. Gulick, RM, McAuliffe, V, Holden-Wiltse, J, et al. Phase I studies of hypericin, the active compound in St. John's Wort, as an antiretroviral agent in HIV-infected adults. AIDS Clinical Trials Group Protocols 150 and 258. Ann Intern Med. 1999;130:510–514.CrossRefGoogle Scholar
49. Czekalla, J, Gastpar, M, Hubner, WD, Jager, D. The effect of hypericum extract on cardiac conduction as seen in the electrocardiogram compared to that of imipramine. Pharmacopsychiatry (Berl). 1997;30(suppl 2):86–88.CrossRefGoogle ScholarPubMed
50. Nierenberg, A, Burt, T, Matthews, J, Weiss, A. Mania associated with St. John's wort. Biol Psychiatry. 1999;46:1707–1708.CrossRefGoogle ScholarPubMed
51. Moses, EL, Mallinger, AG. St. John's wort: Three cases of possible manic induction. J Clin Psychopharmacol. 2000;20:115–117.CrossRefGoogle Scholar
52. Davidson, JRT, Connor, KM. Herbs for the Mind: What Science Tells Us About Nature's Remedies for Depression, Stress, Memory Loss and Insomnia. New York, NY: Guilford Publications; 2000.Google Scholar