Herb, St. John’s wort

In people who take the protease inhibitor indinavir, the herb St. John s wort reduces the concentration of indinavir in the blood. A similar interaction has been reported between St. John s wort and the heart medication digoxin. 

Stentorin. A protein with a bound chromophore called stentorin mediates the light-avoidance response of the protozoan Stentor. Stentorin,610 which is found in pigment granules in the cell surface, is a derivative of hypericin, a plant compound with antidepressant activity and the active ingredient in the herb St. John s wort. 

OFFICIAL NAMES Amitriptyline (Elavil), amoxapine (Asendin), bupropion (Wellbutrin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), fluoxetine (Prozac), imipramine (Norfranil, Tofranil), isocarboxazid (Marplan), maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone (Serzone), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil), phenelzine (Nardil), protriptyline (Vivactil), sertraline (Zoloft), thioridazine (Mellaril), tranylcypromine (Parnate), trazodone (Desyrel), trimipramine (Sur-montil), venlafaxine (Effexor) the herb St. John s wort (Hypericum perforatum) is sold over-the-counter without prescription STREET NAMES Happy pills... 

As far back in history as the Greek physicians Hippocrates, Pliny, and Galen, through to present time, the herb St. John s wort has been used for its antidepressant effect. It is believed to influence the neurotransmitters in the brain. Although some research has shown it to be effective in cases of mild to moderate depression, many questions remain as to its safety and effectiveness. 

The herb St. John s wort (Hypericum perforatum) has a number of constituent parts, including hyperforin, which is currently being studied as the responsible constituent for the antidepressant action. The herb contains at least ten compounds that can have an unpredictable effect on the consumer. 

How has deregulation worked A meta-analysis of the herb St John s wort (Hypericum perforatum) for mild and moderately severe depression, published in 1996 by German and American physicians, concluded that it was more effective than a placebo and was as effective as standard antidepressants but with fewer side effects. However, the authors of the analysis raised questions about the methods employed and cautioned about its efficacy in seriously depressed patients. The active chemical in the herb, they claimed, was not appropriately standardized. Furthermore, the study only compared St John s wort with antidepressant drugs that were given at or below their lowest level of efficacy. And, finally, patients were treated for only 6 weeks. An accompanying editorial concluded that longer term studies are needed before it can be recommended in major depression. ... 

This chapter deals overall with psychotherapeutic medications for mental illnesses, but that does not mean alternative interventions do not exist. One example is the herb St. John s wort (sometimes spelled St. Johnswort). The word wort means plant, and this particular yellow-flowered plant carries the Latin name Hypericum perforatum. Also called goatweed, hypericum, and Klamath weed, St. John s wort grows wild in the western United States and throughout Europe. Its peak blooming period is late June, around the time of the traditional birthday of John the Baptist (June 24), thus the name of the plant. 

SFE has been applied to herb and natural product studies for years (8-10). This chapter describes procedures of optimization of SFE parameters for the separation of active constituents from two popular herbs St John s wort and Ginkgo biloba. The active compounds in St. John s wort are believed to be... 

The male client diagnosed with chronic hepatitis C tells the nurse that he is taking the herb St. John s wort for depression. Which action should the nurse implement ... 

Another important aspect of food databases is that food and some food additives are, by nature, mixtures of componerrts. For example, flavors frequently comprise or contain extracts of plants. Such mixtures and combinations of mixtures provide fertile groimd for irarovatiom Similarly, in the search for bioactive molecirles, natural products have been and contirrue to be a primary soirrce of molecirles with potential therapeutic effect. In fact, traditional medicine around the world is ancestral and still in use. An interesting example of this is the medicinal herb St John s wort Hypericum Perforatum) which is prescribed in some cormtries for the treatment for depression [7]. The chemical composition and pharmacological effect of the... 

Some herbs are standardized for several active constituents, while others are standardized to a single active ingredient. St. John s wort is standardized to contain 0.3% hypericin, whereas ginkgo is standardized to contain 24% flavone glycosides and 6% ter-pene lactones. However, standardizing an herb product to one or more plant component(s) that are identifiable by assay may be incorrect. Many herbalists believe that the whole plant contributes to the efficacy and that there are many unknown active compounds in each plant [6]. 

Many dietary supplements should be avoided in pregnancy because they may have emmenagogue activity, promoting menstruation. Some herbs that are considered emmenagogues are feverfew, garlic, and hawthorn [4]. St. John s wort should be avoided in pregnancy due to its emmenagogue and abortifacient properties. 

Some precautions are based on the dietary supplement s side effect profile. St. John s wort may induce photosensitivity therefore, fair-skinned persons should be cautioned about exposure to bright sunlight while taking the herb. 

St. John s wort is probably effective for mild to moderate but not severe depression. Although well tolerated in most patients, a major concern is its numerous herb-drug interactions mediated by its induction of the cytochrome P450 enzyme system. 

CAM. Data about 145 boys and 35 girls, with a mean age of 10 years, were obtained. The most popular form of alternative therapy was vitamins, minerals, and antioxidants (51%), followed by nutritional supplements (14%), herbs and botanical medicines (11%), massage (9%), chiropractic (4%), homeopathy (4%), and acupuncture (2%). (Horrigan et ah, 1998). An anecdotal report described the use of St. John s wort by four teenagers who were under psychiatric care (Walter and Rey, 1999). Three of the patients had been reluctant to reveal this to their psychiatrist, believing the doctor had no interest in alternative medicine or would disapprove of it. 

Hypericum perforatum, more commonly known as Hypericum or St. John s wort, is used widely because of the perception that it is a safer, natural antidepressant. In Germany, Hypericum is used more extensively than conventional antidepressants for treating depression. Because St. John s wort has been attracting increasing media attention worldwide, consumption of this herb is likely to become more prevalent. 

The adult dosage of St John s wort traditionally recommended for treating depression is 300 mg of plant extract orally three times daily (plant extracts are usually standardised to 0.3% hypericin). There are no data about optimal dosage in young people. Clinicians often start with half the adult dose and increase the amount up to 300 mg three times daily after 3 or 4 weeks if the herb is well tolerated and there is no improvement. Clinical experience shows this regime results in few unwanted effects in the young. 

Smith M, Lin KM, Zheng YP. An open label trial of nifedipine-herb interactions nifedipine with St John s wort. Ginseng, or Ginkgo Biloba. Clin Pharmacol Therapeut 2001 69(2) P86. 

Karliova M, Treichel U, Malago M, Frilling A, Gerken G, Broelsch CE. Interaction of Hypericum perforatum (St. John s wort) with cyclosporin A metabolism in a patient after liver transplantation. J Hepatol 2000 33 853-855. Pennachio DL. Dmg-herb interactions How vigilant should you be Patient Care 2000 19 41-68. 

St John s wort and Ginseng are also frequently suggested for treating mild depression. According to syndrome differentiation in TCM, they are only suitable for treating patients who suffer from depression due to deficiency of Qi and Yang. If the patients have a Yin deficiency, internal heat or constrained heat due to stress and anxiety, these herbs may lead to restlessness and insomnia, and may make the condition worse. In this case, a Chinese herbal formula based on syndrome differentiation is more effective than that of using only these herbs. 

Stevia Stevia rebaudiana) Uses Natural sweetener, hypoglycemic and hypotensive properties Actions Multiple chemical components sweetness d/t glycoside, stevioside hypotensive effect may be d/t diuretic action or vasodilation action Available forms Liq extract, powder, caps Notes/SE HA, dizziness, bloating Interactions T Hypotensive effects W/ antihypertensives esp CCB, diuretics EMS Monitor BP does not encourage dental caries may -1-glucose St. John s Wort (Hypericum perforatum) Uses Mild-mod depression, anxiety, anti-inflammatory, immune stimulant/anti-HIV/antiviral, gastritis, insomnia, vitiligo Action MAOI in vitro, not in vivo bacteriostatic bactericidal, T capillary blood flow, uterotonic activity in animals Efficacy Variable benefit w/ mild-mod depression in several trials, but not always seen in clinical practice Available forms Teas, tabs, caps, tine, oil ext for topical use Dose 2-4 g of herb or 0.2-1 mg of total hypericin (standardized extract) daily Notes/SE Photosensitivity (use sunscreen) rash, dizziness, dry mouth, GI distress Interactions Enhance MAOI activity, EtOH, narcotics, sympathomimetics EMS T Risk of photosensitivity Rxns t effects of opioids and sympathomimetics... 

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