it might reduce levels of aproteininvolved in the body’s
immune system. There are many chemical compounds
within St. John’s wort. The major active ingredients in
St. John’s wort are believed to be hyperforin (thought
to help in the treatment of depression and combat
bacteria) and hypericin (believed to be an antibiotic).
Flavonoids (a possible antioxidant) and tannins (might
help with diarrhea, blood-clotting, andhemorrhoids),
which are also contained in St. John’s wort, could be
active ingredients, too.
St. John’s wort may cause increased sensitivity to
artificial light and light from the Sun. It may make
some people sunburn more easily than normal. Some
research shows that it may cause infertility in both men
and women.
Other common side effects can be anxiety, dizzi-
ness, dry mouth, fatigue and weakness, gastrointestinal
symptoms, headache, sleeping disorders, muscle
cramping, nausea, and restlessness. More infrequently
occurring side effects include: anorexia,constipationor
diarrhea, increased periods of blood pressure and
pulse, heartburn, increased sweating, loss of hair on
scalp and eyebrows, numbness, tingling and nerve pain
or damage, tremors, increased sweating and flushing
(marked redness in face and other body areas), and
tremors.
According to the National Institutes of Heath, when
St. John’s wort is ingested, it can alter the way that the
body uses other drugs. In some circumstances, interac-
tions can be dangerous. Some of these drugs include:
drugs that treat HIV such as indinavir (CrixivanÒ);
drugs that fightcancersuch as irinotecan (CamptoÒ);
drugs that lower cholesterol such as lovastatin
(MevacorÒ), nifedipine (ProcardiaÒ), and midazolam
(VersedÒ); drugs that reduce the rejection of transplanted
organs such as cyclosporine (SandimmuneÒ); drugs that
strengthen contractions of the heart muscle such as
digoxin (LanoxinÒ); drugs that act as anticoagulants
(blood thinners) such as warfarin (CoumadinÒ); drugs
that treat depressants such as amitriptyline (ElavilÒ); and
drugs that control thyroid conditions such as levothyr-
oxine (SynthroidÒ).Complications
St. John’s wort is generally well tolerated by the
human body. Scientific studies show that the body
readily accepts it at recommended doses for up to
one to three months. Sometimes, if St John’s wort is
discontinued suddenly, there may be unfavorable
withdrawal symptoms.
As with any ingested medicinal or herbal sub-
stance, there is always risk with taking too large anamount or having it react negatively with something
else. Because St. John’s wort is a dietary supplement
the U.S. Food and Drug Administration (FDA) does
not regulate it. Consequently, the strength and quality
of it is not predictable within products sold by manu-
facturers. Products can differ from company to com-
pany, and more surprisingly, can change from batch to
batch within a company. Information on labels can
also be misleading because such data is not regulated
by the FDA.Parental concerns
If children have depression, St. John’s wort is not a
proven therapy for its treatment—in fact, it is not a
proven therapy for the treatment of any depressed per-
son. Parents of children suspected of being depressed
should contact a medical professional for assistance.
Effective treatments are available. Patients should be
aware that if St. John’s wortis used with standard anti-
depressant therapies, it can cause side affects such as
anxiety, confusion, headache, and nausea.
Medical professions also commonly warn pregnant
or lactating women about taking St. John’s wort. No
adverse effects have been documented with the use of
St. John’s wort. However, because there are no pub-
lished safety and health data, these women are advised
to avoid the use of St. John’s wort. Likewise, parents
are advised not to give St. John’s wort to their young
children because of a lack of scientific evidence as to its
safety.Resources
BOOKS
Linde, K., and C.D. Mulrow.St.John’s wort for depression
(Cochrane Review) In: ‘‘The Cochrane Library’’. Chi-
chester, UK: John Wiley and Sons, Ltd., 2004.
Singh, Amrit Pal.Compendia of World’s Medicinal Flora.
Enfield, NH: Science Publishers, 2006.
Van Wyk, Ben-Erik, and Michael Wink.Medicinal Plants
of the World: An Illustrated Scientific Guide to Impor-
tant Medicinal Plants and Their Uses. Portland, OR:
Timber, 2005.
PERIODICALS
Hypericum Depression Trial Study Group. ‘‘Effect of
Hypericum perforatum(St John’s wort) in major
depressive disorder: a randomized controlled trial’’
Journal of the American Medical Association. (2002)
287:1807–1814.
Szegedi, A, R. Kohnen, A. Dienel, and M. KIeser.
‘‘Acute treatment of moderate to severe depression with
hypericum extract WS 5570 (St John’s wort): random-
ized controlled double blind non-inferiority trial versus
paroxetine’’British Medical Journal. 330 (7490):
503–506.St. John’s wort