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St. John's Wort: Benefits, Side Effects, Uses, Dosage, Warnings?

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ST. JOHN'S WORT: Benefits, Side Effects, Uses, Dosage, Warnings?

Common names: St. John's Wort herb St. John.
Botanical Name: Hypericum perforatum , or Hypericaceae family Clusiaceae.
English names: St. John's Wort, SJW .
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Parts used: flowering tops, mainly flowers and young leaves surrounding the flower heads.
Habitat and origin: native to Europe, North Africa and the Middle East, the plant is now naturalized everywhere, including Africa, Asia, Australia and North America. It is a perennial plant whose flower, a beautiful bright yellow, peaks around St. John (June 24) is the perfect time to harvest the flowering tops. In the wild, it is found in dry meadows, fields, abandoned or neglected land, beside roads, along the railroad tracks, etc.

Indications
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Effective
Treat mild to moderate depression.
See legend of symbols
Potential Effectiveness
Treating psychosomatic disorders.
Recognized use
Treating psychosomatic disorders, depression, anxiety, nervousness and digestive disorders (dyspepsia).
External Application - heal bruises, muscle aches and minor burns.
For details, see Research on St. John's wort .

Dosage of hypericum
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Depression

Precision and caution

Depression is a disease that must be diagnosed based on specific criteria by a healthcare professional. Depending on the number and severity of symptoms, clinical depression is classified as mild, moderate or severe. Whatever its intensity, depression requires medical attention. Self-medication is not recommended.

Standardized extract (3% hyperforin or 0.2% to 0.3% hypericin). This type of extract that was used in clinical trials. Take 300 mg, 3 times daily for solid extracts. Standard liquids may also be used if they provide equivalent hypericin or hyperforin quantities.
. Dye concentration varies from one product to another, follow the manufacturer's instructions.
Allow four weeks before the effects are fully.
Menopause

Despite some promising results, current data do not establish adequate dosing.
History of St. John's Wort
Although BC, the ancient Greeks, the founders of Western medicine, very familiar with the properties of St. John's wort for the treatment of wounds and injuries, internal infections and nerve disorders. From the late Middle Ages, its use to treat psychological problems took precedence over other uses.

We then considered the wort as a plant capable of chasing "bad spirits." Its flowering tops were also used to treat neuralgia, anxiety, neurosis and depression. The XVIII th century to the middle of the XX th century, American eclectic doctors prescribed in cases of hysteria and psychosomatic disorders related to depression. In Germany, the plant is now considered an antidepressant and prescribed medical prescription.

Herbalists also use St. John's wort oil for a variety of skin ailments: wounds, sores, bruises, chapping, diaper rash, burns, etc. (See details in the St. John's Wort Herbal medicinal section).

In January 2009, the College of Pharmacists of Quebec (OPQ) asked the Office des professions du Québec to change the classification of the wort . Arguing that the plant can cause adverse interactions with certain medications, OPQ wanted only pharmacists are authorized to sell. In April 2011, at the time of updating this page, the Office des professions clarified us that, by mutual agreement with the College of Pharmacists, the issue was dropped.

Research on St. John's wort
Depression
The active ingredients of Hypericum
extracts wort are mostly standardized hypericin, hypericin, but rather appears to be a marker of the plant, because it has no antidepressant effect. Some researchers believe that the main active ingredient of St. John's Wort is hyperforin 1 . It would also be also responsible for most interactions St John's wort with many drugs. Experts are beginning to mention flavonoids as major active ingredients. The debate is far from over, as some researchers believe that this is the set of plant compounds that the antidepressant effect originates 2.3 . See on the shelves for purchase advice of our pharmacist.

The extracts used in the studies
standardized extracts produced in Europe and available by prescription were used in most studies on St. John's wort : Lichtwer 160® LI (0.3% hypericin), ZE 117® (0 , 2% hypericin) 5572® WS (5% hyperforin).

Effective Mild to moderate depression. Data on the effectiveness of standardized extracts of Hypericum are compelling. Several meta-analyzes, including an update in 2008, concluded that the extract of St. John's wort is more effective than placebo and is, as far as the synthetic antidepressants , while causing fewer side effects the latter 4-6 . Antidepressants that were compared St. John's wort also understand those kind of fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and parotéxine (Paxil) the oldest type drugs such as imipramine.

Two studies suggest that St. John's wort has also proven safe and effective in the long term to prevent a relapse . In one of them, which took place in single-blind, 426 participants prone to relapses took a placebo or 900 mg of St. John's Wort (WS 5570®) 26 weeks 7 . In the other trial, conducted with the knowledge (without placebo), 440 subjects with mild to moderate depression took over 1 year 500 mg St. John's Wort (Ze 117®) 8 .

Furthermore, conclusive evidence continues to accumulate. For example, in Germany, were followed for 12 weeks 1541 depressed patients treated with St. John's wort and monitored by their physician. The treatment significantly reduced depressive symptoms and was well tolerated by participants 9 . A Hypericum (LI160, 600 mg daily for 8 weeks) has also proven useful for depression called "atypical", in another trial in Germany involving 200 patients 10 . Atypical depression is characterized by mood swings, excessive consumption of food in a short time (binge) and drowsiness during the day. However, a study published in 2001 reported that St. John's wort (810 mg / day for 3 months), not to have more beneficial effects (depressive symptoms, quality of life) than placebo treatment, and in addition increases the risk of side effects 46 .

An early recognition. the United States and Canada, some associations of mental health specialists are beginning to recognize, albeit reserved, usefulness St. John's wort for mild to moderate depression 11,12 . Other associations do not share this view, however 13 . Whatever their conclusions, these organizations focus on possible interactions with St. John's wort certain drugs (for more information, see Interactions ).

Potential Effectiveness Severe depression. Authors of a meta-analysis published in April 2008 scrutinized 29 studies. They concluded that the data on the effect of St. John's wort in major depression were insufficient to conclude its effectiveness 5 although some studies have shown positive results 4,14,15 .

And anxiety? Current data are insufficient, according to a systematic review published in October 2010 26 . Indeed, some tests on obsessive-compulsive disorder and depression with anxiety have yielded conflicting results.

Potential Effectiveness Psychosomatic disorders. Psychosomatic disorders are psychological problems that interfere with the cure of a disease or increase the risk of adverse movements. For example, stress or depressive symptoms may impede recovery from heart disease or recovering from a surgery.

Two studies conducted in Germany have investigated the effect of St. John's wort on 324 patients with psychosomatic disorders . At 300 mg 2 times a day for 6 weeks, the Hypericum LI 160 was more effective than placebo in relieving symptoms of participants or to reduce their aggravation 16.17 . The methodology of these tests has been criticized: too short of taking treatment, lack of side effects and drug interactions of the review Hypericum. This last point is important because patients with psychosomatic disorders typically take multiple medications 18 .

Potential Effectiveness Menopause. As menopause may be associated with depression, researchers tested the effectiveness of St. John's wort. The results are promising, but as the studies are heterogeneous (different topics and objectives, in particular), making it difficult to draw a conclusion about the effectiveness of St. John's wort.

A first test (1999) double-blind, placebo with 111 German women was successful in terms of reducing anxiety and depressive symptoms, but also physiological (hot flashes, for example) 19 . In a Quebec study, an extract of St. John's wort (900 mg / day for 3 months improved the quality of life of women treated by reducing insomnia 20 . An 8 week trial conducted among 100 women in Iran was published in 2010 compared with the placebo group, the treatment group was given the frequency and duration of hot flashes decreased respectively from the 4 th and 8 th week 21 .

During the trials in Quebec and Iran, the beneficial effects of St. John's wort were especially strong after two months of treatment: they include resulted in a 50% decrease in the frequency and duration of hot flashes by relative to the start of treatment. As often happens in this type of study, the placebo effect occurred, since we have also observed a significant reduction in hot flashes in the placebo groups.

Uncertain effectivenessSt. John's wort in tandem with other herbs used for menopause. Researchers tested preparations combining the black cohosh with St. John's wort. In two double-blind studies with placebo conducted in Korea 22 and Germany 23 , this type of preparation was more effective than placebo in relieving physical and psychological symptoms of the participants. Furthermore, during an observational study conducted in Germany on 6141 women, a combination of black cohosh and St. John's wort was more effective than single black cohosh to improve mood of the participants, while reducing hot heat 24 .

Researchers have also combined St. John's Wort and Chaste Tree during a trial of 93 postmenopausal or perimenopausal women. This treatment was not more effective than placebo in reducing symptoms of the participating 25 .

Recognized use The ESCOP and the E Commission recognize the use of St. John's wort for the treatment of psychosomatic disorders, depression, anxiety and nervous restlessness. The WHO recognizes the plant for the treatment of mild to moderate depression. Commission E also recognizes the effectiveness of St. John's wort oil to treat digestive disorders ( dyspepsia ). Applied externally , it recognizes the efficacy to treat bruises , the muscle pain and burning in the first degree. These traditional uses, however, have not been confirmed by scientific data (see our record in the St. John's Wort Herbal medicinal section).

Various
The results of early clinical trials indicate that the use of a standardized extract of St. John's wort may be useful in case of seasonal depression 27,28 and PMS 29 . A recent study has shown that St. John's wort (900 mg / day) reduces the physical and behavioral symptoms of premenstrual syndrome (eg, swelling, headache, insomnia, fatigue), but does not reduce the pain and disorders Mood 30 . By against St. John's wort was not more effective than placebo in a rigorous trial of 54 children with disorders attention deficit / hyperactivity disorder (ADHD) 31 . A St. John's wort has not been useful to help smokers kick the cigarette 32 . Finally, no clinical studies major not currently support the use of St. John's wort in the treatment of obsessive compulsive disorder 47 .

Precautions
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Watch out
Place a synthetic antidepressant St. John's wort

St. John's wort interacts with potentially dangerous synthetic antidepressants and the agency may take some time to eliminate them. It is recommended to arrange a time interval between discontinuation of treatment with an antidepressant synthesis and the beginning of treatment with hypericum. Your doctor should be able to tell you how long your body has eliminated the synthetic drug.
Discontinue treatment with hypericum

It is often suggested to gradually decrease the dosage of St. John's wort for 1 to 2 weeks when we want to discontinue treatment, to avoid a potential withdrawal syndrome.
Cheese, red wine and decongestants

It was believed for a while that the wort was part of the family of inhibitors of monoamine oxidase (MAO), which led to advise to avoid the simultaneous consumption of cheese and red wine, and the use of decongestants in same time as the plant. This hypothesis is now reversed and the warnings no longer valid. MAOIs are antidepressants second generation, the use of which may increase blood pressure when combined with tyramine, a substance found among others in red wine and cheese.
Cons-indications
We reported a case of a patient with Alzheimer's disease in which St. John's wort would have caused a psychotic break . There were two similar cases involving schizophrenia in remission.
Furthermore, as is the case for antidepressants in general, St. John's wort may cause hypomanic periods in people with bipolar disorder.
The safety of St. John's wort in women pregnant is not established beyond doubt 33 . Among those who are breastfeeding , according to a 1 year follow up with 33 women, it seems safe 34 .
Patients with suicidal ideation should not take St. John's wort.
Do not take St. John's wort before surgery (may reduce the effects of the anesthetic).
Adverse effects
Adverse effects associated with taking St. John's wort are rare and usually mild: mild digestive disorders, skin allergies, fatigue, nervousness, headache and dry mouth.
It has made ​​much of the action photosensitizing plant after cows and sheep grazing in fields hypericum had developed excessive sensitivity to sunlight 35 . However, three clinical trials have confirmed that the photosensitizing effect of St. John's wort is nonexistent at doses normally consumed 36-38 . Individuals who have fair skin or particularly sensitive skin to sunlight should make sure not to exceed the normal dose St. John's wort. It is better that people who receive treatment with ultraviolet rays do not take St. John's wort.

Interactions
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St. John's wort interacts with many drugs 39 . Current data indicate that it is the hyperforin it contains causes these interactions 40-45 .

With plants or supplements
None known.
With drugs
Antidepressants. Whether family selective reuptake inhibitors (SSRIs) such as Prozac, that of monoamine oxidase (MAO) inhibitors, such as phenelzine, or that of tricyclic such as imipramine, the synthetic antidepressants can have dangerous interactions with St. John's wort (increase in serotonin , for example).
The St. John's wort may also interact with tramadol (painkiller) and sumatriptan (migraine) in the same way as with antidepressants.
St. John's wort interacts with many medicines. For example, it reduces the effectiveness of the following drugs:

ivabradine (used in the treatment of stable angina, a heart condition);
protease inhibitor (AIDS);
non-nucleoside reverse transcriptase inhibitor (AIDS);
cyclosporine (immune inhibitor);
digoxin (heart disease);
statin (cholesterol-lowering, atorvastatin and pravastatin for example);
warfarin (blood thinner);
chemotherapeutic agents (e.g., imatinib, irinotecan);
birth control pills;
antipsychotics;
theophylline (asthma).
anti-inflammatory agents (e.g. ibuprofen, fexofenadine).
Antidiabetic
Drugs metabolized with cytochrome P450 enzymes (liver enzymes).
On the shelves

Multiple wort supplements are on the shelves. Jean-Yves Dionne, pharmacist, offers the following advice for choosing an effective product. "I recommend choosing either a traditional non-standardized supplement in tincture, tea or capsule, or a standardized hypericin AND hyperforin extract. A traditional product made with whole plant contains all the active ingredients needed. As for standardized extracts, only those who show their percentage of hypericin are generally poor quality products. The extracts displaying their hypericin and hyperforin percentage are top quality. "

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