St. John’s wort

1. St. John’s wort By: Candice Carlson 10/17/11

2. Why talk about St. John’s wort? • Popular herbal remedy. • Used world-wide. • Learn new information. • Nutrition. • Family, friends.

3. Overview • Describe St. John’s wort • History • Botanical composition • Health claims • The science behind the claims • Recommendations • Safety • Efficacy • Conclusion

4. What is St. John’s Wort? • St. John’s wort is an herb. • Herbaceous perennial. • An herb is a small plant that bears seeds. • Fleshy parts instead of woody parts. • Hypericum perforatum • Saint John’s Word, Hardhay, Goatweed, Amber, Klamath weed, and Tipton weed. • Yellow flowers and leaves are used to make medicine. • Large amount of chemical compounds. • Ingredients believed to produce effectiveness-hypericin and hyperforin.

5. What is St. John’s Wort? • Native to Europe. • Common in United States, Canada, and Australia. • Found in meadows and woods. • Australia considered it a weed. • Now grown as a crop, produces 20% of the world’s supply. • United States • Nutritional supplement • Europe • Prescription medication

6. History • Dates back to ancient Greece. • Hippocrates documented the medical use of St. John’s wort. • Encircled with folklore. • Greeks used it to fight evil spirits and fevers. • England provided the house with protection. • Eliminate witches. • Scientific name is Greek • Hyper (over) • Eikon (ghost) • St. John the Baptist • Blooms around his birthday. • June 24th

7. History • Thought that placing the plant under the pillow would prevent death from occurring throughout the year. • St. John’s Eve • Folk remedy • Used for centuries. • Treat wounds, nervous disorders, and gout. • Native Americans used the plant to treat help with treatment of snakebites. • United States • Not known until 1900’s • Popular • Concerns about the risks and harms.

8. Traditional Use • Has been used as an antidepressants and diuretics. • Used for burns and fevers. • Europe • Used for depression, bedwetting, skin problems, liver problems, and mental exhaustion.

9. Botanical & Chemical Composition • Perennial herb. • Stoloniferous, extensive rhizomes. • Leaves contain dots on the surface. • Five petals, bright yellow • Contains • Melatonin • Tannins • Flavonoids • Flavonal Glycosides • Phenolic acids • Naphtodianthrones • Hypericin • Phloroglucinols • Hyperforin • Essential oils • Comprised of sesquiterpenes.

10. Health Claims • Reduces anxiety symptoms. • May be ineffective for ADHD symptoms. • Improves menopausal symptoms. • Possibly improve wound healing. • Improves dermatitis symptoms. • May reduce premenstrual symptoms. • May be effective treatment for somatoform disorders. • Reduces fatigue. • Effective in treating mild to moderate depression. • Ineffective for treating major depression.

11. Anxiety • Not enough current evidence that St. John’s wort improves anxiety symptoms. • May be beneficial to some. • Study declared 3 cases relieving anxiety symptoms. • Study had participants take 900 mg of St. John’s wort twice a day. • In 4 weeks a woman who had previously suffered from chronic anxiety for 8 years found symptoms were relieved. • Before the treatment she experienced: insomnia, worry, tension, and irritability. • After the study she experienced: reduced worry, ability to cope with stress, sense of relaxation, and improved sleep.

12. ADHD • Unclear whether St. John’s wort is effective for treatment. • May be beneficial for treatment. • Hyperforin (active ingredient) • Inhibit reuptake of serotonin and nor epinephrine (brain chemicals). • Study of 54 children from 6 to 17 years old • showed symptom improvement from the placebo and the treatment. • 300 mg of Hypericum perforatum, 3 times a day for 8 weeks. • Although it showed improvement there were no additional benefits found. • Concerns it may worsen ADHD symptoms when taken with methylphenidate (used for treatment of ADHD). • Further studies need to be performed.

13. Menopausal Symptoms • Some research showing St. John’s wort can improve menopausal symptoms. • Combined with black cohosh. • Study of 301 women • St. John’s Wort combined with black cohosh was superior to placebo. • Improvements in physical and subjective symptoms. • Not enough scientific evidence.

14. Wound Healing • May be effective for wound healing. • St. John’s wort can be used externally as an oil. • Can treat first degree burns • Post therapy • A few research studies conducted regarding application of St. John’s wort ointment. • Taken 3 times a day for a couple weeks may show improvement in wound healing. • May reduce the formation of scars following a C-section.

15. Dermatitis • Positive results regarding sub acute atopic dermatitis. • Further studies need to be conducted. • Ointment applied approximately 3 times a day for a couple weeks may improve wound healing. • Result in reduction of scar formation. • Study of 21 participants • 4 weeks • Participants used a treatment with hypericum. • Applied 2 times a day. • Tolerance of cream was excellent. • Eczematous lesions significantly more effective than placebo.

16. Premenstrual Symptoms • A few studies show that St. John’s wort may be able to reduce premenstrual symptoms. • May improve symptoms by 50% in some women. • One study found that taking 300 mg of St. John’s wort reduced daily symptom ratings. • Modified Social Adjustment Scale scored improved. • Hospital Anxiety and Depression Scale improved. • Preliminary evidence. • Further studies are needed.

17. Somatoform Disorders • St. John’s wort can possibly be effective for symptom reduction. • After 6 weeks approximately. • Study • 600 mg of St. John’s wort were given daily to outpatient adults. • Proven safe and effective for treatment of mild or moderate somatoform disorders. • Proven equally safe as placebo. • Well tolerated. • St. John’s wort may help with Somatoform Disorders but to clearly confirm this further research is needed.

18. Fatigue • St. John’s wort may reduce fatigue. • Study • Open, uncontrolled • Patients were given hypericum 3 times a day for approximately 6 weeks • Results showed a reduction in fatigue. • Also showed reduction in anxiety and depression. • Further control studies should be completed. • This study did no include a control group. • Results were difficult to determine. • St. John’s wort can possibly reduce fatigue.

19. Mild-Moderate Depression • St. John’s wort taken for treatment of mild to moderate depression is likely to be effective. • Scientific evidence is inconsistent on effectiveness of St. John’s wort. • Likely to improve mood, insomnia, and reduce anxiety • As effective as prescription drugs. • St. John’s wort is considered an antidepressant that can be used as a short-term treatment for mild to moderate depression. • 37 clinical trial were conducted. • Results show St. John’s wort may benefit people with mild depression. • Benefits were similar to other antidepressants • May contribute to less side effects

20. Major Depression • Major depression is a common disorder that is likely to spread modern society. • St. John’s wort provides minimal benefits for major depression. • Studies show St. John’s wort is ineffective for major depression. • Study of 340 participants • Measured Hamilton Depression Scores. • St. John’s wort dropped their scores. • Results do not support St. John’s wort for treatment of major depression.

21. Herbal Preparation • Preparation of an infusion • 2 tsp of drug • 150 mL boiling water • Steep for 10 minutes. • Dried herb • Tablets • Tinctures • Capsules • Storage • Room temperature • Keep away from sunlight and heat. • Away from moisture. • Limited shelf life.

22. Recommendations • Dose and Frequency: Recommended to take 200 to 1,000 mg/day for depression treatment. • Capsules and tablets: take 300 mg three times a day (0.3% Hypericin). • 0.2% Hypericin-take 250 mg twice a day. • 5% Hyperforin-take 300 mg three times a day. • Under age 12, 300 mg daily is recommended (0.3% Hypericin). • If taken for premenstrual syndome: 300 mg once a day (0.3% Hypericin). • If taken for somatization disorders: 600 mg a day is advised • Special extract

23. Recommendations • Dried herb: 2 to 4 grams three times a day. • A traditional method is Tea. • For one dose 2 to 3 grams of the dried herb is recommended. Place in boiling water. • Tincture: 2 to 4 mL three times a day. • Cost: For 90 capsules approximately $13.00

24. Concerns with Herbal Products • Food and Drug Administration (FDA) • Classifies St. John’s wort as a dietary supplement. • Herbal products are allowed to be sold without dosage studies. • Not required for safety and effectiveness as well. • Misleading Information • Inaccurate Information • “Natural” is not necessarily considered “safe.” • Especially when taken in large doses • Interaction with drugs

25. Safety • St. John’s wort for general use is believed to be safe for short-term use. • Safety concerns. • Some of the chemical compounds, when combined with prescription drugs, is not advised.

26. Safety Concerns and Precautions • Short term use • Likely safe • May cause side effects • Trouble sleeping • Diarrhea • Dizziness • Irritability • Upset stomach • May be unsafe taken in large doses by mouth. • Special Precautions • Possibly unsafe for: • Pregnancy • Breast feeding • Infertility • Major depression • Alzheimer’s Disease • Anesthesia & surgery • ADHD • Schizophrenia • Bipolar Disorder

27. Interactions with MedicationHealth Risks • Do not combine St. John’s wort with certain medications. • Can decrease effectiveness when taking: • Amitriptyline • Contraceptive drugs • Digoxin • Eplerenone • Imatinib • Irinotecan • Tacrolimus • Several anti-human immunodeficiency drugs • Ivabradine • Warfarin • Cyclosporin • Voriconazole

28. Interactions with MedicationHealth risks • Additional interactions • Alprazolam (Xanax) • Aminolevulinic acid • Cyclosporine • Fenfluramine • Antidepressants (Medications for depression) • Medications for pain (narcotic drugs) • Meperidine • Mephenytoin • Nefazodone • Phenobarbital • Phenprocoumon • Phenytoin • Reserpine • Sertraline • Tramadol • Nortriptyline • Paroxetine • Pentazocine

29. Health Risks • http://www.5min.com/Video/Learn-about-St-Johns-Wort-and-Surgery-284058426

30. Conclusions • Quality of Research • Human research suggests that further research is needed for evidence to support many of the health claims. • St. John’s wort has been used for centuries. • Documented it’s use. • Many studies show that St. John’s wort is likely to be effective for mild depression.

31. Conclusions • Efficacy • Improves anxiety symptoms is weak. • Evidence is unclear on the effect on ADHD symptoms. • Not enough scientific evidence to show it improves menopausal symptoms. • Some evidence it may be effective for wound healing. • Further research needs to be done on improvement in dermatitis symptoms. • Reducing premenstrual symptoms is weak.

32. Conclusion • Efficacy • To clearly confirm the use of St. John’s wort for somatoforam disorders further research is needed. • Further control studies are needed to prove the reduction in fatigue. • Research on depression is inconsistent. • Most likely to help with mild to moderate depression. • Not likely to help with major depression.

33. Conclusion • Safety • Safe for general, short-term use. • Only used 4 to 6 weeks. • May cause side effects. • Unsafe when taken in large doses. • Possibly unsafe when: pregnant, breastfeeding, infertility, major depression, alzheimer’s disease, anesthesia and surgery, ADHD, schizophrenia, bipolar disorder. • Unsafe when combined many medications • Birth control pills, antidepressants, anticancer medicines, and medicines to control HIV

34. Conclusions • Ethics in marketing • Marketed capsule and tablet form. • Ointments are marketed for wound healing, helping with skin irritations, and bruises. • Marketing is directed towards those suffering from mild to moderate depression and anxiety. • Marketed as being as effective as Prozac for treatment of depression. • Many articles showing that it is effective for short-term use for mild to moderate depression.

35. Conclusions • What you should know: • Botanical and chemical composition of St. John’s wort • Health claims • The science behind the claims • Herbal preparation • Recommendations • Concerns and risks associated with St. John’s wort • Interactions with medicines • Safety, efficacy, ethics in marketing

36. The End! Any Questions??