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Date: Sun, 21 Apr 1996 14:28:16 -0700 (PDT)
From: David M Ulansey <davidu@uclink.berkeley.edu>
Subject: Hypericum for depression
An interesting letter, published in the The Journal of the American Botanical Council (HerbalGram) 36: 76, from Dr. Ranate Boesel of Lichtwer Pharmaceutical in Berlin notes that Jarsin300, a standardized extract of hypericum (St. John's wort) is now the most widely physician-prescribed anti-depressant in Germany (prescribed about 6 times more than fluoxetine). The use of hypericum for depression is increasing in Germany by about 70% per year.
Date: Sun, 21 Apr 1996 16:49:47 -0700 (PDT)
From: David M Ulansey <davidu@uclink.berkeley.edu>
Subject: Hypericum for depression
On Sun, 21 Apr 1996, Camilla Cracchiolo wrote:
Interesting. Does it address the fact that it contains an MAOI and whether people are being given MAOI precautions or not?The antidepressant effects of hypericum do *not* appear to be a result of its mild inhibition of MAO. See, for example:
Bladt S, Wagner H. Inhibition of MAO by fractions and constituents of hypericum extract. Journal of Geriatric Psychiatry and Neurology, 1994 Oct, 7 suppl 1: S57-9.
which concludes:
"From the results it can be concluded that the clinically proven antidepressive effect of hypericum extract cannot be explained in terms of MAO inhibition."
Date: Sun, 20 Oct 1996 14:37:59 -0500
From: Constantine J Rigas <Constantine.J.Rigas-2@tc.umn.edu>
Subject: Hypericum for depression
In the October issue of the Psychiatric Times, Kenneth Bender, PharmD, wrote an article entitled "St. John's Wort Evaluated as Herbal Antidepressant." In this article, he highlighted the fact that physicians in Germany prescribe this on a regular basis (66 million daily doses) and that it has been found to be significantly superior to placebo and at least comparable to standard antidepressants with a more favorable side effect profile. He also mentioned the opportunities to scrutinize the potential medicinal properties of natural products through controlled scientific investigation, spurred by the 1992 establishment of the National Institutes of Health Office of Alternative Medicine, the 1994 Dietary Supplement Health and Education Act, and increased funding through the National Cancer Institute for natural products.
Date: Sat, 16 Nov 1996 16:44:38 -0800 (PST)
From: Camilla Cracchiolo <camilla@PrimeNet.Com>
Subject: Hypericum for depression
There do not appear to be any reports of adverse effects of St. John's wort in humans in the scientific literature. I have one anecdote from an herbalist who said that in 20 years of practice, he has had one very fair skinned person develop photosensitivity.
Oh, what I would give for an herbal equivalent of the PDR.
All the information below is from Wichtl's "Herbal Drugs and Phyto-Pharmaceuticals", and from HerbalGram 18/19, published jointly by the American Botanical Council and the Herb Research Foundation.
The German labelling states that there are no counterindications and no known drug interactions. I'm not real comforatable with that last statement, given that there is a known MAOI in St. John's wort, but that's what they say. This herb is in common use in Germany, and I would think that we'd hear something if people were keeling over in the streets after consuming it.
Just about all the studies on St. John's wort (Hypericum perforatum and augustifolia) have been done on extracts or oils and it is most commonly used clinically in standardized extract form. The standard dose approved in Germany is 2-4 grams of drug (meaning powdered raw herb here) or 0.2 to 1.0 mg of hypericin per day. Have fun trying to translate this into doses of the stuff in health food stores. :)
St. John's wort is a complex plant containing at least 20 bioactive agents. The best studied are the flavones, including hypericin (also called hyperocide) and related compounds. The raw plant contains about 0.05 - 0.3% hypericin and related cousins. H. augustifolia contains more hypericin than does perforatum and there is a strong seasonal effect on hypericin concentration (it is highest during full bloom), which may result in inconsistency if a standardized extract is not used. While some people do use St.John's wort in tea form, hypericin appears to be best extracted in oils or glycol. As far as MAO inhibition, the repsonsible agent seems to be hypericin. Many other plants in the family to which H. peforatum belongs (the Guttiferae) and other species of hypericum contain a xanthone that is a clear MAOI called isogentisin, but this chemical appears to be absent in H. perforatum (I don't know about augustifolia). There is one recent animal study that says you don't get any significant inhibition of MAO-A until a very high dose is used. They used rats and found that total inhibition of MAO-A from the whole plant did not occur until 10 ^ -3 mol/L was used, although isolated fractions for the plant gave partial (around 30%) inhibition at 10 ^ -4 mol/L. (I have no idea how to translate that into a human dose, and I don't have the molecular weight.) The authors suggest that the antidepressant effects of St. John's wort are therefore due to some other compound that has not been yet been identified.
However, a 1984 study on 6 women aged 55-65 measured urinary metabolites of norepinephrine and dopamine before and after hypericin treatment. They found a significant increase in levels of 3-methoxy-4-hydroxyphenylglycol. I don't have enough biochemistry background to interpret this.
Another study in 1984, published in Planta Medica by Suzuki et al., found that hypericin irreversibly inhibited MAO-A and B in vivo. I don't have the paper so I don't know the dosage involved, nor do I know whether this was an animal or human study.
St. John's wort also has compounds with anti-viral and anti-fungal activity, carotenoids, a phytosterol (beta-sitosterol, which I believe has mild estrogenic activity, perhaps in part accounting for its effectiveness in women experiencing depression during menopause?) and xanthones, as well as the usual run of the mill alkanes, alkanols, etc. It also has about 10% tannins. It contains coumarins, but not all plant coumarins affect platlet aggregation, and I'm not familiar enough with coumarin chemistry to know if these particular compounds, umbelliferone and scopoletin, affect blood clotting or not.
I hope this is helpful rather than adding to the confusion.
Date: Sat, 16 Nov 1996 19:24:15 -0800 (PST)
From: Camilla Cracchiolo <camilla@PrimeNet.Com>
Subject: Hypericum for depression
One other thing: adulteration and mislabelling of herbal products is very common. People considering the clinical use of herbs might want to to have specific products analyzed at a laboratory familar with the isolation of natural products to make sure that what you're really getting is what's on the label.
I recently asked the phytopharmacogosy list for places that people could have herbal products analyzed.
These names were sent to me by an herbalist named Roy Upton, who I've found to be a very reliable source of information. He is vice-president of the American Herablists Guild and an active member of the American Herbal Products Association Standards Committee.
I have no affiliation with any of these labs and am posting their names for informational purposes only:
A university with a graduate organic chemistry or pharmacology department might also be of assistance.
Date: Thu, 06 Mar 1997 23:34:33 +0000
From: Dean Clay, Ph.D. <Dean@imagina.com>
Subject: Hypericum for depression
See the Hypericum Home Page.
Date: Mon, 31 Mar 1997 15:30:15 -0800
From: "Dr. Raymond W. Lam" <rlam@unixg.ubc.ca>
Subject: Hypericum for depression
At 01:39 PM 03-31-1997 -0800, William Wilson wrote:
In the April 1997 issue of Biological Therapies in Psychiatry, Alan Gelenberg reviewed the use of Hypericum performatum (St. John's wort) in depression. The literature on the subject comes largely from Germany. There have been 8 placebo controlled trials which met methodological criteria, all finding Hypericum "to be superior to placebo." He ended the review with a recommendation against its use "for now," stating, "there is a lack of sufficient data on safety (particularly long term), efficacy, potential interactions, and ... purity of procucts sold as nutritional supplements rather than drugs." As usual, Dr. Gelenberg has provided a concise, cogent review and a sensible recomendation.I know lots has been said about hypericum here and elsewhere, especially with the meta-analysis reported recently in the Br J of Psychiatry. However, I think it should still be pointed out that all controlled studies of hypericum were in mild to moderate depression, usually in primary care samples. Also, in the few studies against comparator antidepressant drugs, most were not placebo controlled and the doses of drugs were not optimal (e.g., 75 mg of maprotiline, 75 mg of amitryptiline). Hence, I would agree with Dr. Gelenberg that it would be difficult to recommend it except for the mildest cases of depression, not usually found in psychiatrists' practices.
Date: Tue, 1 Apr 1997 13:52:01 +0200
From: zimm@mpipsykl.mpg.de (Ulrich Zimmermann)
Subject: Hypericum for depression
A patient came to me for information about Hypericum. She said that her only concern was the purity and unifority of the preparations. She asked about German preparations. She noted the extensive German use of it, and said that she found it inconceivable that the Germans would not have a pure, standardized preparation.Standardized preparations of Hypericum perforatum in Germany and their manufacturers are:--Bill Wilson
each containing 250-500 mg hypericin per capsule or 10 ml.
From: Hart333@aol.com
Date: Sat, 31 May 1997 01:06:47 -0400 (EDT)
Subject: Hypericum
The name Hypericum is derived from the Greek and means "over an apparition", a belief that the herb was so obnoxious to evil spirits that a whiff of it would cause them to fly...
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Dr. Bob is Robert Hsiung, MD,
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URL: http://www.dr-bob.org/tips/split/Hypericum-for-depression.html
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