is in large part due to the fact that, according to the NIH,
depression affects nearly 19 million U.S. citizens annu-
ally, about 6% of the population.
The part of the St. John’s wort used within such
products are the flowers. They are reduced down to
concentrated extracts; that is, specific non-essential
substances that are removed to leave behind desired
chemicals in a concentrated form. St. John’s wort is
sold in most countries as over-the-counter medicines
in capsules and tablets, and as prepared herbal tea bags
(in which boilingwateris added to the dried herb and
steeped). In other countries, such as Germany, it is used
for mild depression more frequently than artificially
made medically approved antidepressants.
The composition of St. John’s wort and how it
works is not well known nor understood. Some scien-
tific evidence suggests it is useful for treating mild to
moderate depression. Other recent reports state that it
has no effect for treating major depression of moder-
ate severity.
DescriptionThe St. John’s wort plant is easily identified by its
leaves and flowers. The toothless, stalkless, narrow,
oblong leaves are yellowish-green in color, opposite to
each other, and have tiny translucent spots scattered
throughout the tissues and obvious black dots on the
lower surface. When held up to light, the leaves appear
to beperforated, which gives them their Latin species
nameperforatum. The leaves also contain glands that
contain oil. The flowers are clustered with five petals.
Each flower is about 12 to 20 millimeters (0.47 to 0.79
inch) long. The flowers are bright yellow in color with
black dots. The five-petaled clusters grow up to 2.5
centimeters (about one inch) in diameter. The flowers
bloom between April and July (late spring and early
summer in the northern hemisphere). When the flow-
ers or seed pods are crushed, a reddish purple liquid is
produced.
As a genus, St. John’s wort is native to the sub-
tropical and temperate regions of Asia Minor, China,
Europe, India, North America, and Russia and the
other countries of the former Soviet Union.H. perfo-
ratumis actively cultivated in parts of southeastern
Europe. It is indigenous to Europe but has been intro-
duced into areas of the Americas.
PrecautionsThe use of H. perforatumfor the treatment of
various medical problems has not been adequately
documented. Previous clinical studies have largely con-
centrated on its effectiveness in clinically recognized
depression,
Some studies show it is effective in mild to mod-
erate depression while other studies show no benefit
over placebos. Recent studies include a 2004 study
called the Cochrane Review, which included 27 later
studies. The results show that St. John’s wort was
significantly superiorto placebos andsimilarly effec-
tiveas general antidepressant medicines.
Between 1998 and 2005, numerous medical stud-
ies showed St. John’s wort to be generally more effec-
tive than placebos and generally of equal effectiveness
when compared to standard antidepressants, but with
fewer negative side affects.
In 2002, the National Institutes of Health (NIH)
funded a large and well designed research study called
the Hypericum Depression Trial Study Group. Three
organizations within the NIH coordinated the study:
the National Center for Complementary and Alterna-
tive Medicine (NCCAM), the Office ofDietary Sup-
plements(ODS), and the National Institute of Mental
Health (NIMH). Three hundred, forty patients diag-
nosed withmajor depression of moderate severitywere
subjected to a double-blind placebo-controlled trial
comparing St. John’s wort to placebo. St John’s wort
was found to be no more effective than placebo.
St. John’s wort has also been studied as a treat-
ment for anxiety, obsessive-compulsive disorder, HIV
(human immunodeficiency virus), atopic dermatitis
(sometimes called eczema, a skin condition), and social
phobia. In treatment of these illnesses, the results did
not show anything conclusive about a positive affect
that St. John’s wort has on reducing symptoms. In all
cases, there is insufficient evidence to make any
recommendations.
In addition, the use of St. John’s wort for such
problems as premenstrual syndrome, depressed mood,
seasonal depressive disorder, and somatoform (psy-
chologically induced) disorders is controversial within
the medical community.InteractionsBoth the German Commission E, which is respon-
sible for review of herbal and other alternative therapies,
and the european scientific cooperative on phytotherapy
have reviewed St. John’s wort and found no interactions
with other drugs.
How St. John’s wort works is not known. Some
studies preliminarily indicate that it might stop nerve
cells in the brain from reabsorbing serotonin, a neuro-
transmitting chemical messenger. Other studies showSt. John’s wort