Important note: Information in this article was accurate in March 2000. The state of the art may have changed since the publication date.
St. John's wort (Hypericum perforatum) is a plant that grows in parts of North America, Europe, Asia and North Africa. This herb contains many active compounds, including hypericin, pseudohypericin and hyperforin, some of which may help people better cope with anxiety and mild depression.
In 1989, researchers found that two extracts of St. John's wort had anti-HIV activity in lab experiments with cells and viruses. Hypericin's antiviral activity in the test tube, however, depends on its interaction with light. An American clinical trial of intravenous hypericin has found no antiretroviral benefit, and 50% of subjects left that study after eight weeks because of toxicity. Most people who use St. John's wort aren't using it, or its extracts, for its anti-HIV activity, perhaps because no clinical benefit has been shown in controlled studies.
Extracts of St. John's wort are being studied and used as a treatment for anxiety and mild to moderate depression. Controlled studies that compared the herb with prescription antidepressants or fake St. John's wort (placebo) found that its extracts can help relieve feelings of anxiety and mild depression in some people. Subjects using the plant's extracts also reported fewer side effects than those on standard antidepressant therapy. Readers should note that most of these studies didn't go beyond six weeks, and some used relatively low doses of prescription antidepressants.
St. John's wort is usually sold in tablet, capsule and liquid form in drugstores and health food stores. Tablets and capsules sold in North America tend to contain 0.3% hypericin. Manufacturing processes can vary widely, as can the concentration of ingredients in different preparations. Given these factors, people who intend to use this herb should ask their health-care providers for advice on brands and dosages.
1. HIV-positive people who feel that they may be experiencing symptoms of depression must have this confirmed by a doctor. Moreover, treatment of depression, as with every other illness, should be done under medical supervision, even if an herbal extract like hypericin is being used.
2. St. John's wort can interact with other drugs and cause the liver to increase or decrease the levels of these drugs in the blood. According to results from a study on eight non-HIV-infected subjects (six male, two female), the use of St. John's wort can cause a large decrease in indinavir levels in the blood, ranging from 49 to 99%. Given its effect on indinavir levels, it is possible that St. John's wort may also reduce the levels of other protease inhibitors as well as drugs such as delavirdine, efavirenz and nevirapine. It is therefore essential that patients taking anti-HIV drugs inform their doctors if they are using St. John's wort or any other herbal supplement. Other drugs that may interact in a similar manner with St. John's wort include:
3. St. John's wort can make people more sensitive to sunlight. Users may therefore develop sunburn, rash, headache, tiredness and other symptoms of photosensitivity. Taking St. John's wort with other drugs that can cause photosensitivity, such as Bactrim or Septra, may increase the risk of developing this side effect.
4. Apart from photosensitivity, reports from some clinical trials suggest that St. John's wort and its extracts may be associated with the following side effects:
Overall, side effects from St. John's wort are supposed to be milder than those from prescription antidepressants, according to studies that compared these two types of treatments. In some cases, side effects associated with St. John's wort were similar to those seen with placebo.
5. Due to its antidepressant properties, St. John's wort and its extracts can potentially cause unpleasant or dangerous reactions when taken with certain other drugs (as can other antidepressants). These drugs include:
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Disclaimer: The editors have taken all such care as they consider reasonable in preparing this database, but they cannot be held responsible for any inaccuracies or mis-statements of fact contained herein. Inclusion in this database of any information on any treatment, therapy, or clinical trial in no way represents an endorsement of that treatment, therapy, or trial by ÆGiS or any of its sponsors. This data should always be used in conjunction with professional medical advice.