St. Johnswort (Hypericum Perforatum) has been a highly respected plant medicine for thousands of years. It has a long history of use for many illnesses. Most widely used today for its effectiveness in treating mild to moderate depression, people are flocking to the stores to buy some. This report is intended to fully inform people about the use of St. Johnswort, so that it may be used both safely and effectively.

St. Johnswort contains a complex mixture of botanical compounds such as hypericin, pseudohypericin, as well as flavanoids, carotenoids, xanthones, phenolic carboxylic acids, essential oils, and phloroglucinal derivatives. Its actions are anti-inflammatory, astringent, vulnerary, nervine, and anti-microbial.

Taken internally, it has sedative, mood elevating, and pain relieving effects, which leads to significant improvement of symptoms of mild to moderate depression, neuralgia, anxiety, and tension. It is especially helpful in menopausal neurosis where changes trigger irritability and anxiety.

Externally, it has been used as a topical lotion, oil, or salve to speed the healing of wounds, bruises, varicose veins, and mild burns. It is especially helpful for sunburns. St. Johnswort Oil makes an excellent massage oil for deep muscle soreness, bruising, and nerve damage. It can be used both externally and internally for nerve injuries to the spine, facial neuralgia, traumatic shock, and as well as hemorrhoids.

Dosages: Many people are quick to grab a bottle of capsules and start using them, not knowing anything about proper use or dosage. The most effective way to take St. Johnswort, or any herb for that matter, is in a liquid form, not a dried powdered capsule! The herb can be made into a tea, using 1-2 full teaspoons of dried herb (2-4 gr.) per cup, steeping it for 15-20 minutes, covered, and drinking 3 cups per day. Most widely used is the concentrated liquid extract form. According to the British Herbal Pharmacopoeia, the dosage would be 2-4 ml., (or about 30-60 drops) 3 times a day. This can be put into water, juice, or tea. These pre-extracted liquid preparations are easily absorbed and will go quickly into the bloodstream, whereas the dried herb in a capsule will have to go through the digestive tract, in the hopes that it can effectively break down and absorb the active constituents, before being passed. Also, the dried powdered herb has a much shorter shelf life, and will lose its potency within months. The dose for a standardized extract is 300 mg. (0.3% hypericin) 3 times per day. As with any standardized extract, it is important that the whole plant is also included for a synergistic effect, not just the active ingredient! This will reduce any possibility of side effects using standardized products.
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A large scale study evaluating the benefits and risks of Hypericum has been published. Results refer to 3250 patients (76% women and 24% men). 49% has mild depressive irritations, 46% intermediate, and 3% heavy depressive irritations. The typical symptoms either reduced in frequency and intensity, the situation normalized or it improved during the therapy in approximately 80% of the patients, 1

In another study 105 outpatients with neurotic depressions or depressive irritations of short duration were treated in a double blind study of either St. Johnswort (Hypericum) extract, or a placebo. The therapy phase was four weeks. The effectiveness was judged according to the Hamilton Depression Scale. In the group using Hypericum, 67% patients, and in the placebo group, 28% patients responded to treatment. No notable side effects were found.2

Researchers from N.Y. University Medical Center and the Weizmann Institute of Science in Israel demonstrated in a preliminary study that St. Johnsworts componets, hypericin and psuedohypericin, inhibit a variety of retro-viruses, including the retro-viruses associated with AIDS or HIV.3 Although this information is encouraging as suggesting a possible role in the treatment of AIDS, there are still many questions to be answered. It is currently primarily used for psychological complaints, such as mild depression, anxiety, and sleep disturbances.

Hypericin is to be considered a MAO inhibitor, according to David Hoffmann, Medical Herbalist, the enzyme responsible for the catabolism of the biological amines. Anti-depressant activity generally interferes with levels of amines in the brain, i.e. serotonin, noradrenaline, adrenaline, and dopamine. The antidepressants increase the activity of these mediators either by inhibiting their re-uptake in the nerve endings, or by the antagonism of the two enzymes responsible, MAO (Mono amine oxidase) or COMT (catechol-o-methlyransferase). However, other authors conclude that the clinically proven anti-depressant activity of the extract cannot be explained in terms of MAO inhibition, as the single constituents responsible for this activity are still unknown. So it is suspected, but not determined that St. Johnswort is an MAO inhibitor.

Tyramine is an amino acid found in various foods which can cause a hypertensive reaction in people receiving MAO inhibitors. Mono amine oxidase is found in the gastro-intestinal tract and inactivates tyramine in which case the amino acid is absorbed and displaces noreinephrine from the sympathetic nerve endings and epinephrine from the adrenals. If a sufficient amount of pressor amines are released, the person may experience a severe headache, palpitations, and the elevation of blood pressure. Patients receiving MAOI therapy should observe strict dietary restrictions. Approximately 10-25 mg. of tyramine is required for a severe reaction, compared to 6 to 10 mg. for a mild reaction. Food containing low amounts of tyramine may become a risk if consumed in large quantities.

Foods to avoid or use with caution are: Alcoholic beverages, Tofu, Soy sauce, and Miso paste, cheeses (except cottage cheese and cream cheese are OK), Smoked, fermented, or pickled fish, Ginseng, protein extracts, non-fresh meat or liver, sausage, bologna, pepperoni, and salami, sauerkraut, shrimp paste, brewers or nutritional yeast (yeast used in baking is OK), overripe avocados, large amounts of caffeine, large quantities of nuts. Avoid all spoiled foods.

What about the toxicity and safety of St. Johnswort? Psychiatric medications are notorious for side effects and the need for safer anti-depressants is widely acknowledged. Hypericum extracts were found to have an anti-depressant effect in the treatment of mild to moderate depression which can be compared to the therapeutic effect of modern antidepressants, and did not cause any side effects, making it the treatment of choice in these illnesses. Internal use of Hypericum may cause changes in lactation in nursing women. Nutritional quality and flavor may be altered and lactation may be reduced or ceased altogether.4 There is the potential for photosensitivity reaction following external application in humans, characterized by dermatitis, hives, or skin sores, and typically follows exposure to sunlight after applying Hypericum to the skin. Used internally, such occurances are extremely rare.

Hopefully now you will make more educated choices in your use of this amazing herb. I prefer the concentrated liquid extract made from fresh wild St. Johnswort, which grows abundantly here in the fields of the northeast. Also, remember that St. Johnswort may take 1-3 weeks for its full effectiveness to be known. If you are using capsules of dried herbs, and are not seeing any effect, please switch to a liquid preparation before giving up. Often used for elderly people, it is traditionally known to folk herbalists to "oxygenate the cells and renew a zest for life", which also makes the cells healthier and more resistant to disease! Enjoy.