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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