Transcript What is St. John`s Wort?

By: Candice Carlson
10/17/11
 Popular herbal remedy.
 Used world-wide.
 Learn new information.
 Nutrition.
 Family, friends.
 Describe St. John’s wort
 History
 Botanical composition
 Health claims
 The science behind the claims
 Recommendations
 Safety
 Efficacy
 Conclusion
 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.
 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
 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
 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.
 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.
 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.
 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.
 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.
 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.
 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.
 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.
 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
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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.
 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.
 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.
 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.
 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
 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.
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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.
 Preparation of an infusion
 2 tsp of drug
 150 mL boiling water
 Steep for 10 minutes.
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Dried herb
Tablets
Tinctures
Capsules
Storage
 Room temperature
 Keep away from sunlight and
heat.
 Away from moisture.
 Limited shelf life.
 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
 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
 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
 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.
 Short term use
 Likely safe
 May cause side effects
 Special Precautions
 Possibly unsafe for:
 Pregnancy
 Trouble sleeping
 Breast feeding
 Diarrhea
 Infertility
 Dizziness
 Major depression
 Irritability
 Alzheimer’s Disease
 Upset stomach
 Anesthesia & surgery
 May be unsafe taken in
large doses by mouth.
 ADHD
 Schizophrenia
 Bipolar Disorder
 Do not combine St. John’s wort with certain medications.
 Can decrease effectiveness when taking:
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Amitriptyline
Contraceptive drugs
Digoxin
Eplerenone
Imatinib
Irinotecan
Tacrolimus
Several anti-human immunodeficiency drugs
Ivabradine
Warfarin
Cyclosporin
Voriconazole
 Additional interactions
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Alprazolam (Xanax)
Aminolevulinic acid
Cyclosporine
Fenfluramine
Antidepressants
(Medications for
depression)
Medications for pain
(narcotic drugs)
Meperidine
Mephenytoin
Nefazodone
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Phenobarbital
Phenprocoumon
Phenytoin
Reserpine
Sertraline
Tramadol
Nortriptyline
Paroxetine
Pentazocine
 http://www.5min.com/Video/Learn-about-St-Johns-
Wort-and-Surgery-284058426
 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.
 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.
 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.
 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
 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.
 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
Any Questions??