Frequently Asked Questions
What is St. John's wort?
St. John's wort (Hypericum perforatum in Latin) is a long-living plant with yellow flowers. It contains many chemical compounds. Some are believed to be the active ingredients that produce the herb's effects, including the compounds hypericin and hyperforin.
How these compounds actually work in the body is not yet known, but several theories have been suggested. Preliminary studies suggest that St. John's wort might work by preventing nerve cells in the brain from reabsorbing the chemical messenger serotonin, or by reducing levels of a protein involved in the body's immune system functioning.
For what medicinal purposes has St. John's wort been used?
St. John's wort has been used for centuries to treat mental disorders as well as nerve pain. In ancient times, doctors and herbalists (specialists in herbs) wrote about its use as a sedative and treatment for malaria as well as a balm for wounds, burns, and insect bites. Today, St. John's wort is used by some people to treat mild to moderate depression, anxiety, or sleep disorders.
What is depression?
Depression is a medical condition that affects nearly 19 million Americans each year. A person's mood, thoughts, physical health, and behavior all may be affected. Symptoms commonly include:
- Ongoing sad mood
- Loss of interest or pleasure in activities that the person once enjoyed
- Significant change in appetite or weight
- Oversleeping or difficulty sleeping
- Agitation or unusual slowness
- Loss of energy
- Feelings of worthlessness or guilt
- Difficulty "thinking," such as concentrating or making decisions
- Recurrent thoughts of death or suicide.
Depressive illness comes in different forms. The three major forms are described below. Each can vary from person to person in terms of symptoms experienced and the severity of depression.
- In major depression, people experience a sad mood or loss of interest or pleasure in activities for at least 2 weeks. In addition, they have at least four other symptoms of depression. Major depression can be mild, moderate, or severe. If it is not treated, it can last for 6 months or more.
- In dysthymia, a milder, but more chronic form of depression, people experience a depressed mood for at least 2 years (1 year for children) accompanied by at least two other symptoms of depression.
- In bipolar disorder, also called manic depression, a person has periods of depressive symptoms that alternate with periods of mania. Symptoms of mania include an abnormally high level of excitement and energy, racing thoughts, and behavior that is impulsive and inappropriate.
Some people still hold outdated beliefs about depression--for example, that the emotional symptoms caused by depression are "not real." However, depression is a real medical condition. It can be treated effectively with conventional medicine, including by antidepressant drugs and certain types of psychotherapy (talk therapy).
Why is St. John's wort used as an alternative therapy for depression?
Some patients who take antidepressant drugs do not experience relief from their depression. Other patients have reported unpleasant side effects from their prescription medication, such as a dry mouth, nausea, headache, or effects on sexual function or sleep.
Sometimes people turn to herbal preparations like St. John's wort because they believe "natural" products are better for them than prescription medications, or that natural products are always safe. Neither of these statements is true (this is discussed further below).
Finally, cost can be a reason. St. John's wort costs less than many antidepressant medications, and it is sold without a prescription (over the counter).
How widely is St. John's wort used for treating depression?
In Europe, St. John's wort is widely prescribed for depression. In the United States, St. John's wort is not a prescription medication, but there is considerable public interest in it. St. John's wort remains among the top-selling herbal products in the United States.
How is St. John's wort sold?
St. John's wort products are sold in the following forms:
- Capsules
- Teas--the dried herb is added to boiling water and steeped for a period of time.
- Extracts--specific types of chemicals are removed from the herb, leaving the desired chemicals in a concentrated form.
Does St. John's wort work as a treatment for depression?
There has been scientific research to try to answer this question.
In Europe, results from a number of scientific studies have supported the effectiveness of certain St. John's wort extracts for depression. An overview of 23 clinical studies, published in the British Medical Journal in 1996, found that the herb might be useful in cases of mild to moderate depression. The studies, which included 1,757 outpatients, reported that St. John's wort was more effective than a placebo (a "dummy" pill designed to have no effect) and appeared to produce fewer side effects than some standard antidepressants.
Other studies conducted recently have found no benefit from the use of St. John's wort for certain types of depression. For example, the results of a study funded by Pfizer Inc., a pharmaceutical company, found that St. John's wort, when compared with placebo, was not effective for treating major depression (Shelton, et al. JAMA, 2001).
In addition, several components of the National Institutes of Health--NCCAM, the Office of Dietary Supplements, and the National Institute of Mental Health--funded a large, carefully designed research study to find out whether St. John's wort extract benefits people with major depression of moderate severity. This trial found that St. John's wort was no more effective for treating major depression of moderate severity than placebo (Hypericum Depression Trial Study Group. JAMA, 2002; for further information, view the press release or contact the NCCAM Clearinghouse).
Are there any risks to taking St. John's wort for depression?
Yes, there are risks in taking St. John's wort for depression.
Many so-called "natural" substances can have harmful effects--especially if they are taken in too large a quantity or if they interact with something else the person is taking.
Research from the NIH has shown that St. John's wort interacts with some drugs--including certain drugs used to control HIV infection (such as indinavir). Other research shows that St. John's wort can interact with anticancer, or chemotherapeutic, drugs (such as irinotecan). The herb may also interact with drugs that help prevent the body from rejecting transplanted organs (such as cyclosporine). Using St. John's wort limits these drugs' effectiveness.
Also, St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe and, in some cases, may be associated with suicide. Consult a health care practitioner if you or someone you care about may be experiencing depression.
People can experience side effects from taking St. John's wort. The most common side effects include dry mouth, dizziness, gastrointestinal symptoms, increased sensitivity to sunlight, and fatigue.
What are some other possible problems with using St. John's wort?
Herbal products such as St. John's wort are classified as dietary supplements by the U.S. Food and Drug Administration (FDA), a regulatory agency of the Federal Government. The FDA's requirements for testing and obtaining approval to sell dietary supplements are less strict than its requirements for drugs. Unlike drugs, herbal products can be sold without requiring studies on dosage, safety, or effectiveness.
The strength and quality of herbal products are often unpredictable. Products can differ in content not only from brand to brand, but from batch to batch. Information on labels may be misleading or inaccurate.
(Back to the Top)
For More Information
NCCAM Clearinghouse
Toll-free: 1-888-644-6226
International: 301-519-3153
TTY (for deaf or hard-of-hearing callers): 1-866-464-3615
E-mail: info@nccam.nih.gov
Web site: nccam.nih.gov
Address: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg, MD 20898-7923
Fax: 1-866-464-3616
Fax-on-Demand Service: 1-888-644-6226
CAM on PubMed
Web site: www.nlm.nih.gov/nccam/camonpubmed.html
CAM on PubMed, a database accessible via the Internet, was developed jointly by NCCAM and the National Library of Medicine (NLM). It contains bibliographic citations (1966 to the present) to articles in scientifically based, peer-reviewed journals on CAM. These citations are a subset of the NLM's PubMed system that contains over 12 million journal citations from the MEDLINE database and additional life science journals important to health researchers, practitioners, and consumers. CAM on PubMed also displays links to publisher Web sites, some of which offer the full text of articles.
National Institutes of Health (NIH)
Building 1
1 Center Drive
Bethesda, MD 20892
Web site: www.nih.gov
NIH's mission is to uncover new knowledge that will lead to better health for everyone. Made up of 27 separate components, mainly Institutes and Centers, NIH works toward that mission by conducting and supporting research, training researchers, and fostering communication of medical information. Descriptions of each of the Institutes and Centers, along with their research priorities and links to their Web sites, can be accessed from the main NIH Web site listed above.
National Institute of Mental Health
6001 Executive Blvd., Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
Web site: www.nimh.nih.gov
Toll-free: 1-800-421-4211
E-mail: nimhinfo@nih.gov
The National Institute of Mental Health is committed to reducing the burden of mental illness through research on mental disorders and the underlying basic science of brain and behavior.
NIH Office of Dietary Supplements
6100 Executive Blvd.
Bethesda, MD 20892-7517
Web site: ods.od.nih.gov
The Office of Dietary Supplements, whose mission is to explore the potential role of dietary supplements to improve health care, promotes the scientific study of dietary supplements through conducting and coordinating scientific research and compiling and disseminating research results.
Combined Health Information Database (CHID)
Web site: chid.nih.gov
CHID Online is a searchable and user-friendly database produced by more than a dozen health-related agencies of the Federal Government, including NCCAM. This database provides titles, abstracts, and availability information for health information and health education resources.
ClinicalTrials.gov
Web site: clinicaltrials.gov
ClinicalTrials.gov provides patients, family members, health care professionals, and members of the public access to information on clinical trials for a wide range of diseases and conditions. NIH, through its National Library of Medicine (NLM), has developed this site in collaboration with all NIH Institutes and the Food and Drug Administration (FDA). The site currently contains approximately 6,200 clinical studies sponsored by NIH, other Federal agencies, and the pharmaceutical industry in over 69,000 locations worldwide.
Computer Retrieval of Information on Scientific Projects (CRISP)
Web site: www-commons.cit.nih.gov/crisp
CRISP is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other research institutions. The database, maintained by the Office of Extramural Research at NIH, includes projects funded by NIH and other health-related Federal agencies.
U.S. National Library of Medicine (NLM)
8600 Rockville Pike
Bethesda, MD 20894
Toll-free: 1-888-346-3656
Fax: 301-402-1384
E-mail: custserv@nlm.nih.gov
Web site: www.nlm.nih.gov
NLM is the world's largest medical library. Services include:
- Interlibrary Loan
Most of the general and historical collections of NLM are available through interlibrary loan to any library. NLM provides copies of journal articles and lends books, audiovisuals, and microforms.
- MEDLINE
MEDLINE is NLM's premier bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical science. MEDLINE contains indexed journal citations and abstracts now covering more than 4,600 journals published in the United States and 70 other countries.
Web site: pubmed.gov
- National Network of Libraries of Medicine (NN/LM®)
NLM is a national resource for all U.S. health science libraries through NN/LM®. The service will refer inquirers to their nearest NN/LM-affiliated medical library.
Toll-free: 1-800-338-7657
(Back to the Top)
Selected Sources
American Herbal Pharmacopoeia and Therapeutic Compendium. St. John's wort (Hypericum perforatum) Monograph. Herbalgram: The Journal of the American Botanical Council and the Herb Research Foundation. 1997; (40):1-16.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, DC: American Psychiatric Association, 1994.
National Institute of Mental Health. Fact Sheets on Depression--"The Invisible Disease: Depression," "Depression Research at the National Institute of Mental Health," and "The Numbers Count: Mental Disorders in America," available online at www.nimh.gov or see "For More Information" above.
Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St. John's wort) in major depressive disorder: a randomized, controlled trial. JAMA, 2002; 287:1807-14.
Shelton RC, Keller MB, Gelenberg AJ, et al. Effectiveness of St. John's wort in major depression. JAMA, 2001; 285:1978-86.
Linde K, et al. St. John's wort for depression--an overview and meta-analysis of randomized clinical trials. Br Med J, 1996; 313:253-8.
Piscitelli SC, et al. Indinavir concentrations and St. John's wort. The Lancet, 2000; 355:547-8.
Mathijssen RHJ, et al. Effects of St. John's wort on irinotecan metabolism. J Natl Cancer Inst, 2002; 94:1247-9.
|
NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.
|
Source: National Center for Complementary and Alternative Medicine, April, 2002
Articles
Websites
Back to the Top
