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St. John's Wort:
Latin name: Hypericum perforatum
Other names: Amber, Goatweed, Hardhay, Klamath Weed, Tipton Weed

A Remedy For
  • Blunt injuries
  • Depression and anxiety
  • Skin inflammation
  • Wounds and burns
  • Although its effectiveness for other ailments has not been proven, St. John's Wort has also been used to treat sleep disturbances, gallbladder disorders, gastritis, bronchitis, asthma, diarrhea, bed-wetting, rheumatism, muscle pain, and gout.

    What It Is; Why It Works
    St. John's Wort is believed to combat depression by boosting the levels of certain chemical messengers in the brain. Like the prescription antidepressant Prozac, it seems to increase the amount of serotonin available to the nervous system. It also tends to promote higher levels of the chemical messengers norepinephrine and dopamine. In some clinical trials, daily doses of 800 to 900 milligrams of St. John's Wort have proven to be as effective as 20 milligrams of Prozac or 75 milligrams of the antidepressant Tofranil.

    Applied to the skin, oily preparations of the herb have an antibacterial and anti-inflammatory action, though they seem to have no effect on viruses.

    St. John's Wort is a golden yellow perennial flower that secretes a red liquid when pinched. Cut at the start of the flowering season and processed in bunches, it must be dried quickly to preserve its oil and secretions.

    This plant has been used medicinally for over 2,000 years. Ancient Greeks believed that its odor repelled evil spirits. Early Christians named the plant in honor of St. John the Baptist because they believed it released its blood-red oil on the 29th of August, the day the saint was beheaded.

    There are no known reasons to avoid St. John's Wort at recommended dosage levels.

    Special Cautions
    With heavy use, St. John's Wort increases sensitivity to sunlight. To avoid a sunburn, minimize your exposure to the sun while using this medication. This herb can also cause bloating and constipation.

    St John's wort used alone refers to the species Hypericum perforatum, also known as Klamath weed or Goat weed, but is used with qualifiers to refer to any species of the genus Hypericum. H. perforatum is sometimes called Common St. John's wort to distinguish it. The species of Hypericum have been placed by some in the family Hypericaceae, but more recently have been included in the Clusiaceae

    Hypericum perforatum is a yellow-flowering, rhizomatous, perennial herb indigenous to Europe, which has been introduced to the Americas and grows wild in many meadows. The common name comes from the fact that it traditionally flowers by and is harvested on St John's day, 24 June. The genus name "hypericum" is derived from the Greek words hyper (above) and eikon (picture) in reference to the traditional use of the plant to ward off evil, by hanging plants over a picture in the house during St John's day. The species name "perforatum" refers to the small windows in the leaves, which can be seen when they are held against the light.





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    Although Hypericum perforatum is grown commercially in some regions of south east Europe, it is listed as a noxious weed in over twenty countries. Ingestion by livestock can cause photosensitization, central nervous system depression, spontaneous abortion, and can lead to death. Effective herbicides for control of Hypericum include 2,4-D, picloram, and glyphosate. In western North America three beetles Chrysolina quadrigemina, Chrysolina hyperici and Agrilus hyperici have been introduced as biocontrol agents.

    Uses of the herb
    The first recorded use of Hypericum for medicinal purposes dates back to ancient Greece, and it has been used ever since. The herb was also used by Native Americans internally as an abortifacient and externally as an anti-inflammatory, astringent, and antiseptic. The aerial parts of the plant can be cut and dried for later use in the form of herbal tea, which has long been enjoyed both for its pleasant (though somewhat bitter) taste and for its medicinal properties.

    In modern medicine, standardized Hypericum extract (obtained from H. perforatum) is commonly used as a treatment for depression and anxiety disorders. In homeopathy, Hypericum is used in the treatment of numerous medical problems, yet the rate of success has not been adequately documented. Historically, the flowers and stems of St John's wort have also been used to produce red and yellow dye.

    St. John's wort is today most widely known as an herbal treatment for depression. In some countries, such as Germany, Hypericum is prescribed for mild depression far more commonly than synthetic antidepressant medication. In most countries, standardized extracts are available over the counter Ė usually in tablet or capsule form, and also in teabags and tinctures.

    Clinical evidence
    Plantlets of St. John's wortClinical studies of St John's wort preparations have mainly focused on the efficacy of the herb in clinical depression. There have been mixed results over the efficacy of St. John's wort in clinical depression. Some studies have found it to be effective in the treatment of mild to moderate depression, with fewer side effects than many conventional antidepressants, while others show no benefit over placebos.

    Evidence for efficacy
    An early meta-study indicated that extracts of hypericum may be more effective than placebo for the treatment of mild to moderately severe depressive disorders. (Linde et al., 1996) This study, which covered the results from 23 smaller, earlier studies, is perhaps the most often cited by manufacturers and other supporters of St. John's wort.

    This meta-analysis study was later updated to include further studies, for a total of 27, to form a Cochrane Review. The updated review found that Hypericum preparations were significantly superior to placebo (rate ratio 2.47; 95% confidence interval 1.69 to 3.61) and similarly effective as standard antidepressants (single preparations 1.01; 0.87 to 1.16, combinations 1.52; 0.78 to 2.94).

    A major study funded by the NIH in the United States, found St John's wort to be ineffective in treating major depression of moderate severity. (Hypericum Depression Trial Study Group, 2002) This study involved 340 patients, diagnosed with Major Depressive Disorder based on DSM-IV criteria and assessed using Hamilton Depression Rating Scale (HAM-D) and Clinical Global Impression (CGI) scores. The trial was a multi-centre randomised double-blind placebo-controlled trial, comparing one preparation of St John's wort to sertraline and placebo. St. John's wort proved no more effective than placebo in alleviating moderately severe major depression. Sertraline was also no better than placebo in this study, based on the primary outcome measure (HAM-D). Further studies on the herb's efficacy in alleviating mild depression are planned by the NIH.

    The St. John's wort mechanism is believed to involve inhibition of Serotonin (5-HT) reuptake, much like the conventional SSRI antidepressants.

    The major active constituents in St John's wort are thought to be hyperforin and hypericin, although other biologically active constituents present, e.g. flavonoids and tannins, may also be involved.

    Hyperforin is believed to be the major constituent responsible for antidepressant activity, and has been shown to inhibit the uptake of 5-HT, dopamine, noradrenaline, GABA and glutamate. (Chatterjee et al., 1998a) Discrepancies in the dose-response relationship imply that constituents other than hyperforin are likely to also be involved.

    Dose/Formulations
    The dosage of St John's wort preparations vary greatly between formulations, due to variability in the plant source and preparation processes. The doses of St. Johnís wort extract used in clinical trials generally range from 350 to 1800 mg daily (equivalent to 0.4 to 2.7 mg hypericin depending on the preparation).

    The recommended dosage for various forms of St John's wort as recommended by the British Herbal Medicine Association Scientific Committee (1983) are as follows:

  • dried herb: 2-4 g or by infusion three times daily
  • liquid extract 2-4 mL (1:1 in 25% alcohol) three times daily
  • tincture 2-4mL (1:10 in 45% alcohol) three times daily

    In markets where standardised extracts are not available, the potency of samples can vary widely. Some brands of over-the-counter St. John's wort can be much more potent than others. The same can even be true of two dosage units from different batches of the same brand. Even where extracts are standardised it is debatable whether using hypericin as the standard is useful, since hyperforin is believed to be the main active constituent.

    As with other antidepressants, Hypericum should be taken for at least four weeks before its effectiveness can be properly assessed.

    Adverse effects
    St John's wort is generally well tolerated, with an adverse effect profile similar to placebo. (Ernst et al., 1998). The most common adverse effects reported are gastrointestinal symptoms, dizziness, confusion and tiredness/sedation.

    St John's wort is also known to cause photosensitivity. This can lead to visual sensitivity to light and to sunburns in situations that would not normally cause them, but the incidence is reported to be rare.

    Drug interactions
    St John's wort has been shown to cause multiple drug interactions mainly through induction of the cytochrome P450 enzyme CYP3A4, but also CYP2C9. This results in the increase metabolism of those drugs, resulting in decreased concentration and clinical effect. The principal constituent thought to be responsible is hyperforin which, unfortunately, is also believed to be the active constituent.

    Examples of drugs causing clinically-significant interactions with St John's Wort Class Drugs

  • antiepileptics carbamazepine, phenytoin
  • antiretrovirals non-nucleoside reverse transcriptase inhibitors, protease inhibitors
  • benzodiazepines alprazolam, midazolam
  • contraceptives combined oral contraceptives
  • immunosuppressants calcineurin inhibitors, ciclosporin, tacrolimus
  • others digoxin, methadone, omeprazole, phenobarbitone, theophylline, warfarin

    Natural Herbal Remedy St. Johns Wort for Depression:

    Active ingredient hypericin has been shown to exhibit monoamine oxidase (MAO) inhibiting activity, acting as a natural anti-depressant. Do not take with other MAO inhibiting drugs or supplements that advise against combining with MAO inhibitors (some people use the natural herbal remedy St. John's Wort with ma huang to get a natural "Phen-Fen" replacement).

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    St. John's Wort Uses

    Used in all pulmonary complaints, bladder troubles, in suppression of urine, dysentery, worms, diarrhoea, hysteria and nervous depression, haemoptysis and other hemorrhages and jaundice.

    BENEFITS OF USE:

    Reports that at least one out of every 20 Americans are diagnosed with depression each year with many of them relying on prescribed anti-depressants, but many new studies show the herb St. John's Wort as just as effective, and with fewer side effects. In the August 1996 issue of the British Medical Journal contains an analysis of approximately 25 studies that suggest that St. John's Wort (Hypericum perforatum) is just as helpful as commonly used drugs, without side effects such as headaches or vomiting.



    RESEARCH & STUDIES:
    Recently known in the United States, but researchers in Europe have been studying St. John's Wort for decades. It is common for doctors in Germany to prescribe it for depression with insurance companies paying for it. It is available in many pharmacies herb shops in Europe and the United States in liquid, capsule and dried form.


    DOSES & DIRECTIONS:

    St. John's Wort Precautions

    Persons with fair skin may want to avoid exposure to sunlight and other sources of ultraviolet light when taking St. John's Wort due to photosensitivity, avoid foods that contain tyramine, alcoholic beverages, and medications such as tyrosine, narcotics, amphetamines, and over-the-counter cold and flu remedies. St. John's Wort should not be taken while also taking prescription antidepressants or during pregnancy or lactation.

    If you have high blood pressure consult your doctor.



    INGREDIENTS:
    St. John's Wort contains hypericin that inhibits monoamine oxidase, a body chemical associated with depression. It appears that hypericin does not act alone. Like many herbal medicines, St. John's Wort relies on the complex interplay of many constituents for its antidepressant effects. Patients given St. John's Wort after suffering from depression received relief, increased appetite, more interest in life, greater self-esteem with reporting better sleep. Perhaps most notable regarding St. John's Wort extract for depression has been favorable comparisons to standard prescription antidepressive drugs like maprotiline hydrochloride and imipramine.

    St. Johns Wort Description

    A herbaceous perennial growing freely wild to a height of 1 to 3 feet in uncultivated ground. Flowers bloom June to August, followed by numerous small round blackish seeds.

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    *These statements have not been evaluated by the Food and Drug Administration.
    This product is not intended to diagnose, treat, cure or prevent any disease


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