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Efficacy and safety of St. John's wort for the treatment of major depression

  • Monica Nangia (a1), Waqar Syed (a1) and P Murali Doraiswamy (a1)
Abstract
Objective

Extracts of St. John's wort have been widely used in the treatment of depression. Our aim was to review information related to the efficacy and safety of St. John's wort as an antidepressant.

Data sources

Primary and review articles were identified by a search of Medline (1960 to February 2000) and through secondary sources.

Study selection

All the articles identified from the data sources were evaluated and all relevant information was included in this review. The pharmacokinetics, mechanism of action, efficacy, side effects and drug interactions of St. John's wort have been examined in various studies.

Conclusion

St. John's wort is a promising investigational antidepressant, but the data are not yet sufficient to accept hypericum as a first line antidepressant preparation for treatment of depression. Besides the need for dose standardization and adequate trial lengths, there is a need for studies in severely depressed patients and long-term studies to assess the risk of relapse and recurrence.

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Corresponding author
*Corresponding author: Email murali@acpub.duke.edu
References
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1Majeroni, BA, Hess, A.The pharmacologic treatment of depression. J. Am. Board Fam. Pract. 1998; 11 2, 127–39.
2Gaster, B, Holroyd, J.St John's wort for depression. Arch. Intern. Med. 2000; 160, 152–6.
3Upton, R. St. John's wort (Hypericum perforatum). American Herbal Pharmacopia (AHP). Santa Cruz: American Herbal Pharmacopia (published in herbalgram 40), 1999 132.
4Schulz, V, Hubner, WD, Ploch, M.Clinical trials with phyto-psychopharmacological agents. Phytomedicine 1997; 4(4): 379–87.
5Leung, AY, Foster, S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. New York: John Wiley & Sons, second edition, 1996.
6Staffeldt, B, Kerb, R, Brockmoller, J, Ploch, M, Roots, I.Pharmacokinetics of hypericin and pseudohypericin after oral intake of the Hypericum perforatum extract LI 160 in healthy volunteers. J. Geriatr. Psychiatry Neurol. 1994; 7(Suppl. 1): S47–53.
7Biber, A, Fischer, H, Romer, A and Chatterjee, SS. Oral bioavailability of hyperforin from hypericum extracts in rats and human volunteers. Pharmacopsychiatry 1998; 31 (Suppl. 1), 3643.
8Cott, JM. In vitro receptor binding and enzyme inhibition by Hypericum perforatum extract. Pharmacopsychiatry 1997 30(Suppl. 2): 108–12.
9Muller, WE, Rolli, M, Schafer, C, Hafner, U.Effects of Hypericum extract (LI 160) in biochemical models of antidepressant activity. Pharmacopsychiatry 1997; 30(Suppl. II), 102–7.
10Muller, WE, Rossol, R.Effects of hypericum extract on expression of serotonin. J. Geriatr. Psychiatry Neurol. 1994; 7(Suppl. 1): S63–4.
11Teufel-Mayer, R, Gleitz, J.Effects of long term administration of hypericum extracts on the affinity and density of central serotonergic 5-HT1 A and 5-HT2 A receptors. Pharmacopsychiatry 1997; 30(Suppl. 2): 113–16.
12Baureithel, KH, Buter, 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 3: 153–7.
13Raffa, RB. Screen of receptor and uptake-site activity of hypericin component of St. John's wort reveals sigma receptor binding. Life Sci. 1998 62 16: 265–70.
14Miller, AL. St. John's wort (Hypericum perforatum); Clinical effects on depression and other conditions. Alt. Med. Rev. 1998; 33 1: 1826.
15Bennet, DA, Phun, L, Polk, JF, Voglino, SA, Raffa, RB. Neuropharmacology of St. John's Wort (Hypericum). Review [Tutorial]. Ann. Pharmacother. 1998; 32 11:, 1201–8.
16Nahrstedt, A, Butterweck, V.Biologically active and other chemical constituents of Hypericum perforatum. Pharmacopsychiatry 1997; 30, 129–34.
17Chatterjee, SS. Antidepressant activity of Hypericum perforatum and hyperforin: the neglected possibility. Pharmacopsychiatry 1998; 31 (Suppl. 1): 715.
18Singer, 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. Ther. 1999; 290 3: 1363–8.
19Laakmann, 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 1998; 31 (Suppl. 1): 543–9.
20Muller, WE, Singer, A, Wonnemann, M, Hafner, U, Rolli, M, Schafer, C.Hyperforin represents the neurotransmitter reuptake inhibiting constituent of hypericum extract. Pharmacopsych. 1998; 1621
21Chatterjee, S, Filippov, V, Lishko, P, Maximyuk, O, Noldner, M, Krishtal, O.Hyperforin attenuates various ionic conductance mechanisms in the isolated hippocampal neurons of rat. Life Sci. 1999 65 22, 2395–405.
22Kaehler, ST, Sinner, C, Chatterjee, SS, Philippu, A.Hyperforin enhances the extracellular concentrations of catecholamines, serotonin and glutamate in the rat locus coeruleus. Neurosci. Lett. 1999; 262 3: 199202.
23Yu, PH. Effect of the Hypericum perforatum extract on serotonin turnover in the mouse brain. Pharmacopsych. 2000; 33 2: 60–5.
24Calapai, G, Crupi, A, Firenzuoli, F.Effects of Hypericum perforatum on levels of 5-hydroxytryptamine, noradrenaline and dopamine in the cortex, diencephalon and brainstem of the rat. J. Pharm. Pharmacol. 1999; 51 6: 723–8.
25Franklin, M, Chi, J, McGavin, C.Neuroendocrine evidence for dopaminergic actions of hypericum extract (L1 160) in healthy volunteers. Biol. Psychiatry 1999; 46 4: 581–4.
26Linde, K, Ramirez, G, Mulrow, CD. St John's wort for depression – an overview and meta-analysis of randomized clinical trials. Br. Med. J. 1996; 313, 253–8.
27Kim, HL, Streltzer, J, Goebert, D.St. John's wort for depression: a meta-analysis of well-defined clinical trials. J. Nerv. Ment. Dis. 1999; 87 9: 532–8.
28Linde, K, Murlow, CD. St John's wort for depression. The Cochrane Database of Systematic Reviews. The Cochrane Library, The Cochrane Collaboration, 1999, vol. 4.
29Wheatley, D.LI 160, an extract of St. John's wort, versus amitriptyline in mildly to moderately depressed outpatients – a controlled 6-week clinical trial. Pharmacopsych. 1997; 30 (Suppl. 2): 7780.
30Holsboer-Trachsler, E, Vanoni, C.Clinical efficacy and tolerance of the hypericum, special extract LI 160 in depressive disorders – a drug monitoring study 19. Schweiz. Rundsch. Med. Prax. 1999; 88 370: 1475–80.
31Schrader, E.Equivalence of St. John's wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild to moderate depression. Int. Clin. Psychopharmacol. 2000; 15 2, 61–8.
32Harrer, G, Schmidt, U, Kuhn, U, Biller, A.Comparison of equivalence between the St. John's wort extract LoHyp and fluoxetine. Arzneimitt.-Forsch. 1999; 49 4: 289–96.
33Volz, HP, Laux, P.Potential treatment for subthreshold and mild depression: a comparison of St. John's wort extracts and fluoxetine. Compr. Psychiatry 2000; 41 2 (Suppl. 1): 133–7.
34Kaspar, S.Treatment of seasonal affective disorder (SAD) with Hypericum extract. Pharmacopsych 1997; 30 (Suppl. 2): 8993
35Wheatley, D.Hypericum in Seasonal Affective Disorder (SAD). Curr. Med. Res. Opin. 1999; 15 1: 33–7.
36Woelk, 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): S34–8.
37Ernst, E, Rand, JI, Barnes, J, Stevinson, C.Adverse effects profile of the herbal antidepressant St. John's wort (Hypericum perforatum). Eur. J. Clin. Pharmacol. 1998; 54 8: 589–94.
38Moses, EL, Mallinger, AG. St. John's wort: Three cases of possible mania induction. J. Clin. Psychopharmacol. 2000; 20 1: 115–17.
39Gordon, JB. SSRI and St. John's wort: possible toxicity? Am. Fam. Physician 1998; 57: 950–3.
40Brockmoller, 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): 94101.
41Bove, GM. Acute neuropathy after exposure to sun in a patient treated with St. John's wort. Lancet 1998; 352: 1121–2.
42Bernd, A, Simon, S, Ramirez, BA. Phototoxic effects of Hypericum extracts in cultures of human keratinocytes compared with those of psoralen. Photochem. Photobiol. 1999; 69 2: 218–21.
43Czekalla, J, Gastpar, M, Hubner, WD, Jager, D.The effects of hypericum extract on cardiac conduction as seen in the electrocardiogram compared to that of imipramine. Pharmacopsychiatry 1997; 30 (Suppl. 2): 86–8.
44Leuschner, J.Preclinical toxicological profile of Hypericum extract LI 160. Presented at the Second International Congress on PhytomedicineMunich, Germany11–14 September 1996; Abstract SL 80.
45Ernst, E.Second thoughts about safety of St. John's wort. Lancet 1999; 354: 1014–15.
46Yue, Q-Y, Bergquist, C, Gerden, B.Safety of St. John's wort. Lancet 2000; 355 9203: 576–7.
47Piscitelli, SC, Burstein, AH, Chaitt, D.Indinavir concentrations and St John's wort. Lancet 2000; 355 9203: 547–8.
48Markowitz, JS, DeVane, CL, Boulton, DW, Carson, SW, Nahas, Z, Risch, SC. Effect of St. John's wort (Hypericum perforatum) on cytochrome P-450 2D6 and 3A4 activity in healthy volunteers. Life Sci. 2000; 66 9: 133–9.
49Lantz, MS, Buchalter, E, Giambanco, V.St. John's wort and antidepressant drug interactions in the elderly. J. Geriatr. Psychiatry Neurol. 1999; 12: 710
50Cupp, MJ. Herbal remedies: adverse effects and drug interaction. Am. Fam. Physician 1999; 59: 1239–44.
51Johne, A, Brockmoller, J, Bauer, S, Maurer, A, Langheinrich, M, Roots, I.Pharmacokinetic interaction of digoxin with a herbal extract from St. John's wort (Hypericum perforatum). J. Clin. Pharm. Ther. 1999; 66 4, 338–45.
52Woelk, H.Comparison of St John's wort and imipramine for treating depression. BMJ 2000; 321 7260: 536–9.
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