St. John's Wort : Health Benefits

by MedlinePlus

Extracts of Hypericum perforatum L. (St. John's wort) have been recommended traditionally for a wide range of medical conditions. The most common modern-day use of St. John's wort is the treatment of depression. Numerous studies report St. John's wort to be more effective than placebo and equally effective as tricyclic antidepressant drugs in the short-term treatment of mild-to-moderate major depression (1-3 months). It is not clear if St. John's wort is as effective as selective serotonin reuptake inhibitor (SSRI) antidepressants such as sertraline (Zoloft®).

Recently, controversy has been raised by two high-quality trials of St. John's wort for major depression that did not show any benefits. However, due to problems with the designs of these studies, they cannot be considered definitive. Overall, the scientific evidence supports the effectiveness of St. John's wort in mild-to-moderate major depression. The evidence in severe major depression remains unclear.

St. John's wort can cause many serious interactions with prescription drugs, herbs, or supplements. Therefore, people using any medications should consult their healthcare professional and pharmacist prior to starting therapy.

Synonyms

Amber touch-and-heal, balm-of-warrior's wound, balsana, bassant, Blutkraut, bossant, corancillo dendlu, devil's scorge, Eisenblut, flor de Sao Joa, fuga daemonum, goatweed hartheu, heofarigo on herba de millepertius, herba hyperici, herrgottsblut, hexenkraut, hierba de San Juan, hipericao, hiperico hipericon, Johanniskraut, klammath weed, liebeskraut, LI 160, lord God's wonder plant, millepertius pelicao, perforate, pinillo de oro, rosin rose, tenturotou, Teufelsflucht, touch and heal Walpurgiskraut, witcher's herb, WS 5572.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence

Depressive disorder (mild-to-moderate)

St. John's wort has been extensively studied in Europe over the last two decades, with more recent research in the United States. Short-term studies (1-3 months) suggest that St. John's wort is more effective than placebo (sugar pill), and equally effective as tricyclic antidepressants (TCAs) in the treatment of mild-to-moderate major depression. Comparisons to the more commonly prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac®) or sertraline (Zoloft®), are more limited. However, other data suggest that St. John's wort may be just as effective as SSRIs with fewer side effects. Safety concerns exist as with most conventional and complementary therapies.

Anxiety disorder

Several studies in patients with depression report that in addition to effects on depression, St. John's wort may also reduce anxiety symptoms. There is one study of St. John's wort (in a combination product with valerian), which specifically treated people with anxiety. It is important to realize that valerian alone is often used to treat anxiety, and therefore any effects of the combination product may be due to valerian and not to St. John's wort. Overall, there is currently not enough evidence to recommend St. John's wort for the primary treatment of anxiety disorders.

Atopic dermatitis

Early study of hypericum-cream c in the topical treatment of mild to moderate atopic dermatitis shows positive results. The therapeutic efficacy of the hypericum-cream, however, has to be evaluated in further studies with larger patient populations, in comparison to therapeutic standards (i.e. glucocorticoids, before a firm recommendation can be made.

Depressive disorder (severe)

Studies of St. John's wort for severe depression have not provided clear evidence of effectiveness. A recent study reported that neither St. John's wort nor the SSRI drug sertraline (Zoloft®) provided benefits over placebo for severe depression. Other recent well-designed research has suggested no benefit of St. John's wort for severe depression, although the evidence is still not completely clear in this area.

Obsessive-compulsive disorder (OCD)

There are a few reported cases of possible benefits of St. John's wort in patients with obsessive-compulsive disorder (OCD). However, due to a lack of large, controlled studies comparing St. John's wort to placebo or drugs, there is currently not enough scientific evidence to recommend St. John's wort for this condition.

Peri-menopausal symptoms

Several small studies suggest possible benefits of St. John's wort for psychological symptoms experienced around menopause. However, there is currently not enough scientific evidence to recommend St. John's wort for this indication.

Premenstrual syndrome (PMS)

One small study suggests that St. John's wort may be effective in reducing symptoms of premenstrual syndrome (PMS). Further studies are needed before a recommendation can be made.

Seasonal affective disorder (SAD)

Despite some promising early data, there is currently not enough evidence to recommend St. John's wort for depressive disorder with seasonal pattern or Seasonal Affective Disorder (SAD).

Human immunodeficiency virus (HIV)

Anti-viral effects of St. John's wort have been observed in laboratory studies, but were not found in one human study. Multiple reports of significant adverse effects and interactions with drugs used for HIV/AIDS, including protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), suggest that patients being treated for HIV/AIDS should avoid this herb. Therefore, there is evidence to recommend against using St. John's wort in the treatment of patients with HIV/AIDS.

Social phobia

Results of early study fail to provide evidence for the efficacy of St. John's wort in social phobia.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Abdominal discomfort or irritation, alcoholism, allergies, anti-inflammatory, antiviral, athletic performance enhancement, bacterial skin infections (topical), bedwetting, bruises (topical), benzodiazepine withdrawal, burns (topical), cancer, chronic bowel irritation, chronic ear infections, dental pain, diarrhea, diuretic (increasing urine flow), Epstein-Barr virus infection, fatigue, glioma, heartburn, hemorrhoids, herpes virus infection, influenza, insomnia, joint pain, liver protection from toxins, malaria treatment, menstrual pain, nerve pain, pain relief, rheumatism, skin scrapes, snakebites, sprains, ulcers, wound healing (topical).

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