2005. Awaiting revision 2008
St John's Wort
St John's Wort has been used since the
middle ages as a valuable relaxing herb. It also has
long-lasting tonic effects on the whole Nervous System.
Its main properties are:
ANTI-DEPRESSANT Well-Proven Benefits
This is what most people know St John's Wort for - it has become the
product of choice for mild to moderate depression. We
examine this in detail below.
MENOPAUSE Some Strong Evidence of Benefits St John's
Wort has proven very helpful during menopause.
Clinical Study
In a clinical study in Germany, 111 women aged from 43-65 years
were given 12 weeks treatment with St John's Wort at standard
dosage. In 75-80% of women, their menopausal symptoms
diminished or disappeared completely - an amazing
result! In addition, the St John's Wort was also reported to
improve 'sexual well-being'. (Advances in Therapy 1999 Jul-
Aug;16(4):177-86)
The results of this study sound - let's be honest - a bit too
good to be true; but there must be something in them. It must
be worth trying St John's Wort if you are approaching or in the
menopause. Please let us know your experiences.
One question I'd ask would be: "Were the benefits maintained
when the women stopped taking St John's Wort?"
I suspect they were not maintained completely - but it
certainly sounds as if St John's Wort could be a good bet for
reducing the symptoms of menopause - and making you feel
better, at least in the short to medium-term.
If this is so, it would be preferable to combine it with a
herbal formula aimed more at balancing the hormone system
deeper down. In other words, aimed more at the cause of
the menopausal symptoms. Such a formula would include a
balanced mixture of herbs such as Carbenia (blessed thistle),
Agnus Castus, Dong Quai, Smilax (Sarsaparilla), Licorice,
Mitchella (Squaw Vine), and other herbs.
NERVE TONIC Very Well Respected by Herbalists
St John's Wort is a persistent, gentle
nerve tonic, boosting the whole Nervous System when taken
regularly over an extended period say for 3-6 months. If
long-term stress has led to nervous exhaustion, St John's
Wort will often help, slowly but surely, to building the
energy level back up towards normal.
This long, slow building up of energy via the nervous system is
something shared by a few other valuable Western herbs, such as
Verbena (Vervain) and Scutellaria (Scullcap). The value of such
herbs is that they calm the Nervous System while they build it
up. This is an opposite effect to that of sedative drugs, which
can certainly calm the nervous system, but have no tonic
powers.
After taking sedative drugs, the Nervous System is weakened,
and the Liver stressed - because it has to deal with the
drugs in the blood stream, which are treated more or less as
poisons by the body. This weakening of the liver by medicinal
drugs just makes matters worse for the poor old nerves and the
emotional balance of the body - both of which are affected
tremendously by the health of the Liver.
There is certainly a place for drugs in our 'ideal healthcare'
system - especially in emergency situations. But herbal and
similar remedies are a better answer in many - in fact, most -
situations where drugs are used today. Especially as no drugs
have yet been found which have a tonic effect on the body -
they are all debilitating. For tonics, you have to use
alternative therapy.
DEPRESSION AND ST JOHN'S
WORT
On to the best known use for St John's Wort - that of helping banish
depression.
St John's Wort is generally recommended for cases of mild to
moderate depression. (There don't seem to have been any studies
of St John's Wort being used in cases of
severe depression.)
In Germany, St John's Wort has been prescribed for depression
by doctors for decades. In 1994 alone, 66 million doses of the
herb were taken.
In fact, St John's Wort is a 'quasi-drug' in that
country; in that it is packaged like a drug, produced by
pharmaceutical companies, and prescribed widely by
doctors.
News of St John's Wort's benefits has slowly filtered out to
the rest of Europe so that in the UK, for example, hardly a day
goes by without an article in the papers about St John's Wort
and depression.
How Much Evidence Is
There?
Lots. Many studies have been performed where St
John's Wort has been tested against a placebo - ie a sugar
tablet; and against a standard drug widely used for
depression.
The results are generally that:
- St John's Wort is
considerably better than a placebo at
alleviating mild to moderate
depression. In other words, it is not
just 'suggestion' that makes people
taking St John's Wort feel less
depressed.
- It is equally as good, or
nearly as good, as the drug it is
compared with in the studies carried
out, but has few or no side effects.
This is a very important point, as
doctors - and members of the public -
are very aware of the many side
effects of many common
anti-depressant drugs - not least,
addiction.
- What the studies should say
(but it is hard to measure, so I am
going to add it as point '3' anyway!)
is that St John's Wort actually
builds up the Nervous System -
as discussed above. So, in this
respect, it is superior to
anti-depressive drugs, which tend to
weaken the body. This is a vital
point! These drugs often make you
walk around in a semi-catatonic state
- and who wouldn't be weakened after
a few months of that? Whereas St
John's Wort has a centuries-old
tradition of strengthening the
Nervous System while it reduces
depression - a valuable combination
indeed.
So, if you take drugs for
depression, you are basically zapped into
'suspended animation' for a few months,
then re-emerge, probably with less energy,
to fight the battle of life again. I know
some people are delighted with a short
course of drugs for depression. But I would
argue that St John's Wort would
help the majority of those with mild to
moderate depression just as well - and
probably better, because of its other
advantages.
This may be a bit of an over-simplification;
but the general argument is sound.
STUDIES
Where a scientific study has
been carried out, it is usually fairly dense
and hard to interpret for most of us mortals.
So it is useful to see a summary of the study.
This is often provided by the team who
performed the study, and is called an
scientific 'extract'. Here are links to a few
scientific extracts from studies involving
St John's Wort and
depression.
(NB Where a URL below is on two lines, you will
probably need to paste them into your browser
text window without a line break for the
link to work. When you paste, make sure there
is no space inserted - browsers don't like
'em!)
1.
www.botanical.com/botanical/mgmh/s/sajohn06.html
2.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=Pub
Med&list_uids=10647752&dopt=Abstract
3.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=Pub
Med&list_uids=10625118&dopt=Abstract
4.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=Pub
Med&list_uids=10591711&dopt=Abstract
In general, these scientific extracts support
the points above.
PREPARATIONS OF ST JOHN'S
WORT
Standardised Extracts
Basically, I do not like standardised extracts.
I prefer whole herbs.
What is a standardised extract?
Someone decides what the 'main active
ingredient' is - out of the dozens of
components of a herb. Well, this is ridiculous
for a start. A herb is a synergistic blend of
all of its components; and the 'whole' is
greater than the sum of its parts. In other
words - don't mess about with it - use the
whole, natural plant.
In fact, 'standardisation' is a method used by
scientific bods so they can say - with
precision - such things as:
'327 people were given an extract of xxxxxx
herb, standardised to 0.05% of xxx ingredient,
three times a day for 18 days, and 27% noticed
such and such happened.'
The whole Alternative Health movement is
pro-holistic healthcare, and anti-'science for
science's sake'. In other words - science has
its place - but don't lets be silly about
it.
A good question for those who are in favour of
'standardised extracts' is, "You have made an
extract of a herb which contains a specified
amount of one of the ingredients. Fine. But -
what have you left out of your extract,
which a holistic herbalist might prefer was
left in?
I say - use the whole herb!
CAUTIONS
What do you have to be
careful of when using St John's Wort?
There have been no reported large scale
reactions to St John's Wort - but there have
been a small number of reactions reported among
people taking the herb.
- Drug
Interactions
There are queries hanging
over St John's Wort with regard
to a number of drugs; particularly
anti-depressants, hypertensive (high
blood pressure) drugs, warfarin, AIDS
medication, and the contraceptive
pill.
The concern with anti-depressants,
hypertensive drugs, and warfarin is that St
John's Wort may possibly raise blood
pressure, leading to an increased chance of
a stroke. With the contraceptive pill and
AIDS drugs, there is some indication that
St John's Wort may
reduce effectiveness of the drugs.
It is true that there is a very long
history of use of St John's Wort in Europe
- and only a tiny number of cases of
strokes among St John's Wort users have
been reported. However, they are there, and
until or unless St John's Wort is cleared
of all implication, it would be wise to
avoid taking this herb with any drugs at
all, including the contraceptive pill.
If you wish to switch to St John's Wort from
an antidepressant drug, consult a doctor
for advice on how to achieve this
safely. As a minimum, close monitoring
of blood pressure would be
desirable.
Recommendation Do not take St John's
Wort together with drugs.
If changing to St John's Wort from
antidepressant drugs, do so only under the
supervision of a doctor or other qualified
person who is closely monitoring your blood
pressure.
- Epilepsy
It is accepted in
scientific literature that
anti-depressant drugs can cause fits
in susceptible people. There have
been a small number of anecdotal
reports of epileptic fits occurring
in patients taking St John's
Wort.
As the herb has anti-depressant properties,
it is recommended that it be avoided where
there are epileptic tendencies.
Recommendation Do not take
St John's Wort if
you have epilepsy, or a tendency towards
fits or seizures.
- Photosensitivity
In other words - sensitivity to light.
St John's Wort can - rarely - cause a rash
when the skin is exposed to the sun. The
hypericin from St John Wort travels to the
skin where, in a few individuals, the sun
changes it to an itchy compound which
causes the rash.
There are only a very small number of
reported cases of this reaction; but it
does happen. Where it has happened, when
the St John's Wort has been discontinued,
the rash disappears.
Recommendation If you are taking
St John's Wort use
extreme caution when in the sun, and do
not use a sun bed, in case you are one
of the minority who could develop
photosensitivity. If you begin to
develop a rash and have been in the sun,
stay in the shade and discontinue the
use of St John's Wort until the rash
clears up.
- Cataract
There was a report in New Scientist
recently which stated that the
photosensitive properties of the hypericin
in St John's Wort could promote cataracts
in rats. There are no reports of the same
occurring in humans.
Recommendation As a precaution, the
researchers recommend that if you are in
the sunshine, you should wearing
'UV-resistant' wrap-around sunglasses, if
you are taking St John's Wort. Sunlight
shining on the eyes is a cause of cataract
in any case, so this is good advice to
follow whether or not you are taking St
John's Wort.
DOSAGE
The usual dosage of raw herb (ie not
'standardised extract'), is:
Capsules
1 capsule 3 times a day.
Herbal Fluid Extract (1:1)
10-15
drops 3 times a day in water or juice, (This
form of the herb is not a standardised extract
- which is a powder. It is a liquid preparation
- usually alcoholic - where 1 litre of the
liquid has been made with 1 kilo of the herb.
Hence the '1:1'.)
Herbal Tincture
1/2 teaspoon, 3 times
a day in water or juice. A herbal tincture is
made with 250-350g of herb steeped in a litre
of alcohol. So it is 3-4 times weaker than the
equivalent fluid extract.
Extract standardised to 0.3%
hypericin
Follow the instructions on the
pack - usually 2 or 3 capsules a day. The
advantage of a standardised extract is that the
quality control is more assured than for most
preparations of the raw herb. But bear in mind
that hypericin is now thought - fairly
certainly - NOT to be one of the main active
ingredients in this herb! So the fact that a
preparation is standardised for a percentage of
hypericin is irrelevant!
SUMMARY
St John's Wort is a
valuable herb with a long history of safe
use in Europe.
It is valuable for:
-
Mild
to
moderate
depression,
-
Symptoms
associated
with
the
menopause,
-
Building
up
the
Nervous
System.
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However, it appears that it can be a very
active herb in some circumstances, so we advise
the following:
Do not take St John's Wort without
thorough investigation if;
-
You
are
any
taking
certain
drugs
-
namely
anti-depressants,
warfarin
or
other
blood-thinning
medication,
AIDS
medication,
or
the
contraceptive
pill.
For a
UK
government-approved
list
of
medications
to
avoid,
and
advice
on
what
to do
if
you
are
already
taking
St
John's
Wort
and
you
are
already
taking
one
of
these
medications,
-
You
have
a
tendency
to
suffer
from
any
type
of
fit.
-
You
are
going
to
use a
sun
bed,
or to
sunbathe.
Use
with
caution
if
you
live
in a
hot
country,
or if
travelling
to a
hot
country,
and
discontinue
the
herb
at
the
first
sign
of a
skin
rash
developing.
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Resources
St John's
Wort
herbs
Nerve
herbs
A herbal
90-day Nerve
Programme
An article
about St John's Wort
and Menopause
----------------------
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