Materia Medica

Hypericum perforatum L.   Hypericaceae.  The common name is St. John’s wort.

The popular name of St. John’s wort has several stories, all having to do with St. John the Baptist.  In Europe it was traditionally gathered on the birthday of St. John on June 24.  It has an even  longer European history of being a plant of magic.  It has been used since Greek and Roman times.  Wort is an old Anglo-Saxon word for plant.

Hypericum perforatum is a perennial weed that has been transplanted from Europe to the United States.  It is troublesome for farmers as it has aggressive growth and causes photosensitizing in their white-faced cattle.  It has lovely yellow flowers that contain a red pigment that produces a red stain when rubbed between the fingers.

The parts of the plant used are the flowers, buds and leaves of the top two to six inches of the plant.  It is available in bulk botanical for tea, capsules, hydroalcoholic extracts and standardized extracts.  It is often found in combination with other herbs such as Piper methysticum (kava kava), Scutellaria (skullcap), Lavandula (lavender) and Sativa (oats).

The most studied effects of Hypericum are its antidepressant properties.  It has not yet been fully determined just what constituents are responsible for this action.  It was first identified as a monoamine oxidase (MAO) inhibitor, but that action appears to be so minor as not to be important.  Newer research suggests that that hypericum is a reuptake inhibitor, prolonging and increasing the effects of seritonine, norepinephrine and perhaps dopamine.  Another explanation for the antidepressant effect is the modulation of the production of cytokines, primarily interleukin-6.  More study will have to be done to determine why hypericum works, but the studies done show that it does work.  There have been many studies with mild-to-moderate depression and response rates have been between 50 and 80%.  The conclusion has been reached that hypericum is as effective as prescription antidepressants for mild to moderate depression with few side effects.  It does take about 10 to 14 days for the full effects to be felt.  Hypericum is licensed in Germany for the treatment of depression, anxiety and insomnia.¹

The indications are that hypericum may be helpful for seasonal affective disorder (SAD).  It also seems to improve cognitive processes and sleep patterns by increasing REM sleep and nocturnal melatonin.²  It also eases anxiety.

Hypericum is effective at inactivating quite a broad range of viruses and retroviruses, due to hypericin and pseudohypericin.  It appears that lipid-envelop viruses and retroviruses are inactivated by hypericum and unenveloped viruses are not.   Studies are being done with HIV patients and the indications thus far are encouraging.

Hypericum has a long history as a wound healer, and modern science is proving this long held reputation.  This may be attributed to the high content of tannins, giving it astringent properties. The sesquiterpenes, caryophyllene and humulene possess antifungal activity and the tannins and flavonoids inactivate Escherichia coli.  Other studies show Hypericum active against gram-positive organisms and Staphylococcus aureus infection.³  It has also been proven quite successful as a remedy for burns.  It has been shown to have significant antioxidant properties.  It decreases inflammation and reduces pain and swelling.⁴

The most popular usage of Hypericum is for depression and many  people self-medicate themselves with it.  It is also used for neuralgic pain, and to ease fibrositis, sciatica and rheumatic pain.  It accelerates healing of wounds, bruises, and varicose veins.⁵   It is used topically in oil or salve form and has a bright red color to the oil.  Hypericum, topically, usually the oil, is used for cold sores.

In addition to the above mentioned uses, it has a place in folklore for uses of bronchial inflammation, cancer, enuresis, gastritis, hemorrhoids, hypothyroidism, insect bites and stings, kidney disorders and scabies.

The plant contains tannins (up to 16% per cent), napthodianthrones (primarily hypericin and pseudohypericin), these are thought to be the primary active ingredients.  Other important constituents include flavonoids, essential oils, proanthrocanidins and other compounds.⁶

It can be used as a tea, prepared with one or two teaspoons of dried herb to one cup of  boiling water and steeped for 10 minutes.  It is taken two to three times a day.   The usual recommendation is 300 mg three times daily of the capsules.  Hydroalcoholic extracts recommend 20 to 60 drops three times a day.  Indications are that it is best taken on an empty stomach.

The antidepressant properties take up to 10 to 14 days to see the full results and it is recommended to take it for two to six months.  If replacing psychoactive drugs like anti-depressants, it should only be done with supervision and over a period of three to six months.⁷

Hypericum causes photosensitivity in cattle and there have been a few reported cases with humans.  Be careful of strong sunlight especially for light skinned, fair-haired people. Photosensitivity is a possibility, although it appears to be fairly rare at average dosage.  Most reported cases in trials were involved with synthetic hypercin.⁸

There is not enough information to know how it interacts with pregnancy, so is not recommenced.  Do not combine with other anti-depressants.

Many references caution about MAO inhibiting effects.  Pharmacist’s Letter reports “Don’t perpetuate the notion that it interacts with tyramine containing food. Whatever  MAOI activity it might have is not enough to cause an interaction with red wine, cheese, etc.”⁹

Other reported adverse reactions were emotional vulnerability, fatigue, gastrointestinal discomfort, and restlessness.  There is some antidotal evidence that occasionally people experience sleep pattern disruptions.  Hypericum should not be taken with other anti-depressant drugs.  It has also been reported that the sleeping time of narcotics is enhanced and the effect of reserpine is antagonized.¹⁰