By: Candice Carlson10/17/11

St. John’s wort

Why talk about St. John’s wort?Popular herbal remedy.

Used world-wide.

Learn new information.

Nutrition.

Family, friends.

Describe St. John’s wortHistoryBotanical compositionHealth claimsThe science behind the claimsRecommendationsSafety EfficacyConclusion

Overview

St. John’s wort is an herb.Herbaceous perennial.An herb is a small plant that bears seeds.Fleshy parts instead of woody parts.

Hypericum perforatumSaint John’s Word, Hardhay, Goatweed, Amber,

Klamath weed, and Tipton weed.Yellow flowers and leaves are used to make

medicine.Large amount of chemical compounds.Ingredients believed to produce effectiveness-

hypericin and hyperforin.

What is St. John’s Wort?

Native to Europe.Common in United States, Canada, and

Australia.Found in meadows and woods.

Australia considered it a weed.Now grown as a crop, produces 20% of the

world’s supply.United States

Nutritional supplementEurope

Prescription medication

What is St. John’s Wort?

Dates back to ancient Greece.Hippocrates documented the medical use of St. John’s

wort.Encircled with folklore.

Greeks used it to fight evil spirits and fevers.England provided the house with protection.Eliminate witches.

Scientific name is GreekHyper (over)Eikon (ghost)

St. John the BaptistBlooms around his birthday. June 24th

History

Thought that placing the plant under the pillow would prevent death from occurring throughout the year.St. John’s Eve

Folk remedyUsed for centuries.Treat wounds, nervous disorders, and gout.Native Americans used the plant to treat help with

treatment of snakebites.United States

Not known until 1900’sPopularConcerns about the risks and harms.

History

Has been used as an antidepressants and diuretics.Used for burns and fevers.

EuropeUsed for depression, bedwetting, skin

problems, liver problems, and mental exhaustion.

Traditional Use

Perennial herb. Stoloniferous, extensive rhizomes. Leaves contain dots on the surface. Five petals, bright yellow

Contains Melatonin Tannins Flavonoids Flavonal Glycosides Phenolic acids Naphtodianthrones

Hypericin Phloroglucinols

Hyperforin Essential oils

Comprised of sesquiterpenes.

Botanical & Chemical Composition

Reduces anxiety symptoms.May be ineffective for ADHD symptoms.Improves menopausal symptoms.Possibly improve wound healing.Improves dermatitis symptoms.May reduce premenstrual symptoms.May be effective treatment for somatoform

disorders.Reduces fatigue.Effective in treating mild to moderate depression.Ineffective for treating major depression.

Health Claims

Not enough current evidence that St. John’s wort improves anxiety symptoms.May be beneficial to some.

Study declared 3 cases relieving anxiety symptoms.Study had participants take 900 mg of St. John’s wort

twice a day. In 4 weeks a woman who had previously suffered from

chronic anxiety for 8 years found symptoms were relieved. Before the treatment she experienced: insomnia, worry,

tension, and irritability.After the study she experienced: reduced worry, ability to

cope with stress, sense of relaxation, and improved sleep.

Anxiety

Unclear whether St. John’s wort is effective for treatment. May be beneficial for treatment.

Hyperforin (active ingredient) Inhibit reuptake of serotonin and nor epinephrine (brain

chemicals).Study of 54 children from 6 to 17 years old

showed symptom improvement from the placebo and the treatment.

300 mg of Hypericum perforatum, 3 times a day for 8 weeks.Although it showed improvement there were no additional

benefits found.Concerns it may worsen ADHD symptoms when taken with

methylphenidate (used for treatment of ADHD).Further studies need to be performed.

ADHD

Menopausal SymptomsSome research showing

St. John’s wort can improve menopausal symptoms.Combined with black

cohosh.Study of 301 women

St. John’s Wort combined with black cohosh was superior to placebo.

Improvements in physical and subjective symptoms.

Not enough scientific evidence.

May be effective for wound healing.St. John’s wort can be used externally as an

oil.Can treat first degree burnsPost therapy

A few research studies conducted regarding application of St. John’s wort ointment. Taken 3 times a day for a couple weeks may

show improvement in wound healing.May reduce the formation of scars following a

C-section.

Wound Healing

Positive results regarding sub acute atopic dermatitis.Further studies need to be conducted.

Ointment applied approximately 3 times a day for a couple weeks may improve wound healing.Result in reduction of scar formation.

Study of 21 participants4 weeks Participants used a treatment with hypericum.Applied 2 times a day.Tolerance of cream was excellent.Eczematous lesions significantly more effective than

placebo.

Dermatitis

A few studies show that St. John’s wort may be able to reduce premenstrual symptoms.May improve symptoms by 50% in some women.

One study found that taking 300 mg of St. John’s wort reduced daily symptom ratings.Modified Social Adjustment Scale scored improved.Hospital Anxiety and Depression Scale improved.

Preliminary evidence.Further studies are needed.

Premenstrual Symptoms

St. John’s wort can possibly be effective for symptom reduction.After 6 weeks approximately.

Study600 mg of St. John’s wort were given daily to outpatient

adults.Proven safe and effective for treatment of mild or

moderate somatoform disorders. Proven equally safe as placebo.Well tolerated.

St. John’s wort may help with Somatoform Disorders but to clearly confirm this further research is needed.

Somatoform Disorders

St. John’s wort may reduce fatigue.Study

Open, uncontrolledPatients were given hypericum 3 times a day for

approximately 6 weeksResults showed a reduction in fatigue.

Also showed reduction in anxiety and depression.Further control studies should be completed.

This study did no include a control group.Results were difficult to determine.

St. John’s wort can possibly reduce fatigue.

Fatigue

St. John’s wort taken for treatment of mild to moderate depression is likely to be effective. Scientific evidence is inconsistent on effectiveness of St. John’s

wort. Likely to improve mood, insomnia, and reduce anxietyAs effective as prescription drugs. St. John’s wort is considered an antidepressant that can be

used as a short-term treatment for mild to moderate depression.

37 clinical trial were conducted.Results show St. John’s wort may benefit people with mild

depression. Benefits were similar to other antidepressantsMay contribute to less side effects

Mild-Moderate Depression

Major depression is a common disorder that is likely to spread modern society.

St. John’s wort provides minimal benefits for major depression.

Studies show St. John’s wort is ineffective for major depression.Study of 340 participantsMeasured Hamilton Depression Scores. St. John’s wort dropped their scores. Results do not support St. John’s wort for

treatment of major depression.

Major Depression

Herbal PreparationPreparation of an infusion

2 tsp of drug 150 mL boiling water Steep for 10 minutes.

Dried herbTabletsTincturesCapsules Storage

Room temperature Keep away from sunlight

and heat. Away from moisture. Limited shelf life.

Dose and Frequency: Recommended to take 200 to 1,000 mg/day for depression treatment.

Capsules and tablets: take 300 mg three times a day (0.3% Hypericin).0.2% Hypericin-take 250 mg twice a day. 5% Hyperforin-take 300 mg three times a day.

Under age 12, 300 mg daily is recommended (0.3% Hypericin).

If taken for premenstrual syndome: 300 mg once a day (0.3% Hypericin).

If taken for somatization disorders: 600 mg a day is advisedSpecial extract

Recommendations

RecommendationsDried herb: 2 to 4 grams

three times a day.A traditional method is

Tea.For one dose 2 to 3

grams of the dried herb is recommended. Place in boiling water.

Tincture: 2 to 4 mL three times a day.

Cost: For 90 capsules approximately $13.00

Food and Drug Administration (FDA) Classifies St. John’s wort as a dietary

supplement.Herbal products are allowed to be sold

without dosage studies.Not required for safety and effectiveness as

well. Misleading Information

Inaccurate Information “Natural” is not necessarily considered

“safe.”Especially when taken in large doses

Interaction with drugs

Concerns with Herbal Products

SafetySt. John’s wort for

general use is believed to be safe for short-term use.

Safety concerns.

Some of the chemical compounds, when combined with prescription drugs, is not advised.

Safety Concerns and Precautions

Short term useLikely safe

May cause side effectsTrouble sleepingDiarrheaDizzinessIrritabilityUpset stomach

May be unsafe taken in large doses by mouth.

Special PrecautionsPossibly unsafe for:PregnancyBreast feedingInfertility Major depressionAlzheimer’s DiseaseAnesthesia &

surgeryADHDSchizophreniaBipolar Disorder

Do not combine St. John’s wort with certain medications.Can decrease effectiveness when taking:

AmitriptylineContraceptive drugsDigoxinEplerenone Imatinib IrinotecanTacrolimusSeveral anti-human immunodeficiency drugs IvabradineWarfarinCyclosporinVoriconazole

Interactions with MedicationHealth Risks

Interactions with MedicationHealth risks

Additional interactionsAlprazolam (Xanax)Aminolevulinic acidCyclosporineFenfluramineAntidepressants

(Medications for depression)

Medications for pain (narcotic drugs)

MeperidineMephenytoinNefazodone

PhenobarbitalPhenprocoumonPhenytoinReserpineSertralineTramadolNortriptylineParoxetinePentazocine

http://www.5min.com/Video/Learn-about-St-Johns-Wort-and-Surgery-284058426

Health Risks

Quality of Research

Human research suggests that further research is needed for evidence to support many of the health claims.

St. John’s wort has been used for centuries.Documented it’s use.

Many studies show that St. John’s wort is likely to be effective for mild depression.

Conclusions

Efficacy

Improves anxiety symptoms is weak.Evidence is unclear on the effect on ADHD

symptoms.Not enough scientific evidence to show it improves

menopausal symptoms.Some evidence it may be effective for wound

healing.Further research needs to be done on

improvement in dermatitis symptoms.Reducing premenstrual symptoms is weak.

Conclusions

Efficacy

To clearly confirm the use of St. John’s wort for somatoforam disorders further research is needed.

Further control studies are needed to prove the reduction in fatigue.

Research on depression is inconsistent.Most likely to help with mild to moderate

depression.Not likely to help with major depression.

Conclusion

SafetySafe for general, short-term use.

Only used 4 to 6 weeks.May cause side effects.

Unsafe when taken in large doses.Possibly unsafe when: pregnant, breastfeeding,

infertility, major depression, alzheimer’s disease, anesthesia and surgery, ADHD, schizophrenia, bipolar disorder.

Unsafe when combined many medicationsBirth control pills, antidepressants, anticancer

medicines, and medicines to control HIV

Conclusion

Ethics in marketingMarketed capsule and tablet form.Ointments are marketed for wound healing,

helping with skin irritations, and bruises. Marketing is directed towards those suffering

from mild to moderate depression and anxiety. Marketed as being as effective as Prozac for

treatment of depression. Many articles showing that it is effective for

short-term use for mild to moderate depression.

Conclusions

What you should know:

Botanical and chemical composition of St. John’s wort

Health claimsThe science behind the claimsHerbal preparationRecommendationsConcerns and risks associated with St. John’s

wortInteractions with medicinesSafety, efficacy, ethics in marketing

Conclusions

Any Questions??The End!