ST. JOHN’S WORT (Hypericum perforatum) - Overview
St. John’s wort (Hypericum perforatum) belongs to
the family Hypericaceae, which consists of eight
genuses and about 350 species. St. John’s wort is a
plant whose leaves are whorled, gland-dotted, simple, and
usually smooth-margined. Its flowers are five-petalled and
yellow with many stamens, which are often united in bundles.
St. John’s wort was first known to be used in the Crusades
to treat battle wounds. Contemporary research supports this,
with various diseases proving Hypericum’s worth in aiding all
types of topical wounds in their healing and recovery. It is
specifically used for putrid leg ulcers that are difficult to heal,
and is used to treat many varying septic wounds, boils, and
inflammation in cellulite and lymphangitis.1
For centuries, St. John’s wort has been used to treat disor-ders of mood and temperament.” Modern research is also
backing this up, with several very recent studies demonstrating
St. John’s wort’s ability to treat mild and moderate forms
of depression as well and with fewer side effects as the standard
antidepressant drugs used.
Recent investigation is also revealing St. John’s wort to be
helpful for a number of other disorders. Among them is
AIDS/HIV, a disease that leads several age/gender groups in
cause of death. But St. John’s wort is being researched for its
ability to hinder viral growth and production, perhaps making
it key to at least treating the virus, if not able to cure the
disease. Hypericum is being used for treatment research of
several other virus-caused diseases as well.
Another area in which St. John’s wort is showing great
promise is that of cancer. Various forms of cancers and
growths have been successfully treated with therapies including
Hypericum or hypericin (one of its compounds). And the
list goes on and on. St. John’s wort is certainly an herb worth
investigating for its seeming abilities to combat various disorders
prevalent among us. ...
HYPERICIN
One of the reasons St. John’s wort is attracting so much
interest is because of one of its compounds, hypericin. The
journal Photochemistry-Photobiology recently published a
review of hypericins and the structurally related hypocrellins,
giving a favorable outline of the various recent breakthroughs in medicine using these two compounds. The review states,
Hypocrellins and hypericins, structurally related plant pigments
isolated from Hypocrella bambuase and Hypericum respectively,
are known photodynamic agents. This review summarizes
certain significant advances in the phtotophysics, photochemistry
and photobiology of these pigments in the last two years
and discusses their prospects as novel therapeutic and diagnostic
agents in the future . . . In particular, substantial progress has
been made in both anticancer and antiviral applications (especially
anti-human immunodeficiency virus). . . . The biomedical
advances of hypocrellins and hypericins have been further
promoted by significant progress in their chemical synthesis and
the recent commercialization of . . . hypericins.2
The compound hypericin was isolated from St. John’s
wort in 1942 and has been used as an anti-depressant and
mood stabilizer for emotionally and mentally disturbed people.
Among its many beneficial qualities is that of increasing
blood flow to stressed tissue, thereby having a tranquilizing
effect. It also reduces the fragility of capillaries and enhances
uterine muscle tone because of its ability to increase blood
flow.3 It is this compound that is being extensively researched
for its possible therapeutic properties for a variety of diseases,
mainly depression, AIDS and other viruses, cancer and sleep
disorders.
Extensive research has been done, especially recently, to
determine exactly how hypericin works in treating these and
other disorders. Nearly all the researchers are saying the same thing—that Hypericum (and specifically hypericin) promi ...Hypericin’s Photodynamic Ability
One of hypericin’s qualities that enhances its ability to act
therapeutically is that of being photodynamic; that is, its different
qualities are either initiated by the presence of light or
enhanced by it. Most of the contemporary studies dealing
with hypericin have in some way or another dealt with how
hypericin performs in its various functions when exposed to
light. A 1995 study published in Photochemistry-Photobiology
touts hypericin’s therapeutic actions in the viral and cancer
worlds, especially when exposed to light. A 1994
Laryngyscope study suggested that hypericin has shown the
ability to be an effective photosensitizer for certain forms of
human cancer. And a 1994 Photochemistry-Photobiology study
states that “the photocytocidal activity of this quinone on
neoplastic cells is superior to that of antitumor
anthraquinone drugs, such as daunomycin and mitoxanthrone
. . .”4
The list goes on and on. The consensus seems to be that
not only does hypericin possess various therapeutic properties,
but that these properties are usually augmented by the presence of light.
...THERAPEUTIC APPLICATIONS OF ST. JOHN’S WORT DEPRESSION—AN OVERVIEW
Depression is a disorder that affects millions of people,
both Americans and worldwide. It takes many forms, but is
usually marked by sadness, inactivity and heightened selfdepreciation.
Hopelessness and pessimism are often common
symptoms, as are lowered self-esteem, reduced energy and
vitality, and loss of the overall capability to enjoy one’s existence.
Depression is probably the most common psychiatric
complaint offered to doctors, and has been described by
physicians from at least the time of Hippocrates, who called
it “melancholia.” The course the disorder runs varies widely
from person to person. Depression may be short-term, or
may occur repeatedly at short intervals. It may be somewhat
permanent, mild or sever, acute or chronic. And who does
depression most affect? Rates of incidence are higher among
women than men (for varying reasons, some not totally
understood). And men are more at risk of suffering from
depression as they age, while a woman’s peak age for experi-encing depression is usually between the ages of 35-45.
Depression is caused by many things—it could come
about because of childhood traumas, or because of stressful
life events—but more and more, doctors and scientists are
pointing to biochemical processes as a main culprit in the
onset of depression. Defective regulation of the release of one
or more naturally occurring monoamines in the brain—particularly
norepinephrine—leads to reduced quantities or
reduced activity of these chemicals in the brain, bringing on
the depressed mood for most sufferers.
Accompanying the increase in depression cases and the
emerging knowledge of its causes has been the rise of drug
and other therapies in treating the disorder. The two most
important are drug therapy and psychotherapy.
Psychotherapy aims to resolve any underlying psychic conflicts
that may be causing the depressed state, while giving
emotional ...DEPRESSION—STANDARD AND ALTERNATIVE TREATMENTS
Depression is a commonly occurring disorder; according
to one recently published report, it affects nearly 17 percent
of all Americans for the length of their lives.7 Because depression
often involves a complex mixture of severity, length, and
mode of treatment, it is often a difficult decision for doctors
and patients alike to decide how to treat the depression. Many
practitioners and patients are reluctant to use antidepressant
drugs because of associated side effects. It seems logical, then
that any additional forms of treatment with little risk, credible
benefit, and moderate cost would be a useful addition to
depression management.
Extracts of St. John’s wort have long been used in “folk”
medicine for a range of symptoms and problems, including
mood and depression disorders. Extracts of St. John’s wort
are licensed in Germany for the treatment of “anxiety and
depressive and sleep disorders.” In 1993, more than 2.7 mil-lion prescriptions of Hypericum were counted in the seven
most popular preparations in Germany.8 In the past ten years,
several randomized clinical trials have compared the effects of
pharmaceutical preparations of Hypericum with placebo and
common antidepressants, with nearly all showing favorable
practical application of Hypericum treatments for depression
and other related disorders.
...RECENT RESEARCH
A recent study (August, 1996) exploring the effect of
Hypericum perforatum on depression re vealed some fairly
stunning results. The British Medical Jo u rn a l published the
results of one major studies, which consisted of twenty - three
randomized trials, including a total of 1757 outpatients with
mainly mild or moderately seve re depressive disorders. Testing
was conducted with single preparations and combinations of
extracts of the plant, and with placebo and anther drug treatment.
As just mentioned, the results were very promising. In all
aspects of the study, Hypericum extracts were shown to be
“significantly superior” to placebo and similarly effective as
standard antidepressants. There were nearly twice the number,
percentage-wise, of dropouts due to side effects from the
standard drugs than those taking the Hypericum extracts.
Side effects occurred in eighty-four patients using standard
antidepressants, while only fifty patients taking the
Hypericum extracts experienced side effects. And the scores
on the Hamilton depression scale, which measures severity of one’s depression, showed those taking Hypericum treatments
scored slightly higher than those taking the standard antidepressant
and significantly higher than those taking the placebo.
9 This study provides some firm ground for St. John’s wort
to stand on in the treatment of depression, both in sheer
numbers and its quality of treatment.
Another contemporary study, carried out in 1995 by
Witte, et. al, showed the Linde study to be accurate in its
findings. This particular study, carried out as a multicenter,
placebo-controlled double-blind trial, used a highly concentrated
Hypericum preparation to treat ninety-seven outpatients.
The course of the illness was assessed with the
Hamilton Depression Scale, the von Zerssen Depressivity
Scale and the Clinical Global Impression Scale. The authors
of the study noted this in their abstract:
Treatment resulted ...Alcohol and Depression
Depression is often a result of other disorders. A recent
study conducted by the Ukranian team of A. Krylov, et. al,
treated fifty-seven outpatients with alcoholism and accompanying
diseases of the digestive organs (such as peptic ulcers
and chronic gastritis). The duration of the treatment lasted
two months, with one-glass treatments occurring four to five
times daily. The study proved St. John’s wort effective (when
combined with rational psychotherapy) in treating the alcoholism-
related depression and also in treating the gastrointestinal
disorders.13 ...ANTIVIRAL PROPERTIES OF ST. JOHN'S WORT
As stated previously, hypericin has recently gained much
of the medical world’s respect as an antiviral agent, with
activity against a broad range of enveloped viruses and retroviruses.
The effective virucidal activity emanates from a com-bination of photodynamic and lipophilic properties. A recent
article in the journal Transfusion details exactly how hypericin
works in inhibiting viral activity among cells:
Hypericin binds cell membranes (and, by inference, virus membranes)
and crosslinks virus capsid proteins. This action results
in a loss of infectivity and an inability to retrieve the reverse
transcriptase enzymatic activity from the virion.14
Another recent study, carried out in 1991, focused on
hypericin’s ability to inhibit virus activity, more specifically,
in the murine cytomegalovirus (MCMV), Sindbis virus, and
human immunodeficiency virus type 1 (HIV-1). The Sindbis
virus was significantly more sensitive than the MCMV virus.
The inactivated MCMV, when used to infect cells, was incapable
of synthesizing early or late viral antigens. In addition
to the direct virucidal effect, when hypericin was added to
cells infected with viable MCMV, inhibition was also
observed, particularly when the compound was added in the
first two hours of infection. The researchers also indicated
that the effect was aided significantly by visible light, pointing
again to the plant’s photodynamic property.
The study states that hypericin appears to have two modes
of antiviral activity: “. . . one directed at the virions, possibly
on membrane components, and the other directed at virusinfected
cells. Both activities are substantially enhanced by
light.”15 And there are other viruses that fall under St. John’s
wort’s antiviral blanket. Contemporary research points to the
equine infectious anemia virus, the lentivirus, the Sindbid virus, the radiation leukemia virus, and most importantly,
the human immunodef ...ST. JOHN’S WORT AND AIDS/HIV
In 1991, some of the first work focusing on St. John’s
wort’s effects on AIDS and the HIV virus began. Science
magazine reported on the first study using the isolated hypericin,
a key compound in Hypericum.16 Fred Valentine and
Howard Hochster, researchers at New York University
Medical Center, began one of the first studies looking at how
hypericin can help uninfected T-cells from being infected
with the AIDS virus in a cell culture. Their focus was on
hypericin because it is a virucidal agent, meaning it can precisely
target new virus particles and prevent them from
infecting other cells.
The only two drugs at that time approved for treating
HIV infection—AZT and ddI—work by interfering with the
key viral enzyme, reverse transcriptase. Since hypericin works
more effectively than many drugs in regards to the reverse
transcriptase phase, and since many animal tests have shown
that it has low toxicity at therapeutic doses, researchers
(including Valentine and Hochster) began these studies largely
hoping that not only would hypericin work on its own,
but that it would have a sort of synergistic effect when used
with either AZT or ddI. 17
Additional studies are pointing to St. John’s wort, and more so, hypericin, as having great potential in treating HIV.
Acosta and Fletcher recently detailed the processes in which
the human immunodeficiency virus works to infect human
cells, and point out that hypericin is at least somewhat effective
in inhibiting the four main phases of virus “growth”—
binding and entry, reverse transcriptase, transcription and
translation, and viral maturation and budding (the
researchers note that hypericin is especially effective in binding
and entry, the first phase.) This denotes that hypericin
could eventually have special importance in completely stifling
the development of the growth of any virus, and most
importantly, that of the HIV virus.18
Another study assessing the u ...SLEEP DISORDERS
Among the many ailments that often accompany middle
and old age are various sleep disorders: insomnia, intermittent
waking, sleep duration, and an overall poor sleep quality.
The medical world has produced numerous synthetic
drugs to deal with these disorders; however, most aren’t completely
effective and produce undesirable side effects as well.
Recent research suggests that St. John’s wort may be able to
improve one’s sleep, especially that of older persons. A 1994
double-blind, placebo-controlled study published in the
Journal of Geriatric Psychiatry and Neurology showed that
Hypericum extracts gave the benefit of increased deep sleep during the total sleeping period of the patients. It explains,
A hypostatic influence of the REM sleep phases, which is typical
for tricyclic antidepressants and MAO inhibitors, could not
be shown for this phytopharmacon [Hypericum]. Instead, LI
160 [Hypericum] induced an increase of deep sleep during the
total sleeping period. This could be shown consistently in the
visual analysis of the sleeping phases 3 and 4, as well as in the
automatic analysis of slow-wave EEG activities.
The study also makes an interesting connection between
sleep and depression; that being many standard antidepressants
and MAO inhibitors used to treat people who suffer
from depression cause a decrease in deep sleep. As discussed
earlier, St. John’s wort has shown great promise in treating
depressed persons. So, besides helping people with sleep disorders,
when used as an antidepressant, it gives antidepressant
properties without the side effect of decreased deep
sleep.21 This is certainly another valuable quality St. John’s
wort has shown to possess.
...WOUNDS
St. John’s wort oil has long been held in high esteem for
treatment of all types of abrasions and wounds. Its fame was
reputedly tested time and time again on the battlefields of the
Crusades. More modern tests using the oil have proved its
reputation. The oil, which does not contain hypericin, contains
another valuable compound, hyperforin, which is mainly responsible for the oil’s therapeutic properties.
Though somewhat difficult to isolate and preserve for
extended periods of time, hyperforin has shown considerable
promise as a primary component in salves or dressings for
topical and other wounds. It only makes sense that in being
able to withstand and inhibit bacterial and viral growth, St.
John’s wort can effectively aid topical wounds in their healing
and recovery. ...CANCER/TUMORS
St. John’s wort, and more specifically, hypericin, has an
outstanding ability to work favorably at the cell level against
normally destructive invaders like viruses and bacterias. But
these are not the only destructive agents that are being targeted
by researchers in Hypericum research. Hypericin has
been shown in various recent studies to work very effectively
against cancerous cells and tumors of varying kinds.
The April 1996 issue of Laryngyscope reported that hypericin
is showing great potential in targeting human cancer
growths through what is called “phototargeting,” a process
that uses laser activation of hypericin, along with chemotherapy,
for improved results in inhibiting the growth of cancerous
cells. The study states,
These results show that hypericin is a sensitive agent for phototherapy
of human cancer cells in vitro and indicate that this
drug may be useful for tumor targeting via minimally invasive
imaging-guided laser fiber optics.22
Another recent study commented on the use of hypericin
in treating human cancer cells, saying that “the nucleus of the
cell . . . is the target for the toxic action of hypericin.” The
study pointed out that the compound is well distributed
throughout the cells, indicating that its value as an anticancer
agent remains high.23
Yet another study points to the photodynamic qualities of
hypericin in combating cancerous cells. The study’s results
suggest that hypericin “has considerable potential for use as a
sensitizer in the PDT [photodynamic therapy] of cancer.”
And when hypericin was used in conjunction with other
“scavenging” agents, its inhibitory abilities were greatly
enhanced.
Again, with such promising results from clinical studies,
St. John’s wort (and hypericin) is perhaps opening the way to
curing one of our most devastating diseases, cancer. Further
research could quickly finalize a cure. ...BLOOD TRANSFUSIONS
With the increasing rates of several blood-carried diseases
(like AIDS), blood transfusion and blood donation rates are
declining. Ensuring that donated blood is not “contaminated”
by disease dictates that fewer people can donate blood,
while fear of being contaminated by blood tainted by blood
usually dissuades physicians from requiring blood transfusions
unless absolutely necessary. Finding some sort of treatment
of tainted blood would not only save money and time, but also calm fears about the possibility of being infected
with a potentially serious disease through a blood transfusion.
Hypericum is showing great promise in being able to
treat blood contaminated by viruses. A recent Transfusion
study states,
Since hypericin is devoid of adverse action in most blood components
and blood analyses, it is investigated as an additive with
potential to inactivate infective viruses in blood components
intended for transfusion. . . . Complete inactivation of 10 (6)
tissue culture-infective doses of human immunodeficiency virus
was obtained in whole blood and in diluted packed red cells
after illumination with fluorescent light for 1 hour. Loss of viral
infectivity to cultured CEM cells has been monitored by use of
a detection assay for human immunodeficiency virus p55 in
enzyme-linked immunosorbent assay and cytopathic assays. In
physiologic media, hypericin interacts with albumin and
lipoproteins, retaining the virucidal activity in bound form. . . .
The apparent transfusibility of hypericin, taken together with
the efficacy of the virucidal activity, the broad range of
enveloped viruses affected, and the absence of adverse effects on
stored red cells, may render hypericin useful for inactivation of
infectious viruses in red cells.24
...SAFETY
Though research is still ongoing as to the specific actions
of St. John’s wort and its constituents, it has been established
that St. John’s wort is quite safe, especially when used as directed. Various studies back up the plant’s therapeutic
properties and safe use, as well as provide technical information
as to what makes St. John’s wort function. A 1994 study
gives very technical information as to how hypericin works
and the optimal methods of extraction, concentration and
storage.25 There have been reports of phototoxicity in animals
when taken in extremely large doses, and long-term studies
are relatively few in number, but the overall consensus seems
to be that Hypericum is a safe and effective medicinal herb.
...PRIMARY USES
• DEPRESSION
• NERVOUS DISORDERS
• EMOTIONAL/MENTAL REGULATOR
• VIRAL INFECTIONS
• TUMOR AND CANCER RETARDANT
• AIDS VIRUS INHIBITOR
• SEPTIC WOUNDS/ BOILS
• BLOOD TREATMENT
...ENDNOTES
1. Ritchason, Jack. Little Herb Encyclopedia. (Pleasant Grove, UT:
Woodland Publishing, 1994; 208-9).
2. Diwu, Z. “Novel Therapeutic and Diagnostic Applications of
Hy p o c rellins and Hypericins.” Ph o t o c h e m i s t ry - Ph o t o b i o l o gy,
1995, 61(6) 529-39.
3. Ritchason, 208.
4. Andreoni, A. et al. “Laser Photosensitization of Cells by
Hypericin.” Photochemistry-Photobiology, 1996, 59(5): 529-33.
5. (Encyclopedia Britannica, 1993: 8, p.21
6. Flynn, Rebecca, M.S. and Roest, Mark. Your Guide to Standardized
Herbal Products. (Prescott, Az..: One World Press, 1995, 73-4.
7. Linde, et al. “St. John’s Wort for Depression — An Overview and
Meta-Analysis of Randomised Clinical Trials.” The Br i t i s h
Medical Journal. 1996, 313(7052): 253.
8. Lohse, Mueller et al. Arzneiverordnungreport ‘94. 1994: 354.
9. Linde, et al., 254
10. Witte, et al.
11. Jackson, Adam. “Herbal Help for Depression.” Nursing Times,
1995: 9(30): 49.
12. Ha r re r, G.; H. So m m e r. “Treatment of Mi l d / Mo d e r a t e
Depression with Hypericum.” Phytomedicine. 1994, 1: 3-8.
13. Krylov, A., Ibatov A. “The Use of an Infusion of St. John’s Wort
in the Combined Treatment of Alcoholics with Peptic Ulcer and
Chronic Gastritis.” Vrach.-Delo. 1993 Feb.-Mar.(2-3): 146-8.
14. Lavie, G. et. al. “Hypericin as an Inactivator of Infectious Viruses
in Blood Components.” Transfusion. 1995, May 35(5): 392-400.
15. Hudson, J.B., Lopez-Bazzocchi, I., Towers, G.H. “Antiviral
Activities of Hypericin.” Antiviral—Res. 1991, Feb. 15(2): 101-
12.
16. Science, 1991, 254: 522.
17. Ibid.
18. American Journal of Hospital Pharmacy. 1994, 51(18): 2251-67.
19. Journal of Association of Nurses Aids Care. 1995, Jan-Feb.: 225.
20. Diwu, 34.
21. Schulz, H. “Effects of hypericum extract on the sleep EEG in
older volunteers.” The Jo u rnal of Ge r i a t ry, Ps yc h i a t ry and
Neurology. 1994, Oct., 7: S39-43.
22. Vander Werf, QM. et al. “Hypericin: a new laser phototargeting
...
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