St. Johns-wort

John s wort is derived from the flowers of the Hypericum perforatum plant that grows throughout England, Europe, Asia, and parts of the United States. This herbal supplement has been used extensively to treat symptoms of depression and anxiety. Although the details are unclear, St. John s wort probably contains several chemicals that alter the balance of central nervous system (CNS) neurotransmitters affecting mood and behavior.46,84 As discussed in Chapter 7, depression seems to be associated with a fundamental defect in amine neurotransmitters such as serotonin, norepinephrine, and dopamine. St. John s wort may promote changes in these neurotransmitters in a manner similar to conventional prescription antidepressants.56,84 Many people have therefore used St. John s wort as an alternative medication to help improve mood and resolve the symptoms of depression.46,72 

Several studies have suggested that products containing adequate amounts of the active chemicals from St. John s wort may be successful in treating mild-to-moderate depression.46,72 The success of this product in more severe or resistant forms of depression remains unclear.50 St.John s wort is generally well tolerated,43,51 but use of this product can accelerate the metabolism of other therapeutic medications such as warfarin (Chapter 2 5), reverse transcriptase inhibitors (Chapter 34), cyclosporine (Chapter 37), and certain anticancer agents (Chapter 36).16,72 Hence, St.John s wort can prevent these other medications from reaching therapeutic levels, and dosages of other medications may have to be adjusted to maintain their efficacy when administered with St. John s wort.46 

Valerian is derived from the root of the valerian plant that grows throughout many parts of the world. It is generally used to treat mild cases of anxiety and to 

Vitamins and minerals are not considered medications, but these substances are essential for maintaining physiologic function and homeostasis throughout the body. Many individuals consume these substances to compliment other medications and to help promote optimal health. It is beyond the scope of this chapter to address all the pertinent issues related to vitamin and mineral metabolism. Nonetheless, a brief overview of these substances and their use as dietary supplements is provided here and summarized in Tables 38-2 and 38-3. Readers are also referred to other sources for a more detailed discussion of vitamins and minerals.4,55 76 

Vitamins comprise a diverse group of organic chemicals that the body needs to facilitate specific metabolic and biosynthetic processes.4 In many cases, vitamins act as enzymatic cofactors that is, the vitamin works directly with the enzyme to catalyze a specific chemical reaction. In other situations, the vitamin forms an essential component of a chemical structure or species that is needed for a specific chemical reaction. The body typically needs small amounts of vitamins to promote normal growth and development, and to maintain optimal health throughout adulthood.32 

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Flavonoids in the diet have been widely promoted as important antioxidant contributors. Their neuroprotective properties, because of this effect, have been demonstrated by several workers. However, they have also been demonstrated to have MAOI activity and this has been proposed as part of the explanation of the use of the common herb, St Johns Wort, Hypericum perforatum L., as an antidepressant. This dual role has now been proposed for a variety of flavonoids, such as kaempferol (22) from the leaves of Ginkgo biloba L., a widely used herbal product which has been suggested as a preventative agent against neurodegeneration. Quercetin (23), similarly, has also shown to inhibit MAO-B " and reverse the effects of induced catalepsy, which mimics the bradykinesia associated with PD. Tangeretin (24) also inhibits MAO-B and crosses the blood brain barrier in a rat model. 

Hennessy M, Kelleher D, Spiers JP, et al. St Johns wort increases expression of P-glycoprotein implications for drug interactions. Br J Clin Pharmacol 2002 53(l) 75-82. 

St. Johns wort (a CYP3A4 inducer) caused a small (about 30%) decrease in eplerenone AUC... 

A possible interaction has been suggested with hormonal contraceptives and the herbal supplement St. Johns wort based on some reports of oral contraceptive users experiencing breakthrough bleeding shortly after starting St. Johns wort . Pregnancies have been reported by users of combined hormonal contraceptives who also used some form of St. Johns wort . Healthcare prescribers are advised to consult the package inserts of medication administered concomitantly with oral contraceptives... 

St Johns Wort Hypericum perforatum With others, wound treatments... 

These species were selected according to a number of criteria including their availability in quantity, whether currently in trade or considered by end users to have potential. In addition, Eyebright and St Johns Wort were among others also felt to have potential. It is possible to see the common species on this latter list and on the list of important plants in Celtic medicine. 

St. Johns wort Depressive disorder (variable evidence for clinical efficacy) May enhance brain 5HT functions Major drug interactions j serotonin syndrome with i SSRIs induces P450, S leading to 4- effects of j multiple drugs j... 

The herb St. Johns wort (Hypericum peforatum) has been used to help detect intestinal cancer during x-ray procedures using barium-watCT enemas. It serves to sharpen the photographic image. 

Also mentioned in the Heinerman reference is the use of an extract of St. Johns wort Hypericum perforatum) for hopeless cancer cases. Mention is made of several cases of cancer cured using Chaparral tea Larrea divaricata). 

The structure of hyperforin 10 was determined with extensive chemical degradation and derivatisation, as well as with spectroscopic means. Bystrov and co-workers described the isolation of 10 and systematically deduced its general chemical and physico-chemical characteristics [34, 35, 36, 37, 38] and suggested its stereochemistry [39, 40]. An acetone extract of St. John Wort was chromatographed over silica gel with gradient elution by petroleum ether-benzene mixtures. Further purification was performed by converting hyperforin 10 into the crystalline 3,5-dinitrobenzoate 11, from which the pure compound 10 was obtained by alcali hydrolysis. The molecular formula of hyperforin 10 was established by elemental analysis and mass spectrometry. From the IR-spectrum, the... 

If you have a mild depression, especially with anxiety, you could begin with a trial of St Johns wort Take 300 mg of St Johns wort three times daily. Make sure it is standardized to 0 3 percent hypericin or 5 percent hyperforin, and it should be a guaranteed potency herb ... 

You should also be taking the nutritional supplements in the box on page 71 entitled "For Prevention Your Basic Prescription/ You can combine St Johns wort with a low dose of the appropriate amino acid Look at the chart entitled "Which Amino Acid Should You Take " on page 81 to find out which amino acid is right for you ... 

Assalian, P. 2000. Sildenafil for St. John wort-induced sexual dysfunction. J. Sex Marital Ther. 26(4) 357-358. 

Anthrone and anthraquinone derivatives are used as laxatives (F 2). The compounds formed in plants may repel potential predators (E 5.5.3). Hypericin, a photodynamic compound, is a feeding deterrent from Hypericum perforatum St. Johns wort, E 5.5.3). 

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