Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-20T15:34:42.816Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2007

Monica Nangia ,
Waqar Syed  and
P Murali Doraiswamy
Monica Nangia
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
Waqar Syed
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
P Murali Doraiswamy*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
*
*Corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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.

Keywords

HypericumMajor depressionClinical trialsAdverse eventsDrug interactionsHyperforin
Type
Research Article
Information
Public Health Nutrition , Volume 3 , Supplement 4a , December 2000 , pp. 487 - 494
Copyright
Copyright © CABI Publishing 2000

References

1Majeroni, BA, Hess, A.The pharmacologic treatment of depression. J. Am. Board Fam. Pract. 1998; 11 2, 127–39.CrossRefGoogle ScholarPubMed
2Gaster, B, Holroyd, J.St John's wort for depression. Arch. Intern. Med. 2000; 160, 152–6.Google Scholar
3Upton, R. St. John's wort (Hypericum perforatum). American Herbal Pharmacopia (AHP). Santa Cruz: American Herbal Pharmacopia (published in herbalgram 40), 1999 1–32.Google Scholar
4Schulz, V, Hubner, WD, Ploch, M.Clinical trials with phyto-psychopharmacological agents. Phytomedicine 1997; 4(4): 379–87.CrossRefGoogle ScholarPubMed
5Leung, AY, Foster, S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. New York: John Wiley & Sons, second edition, 1996.Google Scholar
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.Google Scholar
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), 36–43.Google Scholar
8Cott, JM. In vitro receptor binding and enzyme inhibition by Hypericum perforatum extract. Pharmacopsychiatry 1997 30(Suppl. 2): 108–12.Google Scholar
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.Google Scholar
10Muller, WE, Rossol, R.Effects of hypericum extract on expression of serotonin. J. Geriatr. Psychiatry Neurol. 1994; 7(Suppl. 1): S63–4.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
14Miller, AL. St. John's wort (Hypericum perforatum); Clinical effects on depression and other conditions. Alt. Med. Rev. 1998; 33 1: 18–26.Google Scholar
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.CrossRefGoogle Scholar
16Nahrstedt, A, Butterweck, V.Biologically active and other chemical constituents of Hypericum perforatum. Pharmacopsychiatry 1997; 30, 129–34.CrossRefGoogle ScholarPubMed
17Chatterjee, SS. Antidepressant activity of Hypericum perforatum and hyperforin: the neglected possibility. Pharmacopsychiatry 1998; 31 (Suppl. 1): 7–15.Google Scholar
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.Google Scholar
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.Google Scholar
20Muller, WE, Singer, A, Wonnemann, M, Hafner, U, Rolli, M, Schafer, C.Hyperforin represents the neurotransmitter reuptake inhibiting constituent of hypericum extract. Pharmacopsych. 1998; 16–21Google Scholar
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.Google Scholar
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: 199–202.Google Scholar
23Yu, PH. Effect of the Hypericum perforatum extract on serotonin turnover in the mouse brain. Pharmacopsych. 2000; 33 2: 60–5.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.CrossRefGoogle Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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): 77–80.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.CrossRefGoogle Scholar
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.Google Scholar
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.Google Scholar
34Kaspar, S.Treatment of seasonal affective disorder (SAD) with Hypericum extract. Pharmacopsych 1997; 30 (Suppl. 2): 89–93Google Scholar
35Wheatley, D.Hypericum in Seasonal Affective Disorder (SAD). Curr. Med. Res. Opin. 1999; 15 1: 33–7.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
38Moses, EL, Mallinger, AG. St. John's wort: Three cases of possible mania induction. J. Clin. Psychopharmacol. 2000; 20 1: 115–17.Google Scholar
39Gordon, JB. SSRI and St. John's wort: possible toxicity? Am. Fam. Physician 1998; 57: 950–3.Google Scholar
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): 94–101.CrossRefGoogle ScholarPubMed
41Bove, GM. Acute neuropathy after exposure to sun in a patient treated with St. John's wort. Lancet 1998; 352: 1121–2.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
45Ernst, E.Second thoughts about safety of St. John's wort. Lancet 1999; 354: 1014–15.Google Scholar
46Yue, Q-Y, Bergquist, C, Gerden, B.Safety of St. John's wort. Lancet 2000; 355 9203: 576–7.CrossRefGoogle ScholarPubMed
47Piscitelli, SC, Burstein, AH, Chaitt, D.Indinavir concentrations and St John's wort. Lancet 2000; 355 9203: 547–8.CrossRefGoogle ScholarPubMed
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.Google Scholar
49Lantz, MS, Buchalter, E, Giambanco, V.St. John's wort and antidepressant drug interactions in the elderly. J. Geriatr. Psychiatry Neurol. 1999; 12: 7–10Google Scholar
50Cupp, MJ. Herbal remedies: adverse effects and drug interaction. Am. Fam. Physician 1999; 59: 1239–44.Google Scholar
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.Google Scholar
52Woelk, H.Comparison of St John's wort and imipramine for treating depression. BMJ 2000; 321 7260: 536–9.CrossRefGoogle ScholarPubMed