The New Healing Herbs:

SAINT JOHN'S WORT

The Premier Herbal Antidepressant

Family: Hypericaceae; other members include rose of Sharon

Genus and species: Hypericum perforatum

Also known as: Hypericum

Parts used: Leaves and flowers

"Wort" is Old English for "plant." St. John's wort has been used in herbal healing for more than 2,000 years, most notably as a treatment for wound. Today, it is more popular than ever--in fact, one of the nation's top-selling herbal medicines--because of the discovery in the 1980s that it is as potent an antidepressant as pharmaceutical antidepressant medication. Before the herb became a popular antidepressant, annual sales worldwide totaled around $10 million a year. Now they top $550 million.

Saint's Beheading

The leaves and flowers of St. John's wort contain special glands that release a red oil when pinched. Early Christians named the plant in honor of John the Baptist, because they believed it released its blood-red oil on August 29, the anniversary of the saint's beheading.

In the first century, the Roman naturalist Pliny prescribed St. John's wort steeped in wine as a cure for the bites of poisonous snakes. And the Greek physician Dioscorides recommended it externally for burns and internally as a diuretic, menstruation promoter, and treatment for sciatica and recurring fevers (malaria). The Greeks and Romans also believed the herb was a protector against witches' spells.

Christians adopted the pagan belief that St. John's wort repelled evil spirits and burned it in bonfires on St. John's Eve, June 23, to purify the air, drive away evil spirits, and ensure healthy crops. This poem from around 1400 summed up the popular view:

St. John's wort doth charm all witches away
If gathered at midnight on the saint's holy day.
Any devils and witches have no power to harm
Those that gather the plant for a charm.
Rub the lintels with that red juicy flower;
No thunder nor tempest will then have the power
To hurt or hinder your house; and bind
Round your neck a charm of a similar kind.

"A Most Precious Remedy"

Under the Doctrine of Signatures, the medieval belief that herbs' physical appearance revealed their healing value, red plants were believed to be good treatment for bleeding wounds, and "the juicy red flower" of St. John's wort was no exception. In the 16th century John Gerard recommended it as a "most precious remedy for deepe wounds," and wrote the herb "provoketh urine and is right good against stone in the bladder. "

The first London Pharmacopoeia in 1618 advised chopping St. John's wort flowers, immersing them in oil, and placing the mixture in the sun for three weeks. The resulting tincture was a standard treatment for wounds and bruises for several hundred years.

Seventeenth-century English herbalist Nicholas Culpeper called St. John's wort "a singular wound herb; boiled in wine and drank, it healeth inward hurts or bruises; made into an ointment, it opens obstructions, dissolves swellings, and closes up the lips of wounds.... [It] helpeth all manner of vomiting and spitting blood [tuberculosis]."

Treatment for Wounds

Early colonists introduced St. John's wort into North America but found the Indians using the native American herb in much same way Europeans used the Old World plant--as a tonic and treatment for diarrhea, fever, snakebite, wounds, and skin problems.

Nineteenth-century botanical medicine authority Charles Millspaugh, M.D., touted St. John's wort's value as a wound treatment during the Civil War: "Lacerations of parts rich in nerves yield nicely to this drug." Millspaugh railed against the orthodox physicians of his day ("regulars"), who dismissed the herb as "obsolete," saying "any homeopathic physician of at least three months practice can attest to its merits." Throughout the 19th century, homeopathy was as popular as orthodox medicine, and homeopaths prescribed the herb for a variety of ailments: wounds, asthma, bites, sciatica, diarrhea, hemorrhoids, and certain forms of paralysis. Contemporary homeopaths continue this tradition.

America's 19th-century Eclectic physicians, forerunners of today's naturopaths, also considered St. John'swort a useful wound treatment and tetanus preventive and advocated the whole herb as a treatment for "hysteria" (menstrual discomforts) because of its "undoubted power over the nervous system and spinal cord."

Contemporary herbalists generally recommend St. John's wort only as an antidepressant, but for this indication they are enthusiastic. Some suggest it for treatment of viral illnesses, notably HIV and herpes.

HEALING with St. John's Wort

St. John's wort has been intensively researched. It contains hypericin, the source of its antidepressive action. It also contains antiviral compounds and immune-boosting chemicals, known as flavonoids, that explain its action against viral, bacterial, and fungal infections.

ANTIDEPRESSANT. In the early 1980s, German researcher discovered that hypericin interferes with the activity of a compound in the body known as monoamine oxidase (MAO), making it an MAO inhibitor. MAO inhibitors are an important class of antidepressant drugs. In small pilot studies in German, people with mild to moderate depression obtained significant relief after taking St. John's wort, including mood elevation, improved self-esteem, greater interest in life, increased appetite, and more normal sleep patterns. Herbalists began recommending the herb for depression, but it did not rocket to prominence until 1996.

That year, German researchers published a meta-analysis of human studies (clinical trials) in the prestigious British Medical Journal. Meta-analysis is a statistical technique that allows the results of small studies to be combined as if they'd all been one large study. (In medical research, one large study is more compelling than several small ones.) The meta-analysis included 23 trials (13 testing the herb against a placebo) involving 1,757 adults with mild-to-moderate depression. Combining the results, in the placebo group, 22 percent enjoyed significant mood elevation, but among those taking St. John's wort, the figure was 55 percent.

Since then, many more studies have shown that St. John's wort is an effective antidepressant. In 1999, researchers at the University of Hawaii School of Medicine performed another meta-analysis of six rigorously scientific trials that had been conducted since the earlier report. Again, St. John's wort provided significant benefit.

How beneficial is the herb? The Hawaii researcher concluded that it was as effective as one standard class of pharmaceutical antidepressant medication, the tricyclics. German researchers then compared St. John's wort to Prozac (fluoxetine), the best-known of today's most popular class of pharmaceutical antidepressants, the selective serotonin reuptake inhibitors (SSRI's). Half of the 161 participants with mild-to-moderate depression received the drug (20 mg/day), the other half, the herb (400 mg twice a day). After six weeks, the two treatments produced comparable results--significant mood elevation in 72 percent of those taking Prozac, and 71 percent of the St. John's wort group. The herb produced somewhat fewer side effects.

St. John's wort is generally recommended for mild-to-moderate depression, but at least one study shows that it also helps treat severe depression.

In addition, the herb is beneficial for those with seasonal affective disorder (SAD), winter depression caused by short day length and lack of exposure to sunlight. British researchers gave 301 SAD sufferers either standard medical light therapy (exposure to ultrabright light) or light therapy plus St. John's wort. Both treatments produced significant mood elevation, and although the light-plus-herb treatment was slightly more beneficial, the difference between that approach and St. John's wort by itself was not statistically significant, suggesting that the herb alone might suffice for SAD sufferers who have difficulty taking the time for light treatment.

Initially, hypericin was dubbed an antidepressant because it appeared to be an MAO inhibitor. Those who take pharmaceutical MAO inhibitors must refrain from eating a large number of foods, or face unpleasant side effects. However, many people taking St. John's wort did not observe these food restrictions, but did not develop MAO side effects. German researchers have discovered why: Although hypericin resembles an MAO inhibitor, it is chemically more complicated and similar to an SSRI, meaning no food restrictions.

However, like pharmaceutical antidepressants, you have to be patient with St. John's wort. According to German medical herbalist Rudolph Fritz Weiss, M.D., the benefit "does not develop quickly.... [and may take as long as] two or three months."

Commission E, the expert panel that judges the safety and effectiveness of herbal medicines for the German counterpart of the Food and Drug Administration, approves St. John's wort for treatment of depresssion. According to a 19976 report in the New York Tiems, in Germany, the herb outsells Prozac four-to-one.

ANTIVIRAL. Hypericin is active against a broad range of viruses, among them: influenza, herpes, polio, hepatitis C, and HIV, the virus that causes AIDS. The herb's "dramatic" activity against HIV, discovered in 1988 by researchers at New York University and the Weizmann Institute in Israel, caused a stampede of AIDS sufferers to health food stores for the herb. Some have reported benefits including increased immune function. As this book goes to press, a hypericin-based AIDS drug is in clinical trials. However, enthusiasm for hypericin has waned since the late-1990s introduction of the powerful AIDS drugs known as protease inhibitors.

ANTIBACTERIAL. Hypericin also helps combat several bacteria.

WOUND HEALING. Several studies support St. John's wort's traditional use in wound healing. Hypericin and other antibiotic and anti-inflammatory compounds in the herb's red oil help prevent wound infection and speed healing. One German study showed that compared with conventional treatment, a St. John's wort ointment substantially cut the healing time of burns and caused less scarring. (This product is not available in the United States.) Commission E approves topical application of St. John's wort preparations for treatment of minor wound and burns.

Rx for St. John's Wort

For treatment of depression, buy a standardized extract and follow the label directions in consultation with a physician.

For wound treatment, apply crushed leaves and flowers to the affected area after you have cleaned it with soap and water. Or apply a tincture.

For AIDS treatment, consult a physician.

St. John's wort should not be given to children under age 2. For older children and people over 65, start with low-strength preparations and increase strength if necessary.

The Safety Factor

In livestock fed large amounts of St. John's wort, the hypericin concentrates near the skin and causes sun sensitivity (photosensitization) and blistering sunburn. Laboratory animals injected with large doses of hypericin have died after exposure to sunlight. As a result of these findings, in 1977, the Food and Drug Administration declared St. John's wort "unsafe." The FDA presumed that humans would develop the same reactions. Time has proven the FDA's concerns unfounded. Millions of people use St. John's wort to treat depression, but the medical literature contains very few reports of photosensitization, and none of serious sun-related harm. On the other hand, if you have fair, sensitive skin or have become photosensitive when using other medications, take extra precautions when out in the sun.

AIDS patients report that the herb is relatively nontoxic, but some have reported sun sensitivity, drowsiness, nausea, and diarrhea.

St. John's wort oil may irritate sensitive skin.

Other Cautions

Do not take St. John's wort in combination with any other antidepressant medication without first consulting your physician.

Don't take St. John's wort if you have HIV and are already taking any of the protease inhibitor (PI) medications. The interaction interferes with the PI.

Do not take St. John's wort if you are taking cyclosporine to control organ transplant rejection. The herb may interfere with the drug.

For healthy adults who are not pregnant, not nursing, not taking antidepressants, PIs, or cyclosporine, St.John's-wort is considered safe in amounts typically recommended.

St. John's wort should be used in medicinal amounts only in consultation with your doctor. If anny unusual symptoms develop while taking St. John's wort, use less or stop using it. If symptoms persist, consult your physician promptly.

Flowers That "Bleed"

St. John's wort is a woody, invasively spreading perennial that reaches 2 feet and has an aroma reminiscent of turpentine. Its leaves are dotted with glands that produce a red oil. Its striking star-shaped flowers bloom bright yellow in summer. They also contain the leaf oil, and when pinched, turn red.

St. John's wort is best propagated from root divisions in spring or fall. It grows in almost any well-drained soil under full sun or partial shade. Contain the herb to control its spread. Although it is a perennial, St. John's wort is not particularly long lived. Replant it every few years.

Harvest the leaves and flower tops as the plants bloom. Dry them and store in airtight containers.